How does AvPD affect relationships

Anxious Avoidant Personality Disorder


Andrew Skodol

, MD, University of Arizona College of Medicine

Last full review / revision Jan 2020 | Content last changed Jan 2020
Click here to go to the issue for medical professionals
Anxious avoidance personality disorder is characterized by avoiding social situations or interactions that are associated with a risk of rejection, criticism, or insult.
  • People with anxiety-avoidant personality disorder fear rejection, criticism, or embarrassment and therefore avoid situations that could lead to such reactions.

  • Doctors diagnose anxiety-avoidant personality disorder based on its specific symptoms, such as avoiding situations that lead to interpersonal contact because of fear of rejection and rejection or a feeling of social incompetence, lack of sympathy or inferiority towards others.

  • People with this disorder can benefit from cognitive behavioral therapy, other psychotherapies, and anti-anxiety medications and antidepressants.

Personality disorders are long-lasting, profound patterns of thought, perception, reaction and reference that lead to the person in question suffering greatly from them and / or their everyday life being impaired.

People with Anxious Avoidant Personality Disorder feel inferior. They deal with these feelings in such a way that they avoid all situations in which they could be assessed negatively.

Anxiety-avoidant personality disorder occurs in over 2% of the general population in the United States. Men and women are equally affected by this disorder.

Often also lie other disorders in front. These include one or more of the following:

People with social phobia and anxiety-avoidant personality disorder have more severe symptoms and are more limited than others with only one of these disorders.


Genes and environmental factors can contribute to the development of an anxiety-avoidant personality disorder. For example, people may have an innate fear of social situations and / or experienced rejection and exclusion during childhood. Children as early as 2 years of age have been observed to avoid social situations.


Fear of rejection

People with anxiety-avoidant personality disorder avoid social interaction, including at work, because they fear that they will be criticized, rejected, or that people will reject them. For example, you can do the following:

  • They can turn down a promotion because they are afraid of possible criticism from their employees.

  • You can avoid meetings.

  • You can avoid making new friends if they are not entirely sure that they will be accepted.

People with this disorder assume that others will criticize and reject them until it is clearly proven otherwise. Hence, people with this disorder need repetitive support and uncritical acceptance when joining a group or forging a close relationship.

People with Anxious Avoidant Personality Disorder are reluctant to talk about themselves so that they cannot be ridiculed or insulted.

People with this disorder are reluctant to take risks or participate in new activities for the same reasons. In such cases they tend to exaggerate the dangers and use the slightest symptoms or other problems to explain their absence. They may prefer a limited lifestyle because they are in need of security and protection.

Extreme sensitivity to criticism

People with Anxious Avoidant Personality Disorder are very sensitive to any criticism, rejection, or ridicule because they constantly think about whether they are being criticized or rejected by others. They pay close attention to any sign of negative reaction to them. Their tense demeanor can then lead to ridicule or taunts and thus seemingly confirm their self-doubts.

Other symptoms

These people have low self-esteem and feelings of inadequacy in social situations, especially new ones. They stick to themselves in their exchange with new people because they consider themselves to be socially awkward, unsympathetic and inferior to others. They tend to be calm and shy because they think they might be saying the wrong thing.

People with anxiety-avoidant personality disorder long for social exchange, but are afraid of leaving their well-being in the hands of others. Because people with fearful-avoidant personalities limit their interaction with other people, they tend to be relatively isolated. So they lack the social network that could help them when they need it.


  • Medical assessment based on specific criteria

Doctors usually diagnose a personality disorder based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Fifth edition (DSM-5) published by the American Psychiatric Association.

In order for doctors to diagnose anxiety-avoidant personality disorder, those affected must persistently avoid social contact, feel inferior, and be overly sensitive to criticism and rejection, which is expressed in at least four of the following actions:

  • They avoid work-related activities that involve human contact because they fear being criticized, rejected, or disapproved by others.

  • They are reluctant to get involved with others unless they can be absolutely sure that they will accept them.

  • They are reserved in close relationships because they fear that they will be made fun of or offended.

  • In social situations, they are mainly concerned with determining whether they are being criticized or rejected.

  • In new social situations they are inhibited because of their feeling of inferiority.

  • They see themselves as socially incompetent, ugly, or inferior to others.

  • They are reluctant to take risks or take part in a new activity because they fear being embarrassed.

In addition, symptoms must have started early in childhood.


  • Cognitive behavior therapy that focuses on social skills

  • Other types of psychotherapy

  • Anti-anxiety drugs and antidepressants

Treatment of anxiety-avoidant personality disorder in general is similar to that of all other personality disorders.

People with Anxious Avoidant Personality Disorder can shy away from treatment.

The following therapies may be effective for people with social phobias and anxiety-avoidant personality disorder:

  • Other group therapies when the group consists of other people with the same problems

People with Anxious Avoidant Personality Disorder benefit from:

  • Individual therapies that support and take into account the hypersensitivity of the person to rejection and criticism

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and anti-anxiety drugs, can help reduce anxiety to the point where people can cope with new social situations.

NOTE: This is the output for patients. DOCTORS: Click here to go to the edition for medical professionals
Click here to go to the issue for medical professionals
© 2019 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.)