Schizoid Personality Disorder
Symptoms, causes, and treatment
Do you or someone you love avoid social interaction because of extreme shyness, feelings of inadequacy, or sensitivity to criticism? Here’s how to recognize and manage the symptoms of avoidant personality disorder.
At some point in life, most of us struggle with shyness or fears of social inadequacy. You might feel nervous about impressing someone on a first date, for example, or worry that you can’t match an older sibling’s achievements and your parents will think less of you. However, if you have avoidant personality disorder (AVPD), these types of feelings are so pervasive that they interfere with your ability to function.
AVPD is a cluster C personality disorder, meaning it involves fearful thinking and anxiety, and is categorized alongside dependent and obsessive-compulsive personality disorders. If you have AVPD, you might be so afraid of criticism that you never explore new job opportunities or hobbies, or view yourself as so socially inept that you don't even entertain the thought of making new friends. And if you feel judged in any way, you’re quick to cut off contact, leaving your loved ones feeling hurt and confused.
With avoidant personality disorder, you don’t necessarily want to be alone, but your thoughts and behaviors often lead to isolation and loneliness. Rather than get involved with those around you, you watch other people’s relationships blossom from afar. Feelings of unworthiness can keep you from seeking love or even friendship. And the fear of embarrassment or rejection can limit how much you're willing to share about yourself once you've made a connection. You may feel frustrated or distraught over how easily conversations seem to flow for other people and wish you could find the level of social support you crave.
If you recognize symptoms of AVPD in yourself or someone you love, you’re not alone. Researchers estimate that somewhere between 1.5 and 2.5 percent of the population have avoidant personality disorder. Learning about the symptoms and causes can help you better understand this personality disorder, and empower you to improve your life and relationships.
Avoidant behavior can start to become noticeable as early as two years old; however, personality disorders aren't usually diagnosed until a person is over 18. It can also be easy to mistake the symptoms of AVPD with conditions such as social anxiety. According to the DSM-5, if you have AVPD, you’ll experience four or more of the following symptoms by early adulthood:
If you believe you may have AVPD, a healthcare provider can provide a formal diagnosis. They'll likely do a full review of your medical history. Then, a psychiatrist or psychologist will use assessment tools and conduct an interview to evaluate your symptoms and rule out other possible causes. The interview can be particularly helpful to pinpoint how the personality disorder affects your social interactions.
A 2012 study of Norwegian twins revealed that avoidant personality disorder seems to have some degree of heritability, meaning that it may be passed down in families. But environmental factors, including early childhood experiences, are also strongly associated with AVPD.
Some research links the personality disorder to a fearful-avoidant attachment style. Your attachment style refers to the type of emotional connection you had with your primary caregiver when you were an infant. That bond then influences how you relate to other people throughout your life.
If you had a safe, nurturing connection with your primary caregiver—meaning they responded to your physical and emotional needs—you may have developed a secure attachment. People with secure attachment styles often grow to become self-confident adults, able to manage conflict and trust others.
However, if your caregiver was critical, neglectful, or abusive, you may have developed a fearful-avoidant attachment style (also known as disorganized/disoriented attachment). This attachment style can result in negative views of other people as well as yourself. You felt ignored as an infant, so now your fear of rejection, feelings of unworthiness, and distrust of others overshadow your desire for intimacy.
[Read: How Attachment Styles Affect Adult Relationships]
Aside from attachment style, other life experiences may also contribute to avoidant personality disorder. Some studies show that people with AVPD often view their parents as less affectionate and more likely to guilt-trip or reject them. Rejection by peers may also play a part. If you were bullied, teased, or excluded from groups and events as a child, it could contribute to this personality disorder, as could experiencing childhood abuse or trauma.
If you have AVPD you may also struggle with other, co-occurring mental health conditions, such as:
Anxiety disorders. People who are struggling with AVPD may also be diagnosed with an anxiety disorder, such as panic disorder or agoraphobia. Social anxiety disorder, also known as social phobia, is especially common and has some overlapping symptoms with AVPD.
Depression. The social isolation that can result from AVPD is associated with depression, and depression can make it even harder for you to reach out to others.
Substance abuse. You might turn to alcohol or drugs to cope with social fears or to “drown out” feelings of depression.
Eating disorders. It's possible that low-esteem and a distorted self-image can lead to unhealthy eating habits or even an eating disorder such as anorexia or binge eating disorder.
Personality disorders. Other cluster C personality disorders, such as dependent and obsessive-compulsive personality disorder, can commonly co-occur in people with AVPD. Like AVPD, these other personality disorders are characterized by a high levels of anxiety.
