Avoidant Personality Disorder: Overview of Diagnosis, Prevalence and Treatment of AvPD

Those with AvPD experience an intense level of social anxiety. Extremely self-conscious, they tend to avoid social situations and gravitate to jobs that involve little interpersonal contact. Avoidants often feel inadequate or inferior to others and are hypersensitive to rejection. Unlike individuals with schizoid personality disorder, those with AvPD do crave social relationships, but feel that social acceptance is unattainable (Dobbert 2007).

Diagnosis of AvPD

There are currently 10 conditions considered to be personality disorders, some of which have very little in common. Mental health professionals typically group those PDs that share characteristics into one of three clusters. Avoidant Disorder is a Cluster C Personality Disorder, a class which also contains Obsessive-Compulsive and Dependent PD; all three distinguished by anxious, fearful behavior.

AvPD is only diagnosed when the characteristic behaviors are pervasive and disabling. According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), a patient must fit at least four of the following criteria in order to be diagnosed with Avoidant Personality Disorder:

Prevalence of Avoidant Personality

Estimates of the prevalence of Avoidant Personality Disorder in the general population have ranged from 0.5% to 2.5% (NESARC 2002).

Cause & Course of AvPD

There is no clear cause for Avoidant Personality Disorder. It is relatively uncommon and there is little information on occurrence by gender or existence of family pattern.

The course of AVPD is chronic and typically manifests by early adulthood. It tends to be more severe earlier in life and often improves in middle age (Kantor 2003).

Treatment of AvPD

As is common with many other personality disorders, those with Avoidant personalities are unlikely to seek treatment for the disorder itself. And sweeping changes in personality are not a realistic outcome.

Individual short-term psychotherapy focused on specific life problems appears to be the most effective treatment strategy for those with AvPD. It is important to establish trust early in the therapist-client relationship, since Avoidants are prone to abandon treatment. Group therapy, which focuses on interpersonal interactions, can ultimately be beneficial if the patient has made progress in individual therapy and is willing. Assertiveness training can also be an effective treatment approach.

Medication may be used to treat the associated symptoms of depression or anxiety, but must be carefully monitored. Physicians should be cautious when prescribing to those with AvPD, as the some of the patient’s social anxiety or emotional disconnectedness can be situational and medication may interfere with psychotherapeutic treatment (Dobbert 2007, Kantor 2003).

Information on Personality Disorders

This article is a brief summary of the personality disorder AvPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.

Additional AvPD Sources

American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

Dobbert, D. (2007) Understanding Personality Disorders: An Introduction. Greenwood Press.

Kantor, M. (2003) Distancing: Avoidant Personality Disorder, Revised and Expanded. Greenwood Press.

National Epidemiologic Survey on Alcohol and Related Conditions - NESARC (2002) Journal of Clinical Psychiatry, 65.

Sep 9, 2007 11:46 PM

redback :

This set of PD articles is very interesting. :)

I'm hoping my comments are accepted as complementary rather than conflicting. I have no skills in the treating field. My background is medico-legal and social welfare. Whenever I use the term 'CBT', I think only of cognitive behaviour therapy (CBT) in generic terms and fully accept finding an optimum match between ideal CBT model-to patient-to therapist...may be problematic but still worth the search. If we become too quickly dismissive of the presenting symptoms...depression & anxiety in their many forms...it may exacerbate any underlying PD. But then, not every depressed person has PD. Have you read any of Dr Xavier Amador's theories?

One way to reduce stigma is to de-mystify PDs and I reckon your articles are doing that in a calm, objective manner. But how to apply? How much do we need to know about the underlying cause/s of another's problems. Would we go out of our way to keep in touch with someone with an avoidant personality disorder or someone who is deeply depressed and wants to be left alone. Maybe, pure rational thought may suggest a person who is very easily upset is not the sort of person who should link up with a person who can never see how they upset other people due to their industrial-strength thickened skin or is that thick-head. :) Love aint rational? :)

I come from a place where there are many paths to depression, anxiety, anger et al. I try to be careful how I question the underlying cause as my aim is to seek increased understanding of 'disability' and the risks...not doubt the person's integrity who does have legitimate problems. Tis a way of adding skills to the Mental Health First Aid course I've done. MHFA101...giving everyone a fair go.

Avoidant Personality Disorder

Overview of Diagnosis, Prevalence and Treatment of AvPD