The causes of avoidant personality disorder are thought to involve genetic, environmental, social, and psychological factors. Emotional abuse, criticism, ridicule, or lack of affection or nurturing by a parent may result in the development of this personality disorder if other factors are also present. Rejection by peers may similarly be a risk factor.
Often, individuals with the disorder are very shy as children and do not outgrow this shyness as they age. Social anxiety disorder and avoidant personality disorder share similar symptoms and genetics, with APD being the more severe form of the condition.
Avoidant personality disorder can only be diagnosed by a trained mental health professional based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While a family physician can be a first point of contact for a diagnosis, your doctor should make a referral to a psychologist, psychiatrist, or other professional for diagnosis.
Avoidant personality disorder is typically diagnosed in adults, as children's personalities are still developing, and behaviors such as shyness can be normal experiences in childhood that are later outgrown. According to the DSM-5, at least four of the following criteria must be met in order for a diagnosis to be made:
- Avoidance of occupational activities involving significant social contact out of fear of criticism, disapproval, or rejection
- Unwillingness to become involved with others unless you are certain that they will like you
- Holding back in intimate relationships out of fear of being ridiculed or humiliated
- Preoccupation with criticism or rejection in social situations
- Inhibition in new social situations due to feeling inadequate
- Feelings of being socially inept, unappealing, or inferior to others
- Refusing to take risks or do new things out of fear of embarrassment
Most people with avoidant personality disorder do not seek treatment. When they do, it is often for a specific life problem they are experiencing or other types of symptoms such as depression and anxiety, and they will usually discontinue treatment if that problem is resolved.
Avoidant personality disorder can be hard to treat like other personality disorders because it is an enduring pattern of behavior and it can be difficult for the sufferer to recognize that psychotherapeutic help is needed and can be beneficial. Unfortunately, the outlook for people with avoidant personality disorder who do not seek treatment is rather bleak—typically they become self-isolated and use avoidance as their only coping strategy.
On the other hand, when treatment is successfully applied, it can help to reduce symptoms and increase the range of coping strategies that a person can use. A person with avoidant personality disorder will probably always be somewhat shy, but avoidance won't dominate his or her thoughts.