What is Avoidant Personality Disorder (AvPD)?

AvPD involves a long-standing pattern of social inhibition, feelings of inadequacy, and extreme sensitivity to criticism or rejection, leading to avoidance of social or occupational activities despite a desire for connection.

Core symptoms & diagnostic features

• Persistent fear of criticism, disapproval or rejection in social situations.
• Avoidance of social interactions and occupational activities that involve significant interpersonal contact.
• Self-view as socially inept, personally unappealing, or inferior to others.
• Reluctance to take personal risks or try new activities due to fear of embarrassment.
• Desire for close relationships but avoiding them because of fear of rejection.

How AvPD differs from social anxiety disorder (SAD)

Causes & contributing factors

• Temperamental vulnerability (high behavioural inhibition, sensitivity to negative evaluation).
• Early attachment disruption, bullying, chronic criticism or emotional neglect.
• Learned avoidance patterns and reinforcement of social withdrawal.
• Comorbid depression, social anxiety, or personality features can contribute.

Assessment — practical steps

1. Clinical interview focusing on interpersonal history, work/education impact, and avoidance patterns.
2. Ask about childhood experiences: peer relationships, bullying, parental criticism.
3. Screen for comorbid disorders — SAD, major depression, other personality disorders (e.g., dependent, borderline).
4. Assess functional impairment: employment, social networks, self-care and romantic relationships.
5. Use structured tools when helpful (e.g., SCID-5-PD, personality inventories).

Treatment — evidence-based approaches

Psychotherapy is the first-line treatment. Interventions target social skills, cognitive patterns, and gradual exposure to feared situations.

Cognitive Behavioral Therapy (CBT)

• Cognitive restructuring to challenge beliefs of inadequacy and catastrophic thinking about rejection.
• Graded exposure to social situations with behavioural experiments.
• Social skills training (assertiveness, conversation skills, nonverbal cues).

Schema Therapy

• Targets early maladaptive schemas (defectiveness/shame, social isolation) and uses experiential techniques to change core beliefs.

Mentalization & Interpersonal Therapies

• Improve understanding of others’ intentions and reduce misinterpretation of benign social cues.
• Interpersonal therapy can help improve relationship functioning and role performance.

Group Therapy

• Structured groups provide safe exposure to social interaction, feedback, and skills practice.

Pharmacotherapy

• Medication treats comorbid conditions: SSRIs for social anxiety or depression, short-term anxiolytics in selected cases.
• Medication alone is rarely sufficient—best combined with psychotherapy.

Practical therapy techniques (brief)

• Behavioural experiments: test beliefs (e.g., “If I speak up they’ll reject me”).
• Role-play and rehearsal of social situations in session.
• Homework with graded social tasks and reflective logs.
• Compassion-focused strategies to reduce shame and self-criticism.

Working with families and employers

• Psychoeducation: explain avoidance patterns and how support can enable exposure without rescuing.
• Encourage gradual role expansion at work with reasonable accommodations where needed.
• Support carers to avoid reinforcing avoidance (e.g., doing things for the person that they can practise themselves).

Key takeaways

• AvPD causes pervasive social avoidance despite desire for connection — feelings of inadequacy and hypersensitivity to criticism are central.
• Assessment should screen for comorbidities and functional impact.
• CBT (with graded exposure), schema therapy, and group-based social skills training are effective interventions.
• Combine psychotherapy with targeted medication for comorbid conditions when needed.