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Avoidant personality disorder (AVPD) is a serious mental health condition that has been determined to affect 2 to 6% of the general population. It is considered a fearful or anxious personality disorder characterized by patterns of social withdrawal, self-loathing and heightened sensitivity to criticism or disapproval. People who suffer from AVPD tend to disengage from social situations in order to avoid the risk of being rejected by others. Because of this, it’s often associated with social anxiety disorder.
A person with avoidant personality disorder may pull back from relationships as a form of emotional manipulation or control over friends and family members. Those who are close to sufferers of AVPD may experience the pressure to isolate or create an environment around their loved one to try to help them escape the risk of negative self-thought.
AVPD is considered a cluster C personality disorder, along with dependent personality disorder and obsessive-compulsive disorder. It involves anxious, fearful thinking but is distinct from other anxiety disorders. Someone with generalized anxiety, for example, may recognize that their thoughts or feelings are irrational, while someone with AVPD lacks this insight. Instead, they have a deeply internalized sense of inferiority or worthlessness that they believe to be valid, and accept rejection or criticism as inevitable.
Another key difference is that AVPD is a personality disorder, while anxiety is classified as a mood disorder. Personality disorders are characterized by unhealthy, rigid patterns of thinking and behavior that affect how one relates to others. Meanwhile, mood disorders are about feelings and emotions that aren’t consistent with a person’s circumstances. Other examples of mood disorders include depression and bipolar disorder.
Nobody’s perfect, and even healthy people feel inadequate from time to time. However, this does not mean a person has AVPD — that has to be determined by a trained mental health professional. According to the DSM-5, a consistent pattern of avoiding social contact, sensitivity to criticism and feelings of inferiority must be present for a formal diagnosis.
Those with AVPD are also unlikely to get involved with others or try new things due to a fear of embarrassment. Despite this, most still want to develop meaningful relationships, which may be a motivating factor in seeking help. Additionally, cluster C personality disorders are characterized by anxious thinking and often coincide with poor coping abilities, which makes developing stress and anxiety-related problems more likely. As a result, it can increase the risk of co-occurring disorders such as depression, anxiety or substance abuse.
Like many mental health conditions, the precise causes of AVPD are not well understood. A combination of environmental, genetic, social and psychological factors are thought to play a role. Child abuse and neglect are most often associated with AVPD, but no conclusive evidence exists. Most people who suffer from avoidant personality disorder are by nature reluctant to seek out treatment, as individual and group therapies are likely to make them feel uncomfortable; this results in most cases going undiagnosed and untreated.
At Avalon Malibu, there is no treatment program where one-size-fits-all. Every person is unique and comes to us with different histories and backgrounds; as well as different issues and needs. Our treatment programs are individually designed for each client. We use all available methodologies to make sure that those suffering from AVPD feel as comfortable as possible, and that they feel safe and supported during treatments.
Cognitive behavioral therapy (CBT) is usually very effective in helping clients develop skills to overcome shyness and acquire new behaviors. The emotion of shame is difficult and painful – it involves complete self-condemnation, and a person feeling shame also expects condemnation from everyone else. It’s a major attack upon the self, in which the client believes he/she is utterly unacceptable to society, and as a result, they hide from everyone. Shame and avoidant personality disorder are intertwined in Western society.
All of us have a need to belong. While most of us value some time alone, too much time spent alone can cause depression. The healthy need to feel accepted and to belong outweighs the wish to avoid, and this is where we can help those suffering from this disorder. We’ve found that CBT is most useful with social phobias and AVPD because the emphasis is on changing thinking patterns as well as modifying behavior. Another form of psychotherapy, called dialectical behavior therapy (DBT), can also help with improving social skills by teaching distress tolerance, emotional regulation, reality acceptance and mindfulness.
The Avalon Malibu staff focuses on helping the client face social situations with the goal of becoming desensitized to what causes them the most anxiety.
Avoidant personality disorder can affect every aspect of a person’s life and cause them to isolate themselves from the world. Although treatment can be difficult, it is possible to reduce the symptoms and change harmful or rigid ways of thinking. With time, therapy can help those with AVPD learn how to relate to others more appropriately. The goal is to help individuals feel safe, comfortable and accepted for who they are.
Follow-up data from AVPD therapies suggests that some people can maintain their gains and even continue to see improvements for several months to years after treatment. As clients overcome their fears of rejection, they learn to make additional changes outside of therapy, where they may also become more confident in their own skills and abilities.