Avoidant Personality Disorder

What are personality disorders?

We all have unique personalities that have developed as a result of both genetics and environment. As we grow our personalities are constantly shaped by our experiences and behaviour choices.

Those with a personality disorder have developed rigid or extreme thoughts and behaviours that they cannot control. They have trouble relating to others and are often limited in their ability to deal with daily life. Personalities normally continue to develop through teenage years so disorders are generally not diagnosed until adulthood.

There are 3 main groups or clusters of personality disorders.

Cluster A – odd or eccentric behaviour

• Schizotypal Personality Disorder
• Schizoid Personality Disorder
• Paranoid Personality Disorder

Cluster B – Dramatic or erratic behaviour

• Borderline Personality Disorder
• Antisocial Personality Disorder
• Histrionic Personality Disorder
• Narcissistic Personality Disorder

Cluster C – Anxious or fearful behaviour

• Avoidant Personality Disorder
• Dependant Personality Disorder
• Obsessive Compulsive Personality Disorder

What is Avoidant Personality Disorder (APD)?

Avoidant Personality Disorder is a serious mental health issue that is often misunderstood. Sufferers have an intense fear of being inadequate, unliked or humiliated. They avoid most social activities and become very isolated and lonely.

Although APD shares many similarities with both Antisocial Personality Disorder and other anxiety related disorders, a defining characteristic is that sufferers not only pay excessive attention to their own thoughts and behaviours in social situations, they also closely monitor and obsess over the reactions of others. A sufferer, in extreme cases, may become people avoidant alltogether. 

The prevalence of APD in Australia is largely unknown as the very nature of the condition means sufferers are often reluctant to come forward. It is estimated, however, that it may affect between 2 – 5% of the population. APD affects roughly the same number of males and females.

Those with other related disorders including Panic Disorder, Agoraphopia, Generalised Anxiety Disorder and Obsessive Compulsive Disorder are more at risk of developing APD.

What causes Avoidant Personality Disorder?

APD does not have a direct cause. Instead it is widely believed to be triggered by a combination of genetics, biochemistry, and social environment. Chemical messengers in the brain – called neurotransmitters – can sometimes become confused resulting in altered thought and behaviour patterns.

Our personalities develop throughout childhood and the teenage years so disorders, such as APD, are generally not diagnosed until early adulthood. Risk factors for APD include:

• Having one or more family members with a mental health condition.
• Being physically or emotionally abused or neglected as a child.
• Suffering peer group rejection or bullying during childhood.
• Having another mental health issue.

 What are the most common symptoms?

Many of the symptoms of Avoidant Personality Disorder may seem normal to most people. We all experience fears like isolation and rejection at some stage however for APD sufferers the symptoms are extreme and disruptive to daily life.

To be diagnosed with APD the person must display 4 or more of the following symptoms. There is generally not much variation in the range of symptoms shown.

Those with APD:

• Do not initiate social interactions unless they are sure of being liked. They usually only interact with close family and a few friends.
• Avoid intimate relationships and are excessively shy.
• Choose careers that allow them to work alone.
• Avoid activities that involve socialising due for fear of disapproval, rejection and criticism.
• Believe themselves to be unattractive, unappealing or inferior to others.
• See themselves as being socially incompetent and fear shame and ridicule.
• Avoid risks, including work promotions, due to the intense fear of embarrassment and failure.
• Always assume the worst case scenario.

Like most personality disorders, these symptoms can decrease with age; however it is rare for a person to gain control of their condition without professional help. If sufferers are diagnosed early then they are less likely to develop complications such as depression or substance abuse. Unfortunately, APD sufferers often resort to drugs and alcohol to help them deal with social situations. Also, spending so much time alone makes it easy to develop addictive behaviour that can go unnoticed until it starts to impact others.

What are the main treatment options?

The most effective way to treat Avoidant Personality Disorder is through counselling and psychotherapy with an experienced mental health care professional. Medication is rarely used except to control violent or harmful behaviour.

The counsellor may use a combination of approaches including Cognitive Behavioural Therapy (CBT) and group therapy. They will tailor the sessions to meet individual needs and allow the person to progress slowly. This usually means starting with one-on-one discussions in a non-threatening environment. Later sessions may include family members or the person may join a peer support group.

Overall, the aim of avoidant personality treatment is to help sufferers explore unhelpful thoughts and beliefs. Once these are identified, the counsellor will guide the person to find new, healthier ways to manage their stress and anxiety. With time, they can learn to be more comfortable in social situations and be more realistic about how others perceive them.

Why seek professional help?

Mental illness can be frightening and isolating, especially if you are in a depressed or suicidal state. Talking to friends and family may help but having the support and guidance of a professional counsellor is usually more beneficial. Therapy sessions are confidential and non-judgemental. Seeking help early gives you a greater chance of overcoming your condition and getting your life back to normal.

Where to find help

Our True Counsellor Directory lists hundreds of psychotherapists and counsellors from Australia.

Some psychotherapists and counsellors listed in our directory offer counselling over the phone and online in addition to one-on-one consultations. Many also offer workshops and seminars.