Avoidant personality disorder (A 5 point guide)

In this brief blog we will explore what Avoidant Personality Disorder is according to the DSM-5. 

We will also discuss the various criteria streamlined by the DSM5 for the diagnosis of Avoidant Personality Disorder, the prevalence rates for the disorder, as well as the treatment options available for this disorder. 

What is Avoidant personality disorder according to the DSM-5?

Avoidant Personality Disorder, according to the Diagnostic and Statistical Manual of Mental disorders is a Cluster C personality disorder that is characterised by persistent pattern of behaving in ways that involve avoidance, social inhibition, feeling of inadequacy, and hypersensitivity towards rejection. 

People who are affected by this disorder experience worry that they are not enough, that they will be rejected by other people, and experience anxiety over being criticised and disapproved of. 

They worry often about being shamed or ridiculed and are often preoccupied with the thought of being rejected in social situations. 

People who have this particular disorder often avoid social interaction with others, and even go as far as to avoid developing relationships and progress in their careers because of their fears of disapproval and inadequacy .

What are the criteria for the diagnosis of Avoidant personality disorder?

The diagnostic and statistical manual of Mental disorders published by the American Psychological Association has listed out the following criteria for the diagnosis of GAD. 

The information below has been retrieved from the DSM-5.

The disorder is marked by as pervasive patterns of social inhibition or avoidance, with marked feelings of inadequacy and hypersensitivity towards rejection that begins in early adulthood and manifest in multiple situations and contexts. 

The also exhibit the following behaviours:

  • They avoid occupation related activities that involve interpersonal mingling and contact because they fear criticism and rejection. 
  • They are unwilling to get involved with other people unless they are certain that they are liked. 
  • They often show restraint and rigid boundaries in relationships that an estimate for fear of being shamed or ridiculed for their vulnerability. 
  • They are often occupied with the thought of being criticised and rejected in social settings. 
  • They are also inhibited in new interpersonal situations as well as other social situations because they feel inadequate.

People with these beliefs often view themselves as socially unappealing or inferior to others. They fear that no matter what they do or say, others will see it as wrong or reject their ideas so they choose not to engage for fear of that. 

They are often reluctant to take personal risks or engage in new scotties because they are afraid that they will prove themselves inadequate. 

The disorder often causes function as well as hampers their progress in their career as well as their personal relationships. 

They are often tense when they come in contact with others and often described by people as shy, lonely, or isolated. 

People who have this disorder often crave and desire intimacy and loving relationships and often fantasise about such relationships however because of their avoidant behaviours they often lose out on chances that allow them to explore and meet people. 

What are the prevalence rates of Avoidant personality disorder according to the DSM?

According to the DIagnostic And Statistical Manual of Mental disorders, the prevalence rates of Avoidant personality disorder are more in adults as opposed to any other population in the United States. 

The prevalence rates for Avoidant personality disorder, as of 2002, was 2.4% in adults in the U.S population. 

Avoidant personality disorder is found to be prevalent at the same rates for both men and women.

What are the risk factors and comorbidity for Avoidant personality disorder?

Some of the risk factors that makes the development of Avoidant personality disorder  more likely in individual include:

Temperament: High levels of Neuroticism and low in openness to experience related personality traits or temperament makes it more likely that a person will develop this disorder. Individuals who are very low in openness to experiences and exhibit shyness in younger age tend to develop these personal disorder symptoms in adolescence and adulthood. 

Environment: Early life experiences which were negative such as parenting styles, trauma in childhood due to parental rejection and neglect as well as peer rejection is seen as a risk factor.

Genetic and physiological risks: It has been hypothesised that Avoidant personality disorder could be passed down from genetics however there is a lack of conclusive evidence regarding this. 

Cultural issues related to diagnosis are related to the lack of clarity of what includes avoidance and what includes diffidence due to cultural differences in norms and customs. Moreover it is also possible that avoidant personality disorder can also be a result of acculturation after migration. 

Avoidant personality disorder appears to have high rates of comorbidity with disorders like Dependent personality disorder because they become extremely dependent on people who they allow themselves to rely on. 

The disorder also has high rates of diagnosis with disorders like Borderline Personality disorder as well as other Cluster A personality disorders. 

Individuals often also have major depressive disorder, persistent depressive disorder, obsessive-compulsive disorder, or an anxiety disorder 

What are the functional consequences of Avoidant personality disorder according to the DSM5?

The DSM5 noted that functional dysfunction is one the major criterias for the diagnosis of Generalised anxiety disorder. 