Suicidal ideation. If you feel like your condition is hopeless or overwhelmed by loneliness and isolation, it can trigger suicidal thoughts.
[Read: Are You Feeling Suicidal?]
If you’re experiencing multiple mental health problems, it’s important to consider how each one may be compounding the others. For example, substance abuse can deepen your depression, and depression can further diminish your sense of self-worth. It’s then important to seek help for both conditions.
Some researchers view AVPD as a more severe version of social anxiety disorder. Others argue that AVPD and social anxiety disorder are distinct conditions. While they share similar symptoms, AVPD symptoms tend to be so severe they greatly interfere with relationships and lead to more social isolation.
If you have social anxiety disorder, you're often afraid of doing something that will lead to other people rejecting or criticizing you. You likely experience performance anxiety and feel insecure in certain interactions.
[Read: Social Anxiety Disorder]
If you have AVPD, however, your social fears are more ingrained in your own sense of self. Your low self-esteem and negative self-image lead you to assume that other people will dislike and reject you. Once you conclude that all of your social interactions are doomed to fail, you may be less likely to make any effort to reach out to others.
Shyness: “You initially feel uncomfortable talking in class or in a work meeting because you're nervous about being judged by unfamiliar people. Once you start talking, the shyness tends to subside, so it doesn’t necessarily affect your ability to function.”
Social anxiety disorder: “You avoid talking in class or in a work meeting because you're afraid of giving an incorrect answer and feeling embarrassed. You likely recognize that this fear is overblown, but the anxiety holds you back regardless and affects your performance.”
Avoidant personality disorder: “You avoid speaking up in class or at work as well as in most social situations. You have a strong belief that you’re not as smart as the people around you, and think that engaging in conversations will surely lead to rejection or criticism. This core belief interferes with your ability to engage with peers.”
Avoidant personality disorder can make you feel as if you lack control over yourself or even a sense of identity. It can affect your life in the following ways:
AVPD can hold you back from making new relationships. You might frequently turn down invitations to events because you're certain that no one there will like you. Or perhaps you go to the event but find it impossible to engage with new people.
AVPD affects your ability to grow and learn. Perhaps you want to learn a new skill through a college course. But since the learning process always involves making mistakes, you decide to avoid the class because you don't want to look foolish, feel judged, or receive negative feedback. In the workplace, you might decline a promotion because you feel unworthy, or keep a job you dislike because you can't bear the thought of going through another interview process.
AVPD can also affect the lives of your loved ones. Perhaps your partner is unable to get a full understanding of your feelings since you have a hard time sharing—and the lack of intimacy becomes a roadblock in your relationship.
If you or a loved one have AVPD, know that there are ways to manage the symptoms and cope with the condition. AVPD is responsive to many of the same strategies that people use to overcome social anxiety disorder. The path forward involves learning to address your negative inner voice and building your confidence in social situations. Managing stress levels and confronting the roots of an insecure attachment style can also help.
Your inner monologue—the way you talk to yourself—can fuel your fears and drive you toward more avoidant behaviors. For example, you may engage in negative self-talk, telling yourself things like: “The people around me think I'm a burden” or “Everyone will laugh at me if I speak up.” Those thoughts can then discourage you from socializing. As you fall into isolation, you only reinforce those negative beliefs, or at least leave them unchallenged.
But you can learn to examine your own thoughts. They’re not always objective facts. In some cases, you might be catastrophizing (assuming the worse will happen) or mind reading (making assumptions about what other people are thinking) despite a lack of evidence. When you catch yourself engaging in negative thinking, try to challenge and replace those anxieties with positive self-talk.
Negative self-talk example: “Everyone is judging my outfit.” Neutral or positive self-talk alternative: “People may not be paying attention to what I’m wearing. Or maybe they like my outfit.”
Negative self-talk example: “If I try playing this game, I will fail and feel embarrassed.” Neutral or positive self-talk alternative: “No one expects me to be perfect. I should just focus on enjoying the game.”
Negative self-talk example: “I can’t talk to my coworker because they may not like me.” Neutral or positive alternative: “My coworker might be feeling lonely and appreciate my company.”
Negative self-talk example: “There’s no point in engaging with this stranger because I can’t carry a conversation.” Neutral or positive self-talk alternative: “I might learn something new or make a new friend by starting a conversation.”
Negative self-talk example: “I can’t share my feelings with my parents because they will criticize me.” “Neutral or positive self-talk alternative: “Sharing my feelings can help me grow closer to my family.”
