Avoidant Personality Disorder DSM 5 Criteria

What is avoidant personality disorder?

Living with a personality disorder can significantly affect individuals' lives, shaping their self-perception and social interactions. Seeking understanding and support is crucial for navigating these personality disorders and fostering a sense of connection and well-being.

Avoidant personality disorder (AVPD) entails excessive shyness, feelings of inadequacy, and heightened or extreme sensitivity to criticism. Those affected may avoid social interaction unless assured of acceptance, fear criticism or rejection, and perceive themselves as socially incompetent or unworthy (Robitz, 2022).

The Diagnostic and Statistical Manual of Mental Disorders provides comprehensive information about personality disorders, including different classifications. Avoidant Personality Disorder is categorized within Cluster C, along with other personality disorders. Inclusive in the cluster are Dependent Personality Disorder and Obsessive-Compulsive Personality Disorder (American Psychiatric Association, 2013). These classifications help clinicians and mental health professionals better understand and diagnose individuals experiencing these behaviors and thought patterns.

Avoidant personality disorder symptoms

Recognizing signs and symptoms is crucial for diagnosing avoidant personality disorder. Individuals with this condition often have a social anxiety disorder and exhibit fear, sensitivity, and avoidance patterns in social situations (Zimmerman, 2023), impacting their interactions and well-being.

Fear of criticism or rejection

Individuals avoid situations where they might face criticism or rejection, such as refusing promotions or avoiding meetings, impacting their professional and social opportunities and fostering a sense of insecurity and self-doubt.

Need for assurance

Seeking repeated assurances of support and acceptance before forming close relationships or joining groups, individuals rely heavily on external validation, which can strain relationships and limit their ability to develop independence and self-confidence.

Social isolation

Patients limit social contact and interactions due to fear, leading to isolation and lacking a supportive network, resulting in feelings of loneliness and detachment from others, which can exacerbate their symptoms and impede their ability to seek help or support from others.

Sensitivity to criticism

Patients are susceptible to criticism or disapproval, constantly vigilant for negative responses, and fear mockery, causing them significant distress and anxiety in social situations, potentially leading to avoidance behaviors and further isolation.

Low self-esteem

They have low self-esteem and feel socially inept, inhibiting interactions and causing reluctance to talk about themselves, which can perpetuate feelings of personal inadequacy and prevent them from forming meaningful connections with others.

Avoidance of risks

Patients avoid personal risks and new activities, exaggerating dangers and preferring a limited lifestyle for security and certainty. This may lead to missed opportunities for personal growth and fulfillment, reinforcing their avoidance behaviors and maintaining their symptoms.

How does avoidant personality disorder develop?

Understanding Avoidant Personality Disorder is crucial due to its significant distress and impairment. However, once seen as a severe form of social anxiety disorder, recent research highlights distinctions like attachment pathology and self-concept. (Lampe & Malhi, 2018).

Early childhood environment, temperament, and childhood neglect act as risk factors for Avoidant Personality Disorder and Social Phobia, emphasizing the need for targeted interventions (Eikenaes et al., 2015). By examining contributing factors and risk elements, we can gain insights into how this manifests and progresses in individuals.

What are the DSM 5 criteria for avoidant personality disorder?

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guidebook used to diagnose mental health conditions. It provides information for identifying disorders like avoidant personality disorder, helping clinicians make accurate diagnoses and develop effective treatment plans. Below are the DSM 5's diagnostic criteria for AVPD as cited in Fariba and Sapra (2021):

Feelings of inadequacy, a pervasive pattern of social and behavioral inhibition, and hypersensitivity to negative evaluation are present in a variety of contexts, beginning by early adulthood as indicated by four (or more) of the following:

1. Avoid occupational activities involving significant interpersonal contact due to fears of such issues as disapproval, criticism, or rejection.
2. Do not want to get involved with people unless they are sure of being liked.
3. Displays restraint within intimate relationships because of the fear of being ridiculed or shamed.
4. Is preoccupied with being rejected or criticized in normal social situations.
5. Shows inhibition in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, and inferior to other people.
7. Is unusually reluctant to take personal risks or engage in new activities because they may prove embarrassing.

How is avoidant personality disorder treated?

Individuals with avoidant personality disorder encounter struggles in maintaining relationships and managing daily stresses, which lead to feelings of isolation and impede personal development. While there is limited research conducted into its treatment, below are some of the options (Zimmerman, 2023):

Cognitive-behavioral therapy

This therapy teaches people with AVPD how to handle social situations better by changing their thoughts and actions. They learn skills like starting conversations and feeling more comfortable around others, which can help them build stronger relationships and feel more confident in their interpersonal relationships.

Supportive psychotherapy

In this therapy, people get a safe place to discuss their feelings and problems. The therapist or mental health professional listens and helps them feel better about themselves, giving encouragement and understanding, which can improve their self-esteem and sense of belonging.

Psychodynamic psychotherapy

This therapy looks at how past experiences affect how people act now. By understanding why they feel a certain way, people can learn to manage better and feel more confident in social situations, helping them break free from old patterns and develop healthier ways of relating to others.

Anxiolytics and antidepressants

These are medicines that can help reduce anxiety and sadness. They can make it easier for people to engage in therapy and learn new skills. Still, they work best when combined with talking therapies, providing temporary relief while individuals work on long-term solutions.

References

American Psychiatric Association. (2013). Section I: DSM-5 basics introduction use of the manual cautionary statement for forensic use of DSM-5. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Contents.pdf

Eikenaes, I., Egeland, J., Hummelen, B., & Wilberg, T. (2015). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLOS ONE, 10(3), e0122846. https://doi.org/10.1371/journal.pone.0122846

Fariba, K., & Sapra, A. (2021). Avoidant Personality Disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559325/

Lampe, L., & Malhi, G. (2018). Avoidant personality disorder: current insights. Psychology Research and Behavior Management, 11(11), 55–66. https://doi.org/10.2147/prbm.s121073

Robitz, R. (2022, September). What are personality disorders? American Psychiatric Association; American Psychiatric Association. https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

Zimmerman, M. (2023, September). Avoidant personality disorder (AVPD) - psychiatric disorders. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/psychiatric-disorders/personality-disorders/avoidant-personality-disorder-avpd#v84056781