Avoidant personality disorder (AVPD) is characterized by a persistent pattern of social anxiety, heightened sensitivity to rejection, and pervasive feelings of inadequacy, coupled with a deep-rooted longing for meaningful connections with others. Swiss psychiatrist Eugen Bleuler first described an avoidant personality type in his 1911 work Dementia Praecox: Or the Group of Schizophrenias. German psychiatrist Ernst Kretschmer clarified the distinction between schizoid personality types and avoidant personality types in 1921. Research on the etiology of AVPD is relatively limited, and high-quality studies specifically investigating its causes are scarce.
Individuals with AVPD have very high harm avoidance, as most of their pathological behavior emerges from a fear of potential emotional harm or rejection. Individuals with AVPD have low novelty-seeking behaviors. Although they long for social relationships, their harm avoidance typically outweighs their novelty-seeking initiatives. Individuals with AVPD have low to moderate reward dependence. The disparity between their need for connection and the actual fulfillment of that need often results in feelings of disappointment and dissatisfaction. Persistence refers to the ability to maintain efforts and continue with behaviors despite obstacles, frustration, fatigue, or limited reinforcement. Individuals with AVPD exhibit low persistence and are more prone to giving up on their pursuits when encountering challenges.
Individuals with AVPD avoid the risk of criticism or comments about their appearance. Reserved and nervous behaviors, downcast gaze, difficulty making eye contact, or feeling uncomfortable when eye contact is established may be seen in individuals with AVPD. Individuals with AVPD may exhibit decreased speech due to shyness. However, no expected speech initiation, volume, or vocabulary concerns exist. Affect is likely to present as anxiety or other stress. Thought content in individuals with AVPD is likely to center around a fear of being disliked; however, it is not typically at a delusional or obsessional level. Thoughts of suicide, particularly regarding fear of abandonment, may be more suggestive of borderline personality disorder than AVPD. In individuals with AVPD, the thought process is expected to be linear but limited in range and logic. Their fear of being judged tends to influence their thinking, leading to a heightened focus on concrete and specific aspects of potential criticism. General cognition and orientation is not expected to be impaired in individuals with AVPD. Judgement in individuals with AVPD is poor, as their fear of rejection is generally largely unfounded but prevents them from making rational decisions about their interpersonal functioning.
Meeting the DSM-5 diagnostic criteria for AVPD requires the presence of a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning in early adulthood and present in various contexts. The pattern must be persistent and cause significant distress or impairment in social, occupational, or other important areas of functioning. Clinical features include at least four of the following:
- Avoidance of social, interpersonal, and occupational activities that involve frequent contact due to an underlying fear of criticism, disapproval, or rejection.
- Unwillingness to become involved with new relationships unless there is a certainty of being liked.
- Restraint in intimate relationships due to a fear of being ridiculed or shamed.
- Preoccupation with criticism and rejection.
- Inhibition in new interpersonal situations due to feelings of inadequacy.
- Low self-confidence with the belief that they are inherently inferior or unappealing to others.
- Reluctance to take personal risks or engage in activities that can result in embarrassment or perceived failure.
Fariba KA, Torrico TJ, Sapra A. Avoidant Personality Disorder. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559325/