The functional impairments caused by the disorder includes the following:

The symptoms of the disorder such as excessive worrying as well as other somatic symptoms impairs one’s ability to do things quickly, work efficiently in various settings. This can cause disruption in their performance at work as well as hinder their ability to meet the demand of their daily responsibility.

The disorder, specially the cognitive symptoms manifested in the form of excessive worrying can impair their ability to parent and often causes impairment in their ability to instil confidence in their children with them experiencing low self esteem. 

The associated somatic symptoms can also cause them to experience tiredness, lethargy, muscle tension, and difficulty focusing and concentration that can majorly impact their ability to function. 

The disorder causes impairment and distress that is independent of that caused by a comorbid disorder and often even individuals who are not hospitalised experience moderate to severe anxiety. 

What are the treatment options for Avoidant personality disorder?

People affected by this disorder often struggle for months and years before seeking treatment. As of recent years, many people have become aware about the various services that are available that provide treatment for mental health disorders. 

One of the first things you can do, if you suspect you have this disorder, is to get medical help- talking to your general physician or a psychiatrist/psychologist is advisable.

Based on their assessment of you, they will most probably refer you to a psychiatrist, a clinical psychologist who is a licensed practitioner. 

The treatments available for Avoidant personality disorder include:

Psychotherapy

Psychotherapy is the treatment for avoidant personality disorder especially Psychodynamic therapy and cognitive behavioural therapy (CBT). In psychodynamic therapy, people with this disorder are guided into exploring the various aspects of their fears and feelings of inferiority that stem from past conflicts. 

Usually in this form of therapy, efforts are made to resolve past conflicts and make sense of past experiences that are causing this issue. 

When it comes to CBT, the main focus is the identification of irrational beliefs and cognitive assumptions about relationships, about commitment, and about themselves, especially related to self esteem and inferiority. 

The effort is made to modify these thoughts and change behaviour towards more effective ones. Alongside these therapies clients are also taught social skills.

These social skills are taught to help individuals communicate with others in effective ways, develop assertive skills, and also taught skills to manage and maintain healthy boundaries and relationships. 

Medication

Currently there is no medication for avoidant personality disorder however, doctors might prescribe you anti anxiety or antidepressants to help you manage depression or anxiety symptoms that arise out of the avoidant personality disorder.

These medications can also have side effects, such as dry mouth, nausea, and diarrhoea and can cause people to stop taking medication which is not advisable.

The best thing you can do for yourself is to talk to your doctor when you experience any side effects- physical and psychological side effects. These symptoms can bother some people so much that they stop taking these medications.

Lifestyle changes

Along with pharmacological and therapy treatments, people can also engage in lifestyle changes that have been observed to bring some improvements when it comes to this disorder. 

Lifestyle changes can include better and healthier coping styles such as 

  • Meditation
  • Seeking out and establishing support from friends and family
  • Avoiding substances like alcohol and drugs
  • Joining a support group for people with avoidant personality types. 

Conclusion

In this brief blog we have explored what Avoidant personality disorder is according to the DSM-5. 

We have also discussed the various cereals streamlined by the DSM5 for the diagnosis of Avoidant personality disorder, the prevalence rates for the disorder, as well as the treatment options available for this disorder. 

FAQ related to Avoidant Personality Disorder DSM5

What is an example of avoidant personality disorder?

People with avoidant personality disorder generally avoid social interaction, even at work, because they fear that they will be rejected by others. 

They might also struggle with maintaining relationships with their friends and partners especially when it comes to being emotionally vulnerable towards them for fear of being abandoned and rejected. 

How serious is an avoidant personality?

People with avoidant personality disorder (APD) struggle with their fears of abandonment and their inability to establish and maintain relationships with people. 

Because of their hypersensitivity to rejection and their fear of not being enough, it can often cause them to underperform at work, cause problems in their career, as well as problems in sustaining a relationship.

Do people with avoidant personality disorder want relationships?

Yes, people who are of avoidant personality disorder want relationships where there is intimacy and affection however, because of their fear of rejection and abandonment they often have trouble maintaining meaningful relationships. 

Their fear of rejection prevents them from opening up and meeting new people as well as being emotionally vulnerable with others that is needed for the relationship to grow emotionally intimate. 

What are Avoidants afraid of?

People who have developed a fearful-avoidant attachment style are afraid of intimacy and commitment because they have a deep seated fear of getting hurt, rejected, or abandoned by other people. 

This causes them to avoid intimacy, commitment, as well as getting too close to a partner emotionally or to others as well.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

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