Avoidant personality disorder

Avoidant personality disorder (AVPD) is defined in the DSM-5 as a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Criteria include avoidance of occupational activities involving significant interpersonal contact due to fear of rejection or criticism, unwillingness to get involved with people unless certain of being liked, restraint in intimate relationships due to fear of shame, preoccupation with being criticized or rejected, inhibition in new interpersonal situations due to feelings of inadequacy, self-perception as socially inept or inferior, and reluctance to take personal risks due to fear of embarrassment.

One of the most debated diagnostic questions is the relationship between AVPD and social anxiety disorder (SAD). Both share fear of negative evaluation and social avoidance, and their comorbidity is very high (25–89% across studies). Theodore Millon, who proposed the original category, conceived AVPD as a deeply rooted personality pattern with an intense desire for social connection frustrated by an overwhelming fear of rejection — unlike SAD, which is more circumscribed. Millon described the avoidant pattern as "active detachment": the individual is not indifferent to relationships (like the schizoid) but craves them yet avoids them for self-protection.

Treatment of AVPD combines multiple approaches. Cognitive-behavioral therapy (CBT) addresses distorted thoughts about rejection and uses gradual exposure to feared social situations. Young's schema therapy identifies early maladaptive schemas such as defectiveness/shame and social isolation, working to modify core beliefs of inadequacy. Group therapy can be particularly valuable, offering a safe environment to practice social skills and experience acceptance. Medication (SSRIs, SNRIs) may be helpful as an adjunct, especially when there is comorbidity with depression or social anxiety.