Avoidant personality disorder, or AvPD, is a long-standing pattern of social inhibition, feeling inadequate, and strong sensitivity to criticism or rejection. It runs across most situations and most of adult life, not only particular settings.
Key points
- Avoidant personality disorder is a long-standing pattern of social inhibition, feeling inadequate, and strong sensitivity to criticism or rejection.
- It runs across most situations and most of adult life, not only particular settings.
- Whether it is separate from social anxiety disorder is disputed, and a large literature treats the two as one problem at different severities.
- About 0.8% of adults met the criteria in a national survey in Great Britain, and it is the most common personality disorder among people treated for social anxiety.
- There is no NICE guideline and no NHS pathway; the strongest evidence is for adapted cognitive behavioural therapy.
Symptoms
- A belief of being inferior, unappealing or not good enough; an expectation of being criticised or turned down.
- Avoiding work or study involving contact with others; holding back from friendships unless certain of being liked.
- Keeping personal feelings private for fear of rejection; loneliness, because the wish for company remains.
Causes and risk factors
- A mix of inherited genes and early environment; more severe childhood neglect is linked to it in some research.
- Some researchers argue the pattern is largely what happens when social anxiety disorder runs untreated for many years.
Treatment
- Cognitive behavioural therapy adapted for the avoidant pattern showed the strongest results in the main trial available.
- Treating a co-occurring social anxiety disorder also reduces the rate of avoidant personality disorder.
- NHS Talking Therapies does not treat personality disorders directly; referral is usually via a GP to a community mental health team.
When to speak to a professional
- Avoiding people is shaping your work, study, friendships or daily life, and has done so for years rather than during a bad patch.
- Low mood or hopelessness has developed alongside the avoidance, or you are drinking or using drugs to manage social situations.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.