Avoidant Personality Disorder in the DSM

Avoidant personality disorder only showed up in 1980 with the DSM-III¹ when schizoid personality disorder was separated into schizoid, schizotypal, and avoidant personality disorders. The DSM-III described avoidant personality disorder as long-term low self-esteem, hypersensitivity to rejection, avoidance of closeness if there’s a chance of criticism, social withdrawal, and a desire for affection/acceptance. The most recent (2022) criteria of avoidant personality disorder can be found in the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision²). While avoidant personality disorder is becoming more and more popular, theorists are still arguing about whether it should be its own separate personality disorder or just traits, or whether it should be in the DSM at all^{3 4}. Let’s take a look at what the DSM-5-TR says about avoidant personality disorder.

Avoidant Personality Disorder Criteria

The DSM-5-TR gives a framework for avoidant personality disorder involving long-term, pervasive patterns that don’t just appear one day, but have been growing consistently since early adulthood. Avoidant personality traits like shyness and fear of strangers/new situations are actually common in childhood, but usually decrease with age. In contrast, avoidant personality disorder involves increases in shyness and fear during adolescence and early adulthood. Additionally, the patterns have to be seen in multiple settings, like home, school, and work. So these are not just symptoms that pop up like a common cold, but patterns that are intertwined within the whole person.

The main patterns involved in avoidant personality disorder are social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Those with avoidant personality disorder do not feel like they are capable or good enough, making them super aware of any possible criticism or rejection from others. This results in restricted expression and engagement in relationships with others because others might disapprove of them. It makes sense then, that it’s called avoidant personality disorder. There’s avoidance of criticism, rejection, and social interaction. And, there has to be four or more of the following criteria noted in the boxes below.

For those with avoidant personality disorder, work and job functioning is very much negatively impacted due to fears of others not approving of them, evaluating them negatively, or just flat out rejecting them. This is especially prominent for situations that involve social interactions. They really attempt to avoid any meaningful interpersonal contact in their job, even if it’s important for job success or advancement. For example, they might turn down a promotion because they’re fearful that failing to do a good job in the new position could result in others criticizing them.

This is pretty self-explanatory. Those with avoidant personality disorder have a hard time with rejection and not being liked, and they have a foundational belief that others are critical, disapproving, and rejecting. And they are super aware and vigilant of watching others’ movements and expressions. Others have to pass tests and jump through hoops to shed that default assumption. So what do they do with new people or groups? They avoid - unless there is certainty that they will be liked. This often results in loneliness and isolation.

Because of all their fears of being criticized, ridiculed, shamed, exposed, etc., intimacy is hard and troublesome. There’s fear of getting too close, so those with avoidant personality disorder might act with restraint, avoid talking about themselves, and not share their intimate feelings. However, if they feel safe and are super assured that they won’t be judged or criticized, they can show interpersonal intimacy. Additionally, because they really do desire affection and acceptance from others, but might now obtain it, they can put their desires into fantasy. They might fantasize about idealized connections with others instead of actually engaging in them.

Those with avoidant personality disorder constantly worry about being negatively evaluated or rejected in interpersonal situations. This means they are always on alert for the possibility of criticism/rejection and can detect if someone is even a tiny bit critical or disapproving. Then, of course, they feel extremely hurt. Thus, they react very strongly to even the most subtle cue that may suggest someone is mocking them or being derisive. And, sometimes they even misinterpret other people’s neutral gestures, statements, or responses as critical or rejecting, which only serves to confirm their self-doubts.

Because those with avoidant personality disorder feel inadequate and have low self-esteem, they are not confident enough to act like themselves in new social situations. They are afraid that no matter what they say or do, others will see them as wrong and flawed, so they tend to not say much, if anything. They fear and avoid any attention because it might be critical or rejecting. Thus, they are viewed as shy, quiet, timid, inhibited, lonely, isolated, and “invisible.” Their hypersensitivity to rejection and low self-esteem lead to reduced social functioning and interactions. But remember, they really do desire and yearn to be social and interpersonally active. They just are really scared to put their “psychological welfare in the hands of others” (DSM-5-TR, p. 766).

Those with avoidant personality disorder do not view themselves in a positive light, holding beliefs that they are socially incompetent and personally unattractive. For some, those beliefs are super intense when interacting with strangers. But for many others, repeated interpersonal interactions are more difficult, since there’s a social expectation that more and more personal information should be shared. And that increases the risk that their flaws and inferiority might be seen, which means they could be criticized or rejected. The more interactions, the more they might start to convince themselves over time that others are seeing them as valueless and inferior, resulting in distress that is not tolerable. Sometimes the anxiety is so high that it leads to avoidance of (possible) friendships or even quitting jobs.

Individuals with avoidant personality disorder tend to interpret the potential peril of normal situations as much more dangerous than they actually are, meaning they can be super duper anxious in a way that is out of proportion to the event. Because of this, they put their needs of security, certainty, and assurance way above other values. They’re not willing to take the leap - be it jobs, friends, hobbies, traveling, or maybe even trying new foods. Their lifestyle is restricted because of fear.

Living with avoidant personality disorder can be distressing and difficult. There tends to be a lot of fear that impacts social and work functioning. And a lot of times, it can feel like others don’t get it - making it worse. If you want to better understand and care for an avoidant personality in your life, or if you are an avoidant personality and want to explore it, feel free to reach out! You can look on Psychology Today, or if you’re in Virginia (or a PsyPact state), check out our private practice, Quest Psychological and Counseling Services for available services. If you’re a provider stuck on a case, we also offer consultations for mental health professionals!

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