Countering negative thoughts is always an ongoing process. Be patient with yourself and know that you can improve with practice.
If you believe you’re socially inept, you may feel too discouraged to even make small talk. Here are some ways to improve your social skills and raise your confidence when talking with others:
Focus on the other person. Rather than dwell on your internal monologue, shift your focus outward. What is the other person’s body language like? What are they wearing? What are they doing?
Look around for conversation points. Again, shift your focus away from yourself. Take in your surroundings and try to find topics to fill a lull in the conversation. Is there music playing in the background? Are you somewhere with an interesting décor scheme? A small comment can easily lead to a longer dialogue.
Get curious. Don’t feel pressured to carry a conversation all alone. When you show curiosity about other people, you’ll find that they’re often willing to chat. “Yes” or “no” questions, such as “Did you have a good day?” can cut conversations short. Instead, use open-ended questions, such as “What was the best part of your day?” to inspire longer answers. Think of questions that begin with “what,” “why,” “where,” “when,” and “how.”
Take your time. When you’re feeling anxious, you may find yourself talking too fast and getting tongue-tied. Make a conscious effort to slow down your speech. Don’t hesitate to use pauses to gather your thoughts. You’ll come across as a thoughtful speaker and have an easier time getting your message across.
If you have AVPD, it’s likely that all sorts of social worries wander through your head throughout the day. Are strangers judging you as you walk through the supermarket? Is a peer going to humiliate you with a criticism? Those fears can leave you feeling overwhelmed by stress.
However, there are many ways to reduce your overall stress and anxiety levels and leave you feeling more in control. Learning effective ways to manage stress can also boost your self-esteem and help you achieve a growing sense of calm.
Focus on mindful breathing. When you’re nervous, you might notice that you’re taking short, quick breaths. Try using long, deep breaths to rein in your nervous system’s stress response. You can use this to help control in-the-moment anxiety or you can set aside time each day to practice a mindful breathing meditation to help reduce your overall stress.
Avoid unhealthy coping methods. You may lean on alcohol or drug use to make you feel more at ease in social situations. In the long term, though, these habits can actually increase your anxiety. Try to replace them with healthier coping techniques, such as monitoring your breathing or practicing positive self-talk.
[Read: Self-Medicating Depression, Anxiety, and Stress]
Live an active lifestyle. Exercise can lead to a drop in stress hormones and an increase in mood-boosting hormones, like serotonin and dopamine. Aim for about 150 minutes of physical activity each week. While going to the gym can be a good way to practice confronting your social fears, there are plenty of exercises you can do in the comfort of your own home or around your neighborhood.
Take care of your body. Aside from exercising and eating well, getting enough sleep at night can also help you manage stress levels. On the other hand, when you’re sleep-deprived or overeating junk food, you’ll notice dips in your mood and overall well-being.
Avoiding social situations can seem like the easiest way to navigate life, but it only compounds your feelings of loneliness. It can also makes your fear more intense and prevent you from learning better coping strategies.
A more helpful approach is to gradually confront your social fears with the aid of a fear ladder. A fear ladder arranges stressful situations in order of least to most frightening. By slowly moving up the ladder, you can confront your fears one step at a time, in a gradual, controlled way. Whenever you start to feel overwhelmed, use quick stress relief techniques to ease your anxiety and feel more in control.
Don’t feel the need to jump to the more intense steps immediately. You may want to spend a little extra time repeating each particular step until you’re comfortable. For example, you could spend a week working on asking questions and making small talk.
Your attachment style is influenced by your relationship with your primary caregiver, most commonly your mother. You may assume you have little to no control over your behavioral patterns in relationships, but it is possible to feel more secure by better understanding your attachment style and seeking supportive relationships.
Understand the roots of your attachment style. Many circumstances can lead to insecure attachment. It's possible your parent was young and inexperienced, struggled with depression, or suffered from emotional or physical abuse themselves. If possible, reconnecting with that caregiver and talking about those early years can give you a chance to unpack and resolve past trauma.
Even if you can’t speak with your parent, a therapist can help you navigate your past experiences. Developing an autobiographical narrative can help you make sense of AVPD and allow you to assess it in a less judgmental way. In other words, thinking about the origins of your condition can move you toward self-awareness and acceptance.
Improve your emotional intelligence (EQ). People with high emotional intelligence understand their own emotions and can manage them in a way to foster healthy relationships. When it comes to coping with AVPD, you might use emotional intelligence to better understand how your emotions are guiding your avoidant behavior and how you can use nonverbal communication to create positive social interactions.
[Read: Improving Emotional Intelligence (EQ)]
Develop connections with people who have a secure attachment style. It’s possible for friendships or romantic relationships to thrive between people with insecure attachment styles. However, spending more time with someone who has a secure attachment style can help you develop and grow. Although the other person can’t fix all of your problems for you, they can offer validation and help you recognize healthier patterns of thoughts and behaviors.
If the self-help techniques listed above aren’t enough to manage your avoidant personality disorder symptoms, therapy and medication may offer further relief.
Cognitive-behavioral therapy (CBT) is often effective in treating social anxiety disorder, so it may be useful for AVPD as well. CBT is based on the idea that your thinking patterns affect your feelings, and your feelings influence your behavior. Some CBT-based practices for avoidant personality disorder could include:
CBT can take place either in person or online. You'll work with a therapist who is able to offer feedback and guide you through the activities.
[Read: Cognitive Behavioral Therapy (CBT) for Mental Health]
Metacognitive interpersonal therapy (MIT) can help improve metacognition, your ability to understand your mental states. This is particularly useful if you have difficulty recognizing and judging the accuracy of your own thoughts and feelings. Through MIT you also begin to build a better awareness of your emotions and how they affect your decision-making.
Acceptance and commitment therapy (ACT) puts an emphasis on acknowledging and accepting discomfort and then taking actions that match your values. For example, you might accept that being in social situations will lead to discomfort, such as physical tension and feelings of inadequacy. However, you can use mindfulness techniques to experience those thoughts and sensations in a nonjudgmental way. From there, you can commit to taking actions that you believe will improve your well-being, such as engaging in a conversation.
Although you might want to work one on one with a therapist, group therapy is also an option. It might be initially intimidating since all participants have an intense fear of social rejection. But learning that other people are suffering in similar ways can be a source of common ground and comfort.
There aren’t any medications that are prescribed specifically for AVPD. However, a few medications that reduce anxiety symptoms could be effective. Gabapentin, a class of drugs used to treat seizures, may also help with social phobia as it decreases overexcitement in the brain.
If a loved one has AVPD, you may have a hard time seeing the world from their perspective. You could feel frustrated at their unwillingness to try out new activities or feel they overreact to the smallest criticisms.
You may also struggle to get someone with AVPD to open up to you. They fear voicing their opinions and expectations, so you’re stuck guessing what they want and how they really feel. They likely have a hard time connecting with your wider social circle as well, including friends and family members.
If the person with AVPD is your romantic partner, it can feel as if they’ll never be fully integrated into your life because they can’t bond with your other loved ones. This can all leave you feeling untrusted and unsatisfied with the relationship.
The following strategies may help you better connect with someone with avoidant personality disorder:
Listen. It’s easy to brush their fears and anxieties off as “overreactions.” But if you take the time to listen and reflect on their experiences, you’ll discover that AVPD is a serious issue that affects their daily life in all sorts of ways.
Foster a safe space for conversations. Reassure them that they can be open with you. Let them know that you will accept them without judgment. Be mindful of your body language as well. They might misinterpret small nonverbal cues, such as frowns or raised eyebrows, as signs of rejection or criticism.
Help them challenge confirmation bias. If your loved one believes they are inferior to other people, they’ll look for evidence to back up that belief. So, when they make statements like, “I’m socially inept because I didn’t add to the conversation,” gently offer evidence to the contrary. Maybe you can point to other times in which they contributed to a conversation or said something insightful. This can help them identify negative self-talk.
Be patient. You might think that a simple solution is to introduce your loved one to as many of your friends and family members as possible. Perhaps you believe that, once they meet the right people, your loved one will quickly blossom into a more socially confident person. Don’t try to force the process. Expect some setbacks, and know that your loved one will need plenty of time to build solid connections. Also remember that it’s not your responsibility to “fix” your loved one’s AVPD. Your goal should be to offer love and understanding. With a combination of your support, self-help steps, and professional intervention, they can enjoy a healthier social life and build a greater sense of control.
Call the NAMI HelpLine at 1-800-950-6264
Call the Mind Infoline at 0300 123 3393
Call the Sane Helpline at 1800 187 263
Find Your CMHA for a helpline near you
Call the Vandrevala Foundation Helpline at 1860 2662 345 or 1800 2333 330
Search HelpGuide’s directory of Mental Health Helplines
Millions of readers rely on HelpGuide.org for free, evidence-based resources to understand and navigate mental health challenges. Please donate today to help us save, support, and change lives.Donate to HelpGuide.org today