High Functioning Avoidant Personality Disorder

Avoidant personality disorder (AvPD), also known as anxious personality disorder, social anxiety disorder, or social phobia. A mental health condition characterized by extreme fear, self-consciousness and sensitivity to negative evaluation. while forming close relationships with other people (DSM-5, 2013).

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Individuals with AVPD have a profound sense of inadequacy, social inhibition, hypersensitivity to rejection, and lack of enjoyment in social activities. They avoid social situations due to intense fear of ridicule, embarrassment, humiliation or embarrassment.

Signs And Symptoms Of Avoidant Personality Disorder

Some of the key signs and symptoms of AvPD include (DSM-5, 2013):

Extreme social anxiety and fear of embarrassment or rejection in social or performance situations. This often leads to avoidance of social activities and interaction.

Hypersensitivity to negative criticism and rejection from others. Individuals with AvPD are intensely afraid that others will not like them or will think poorly of them.

Social inhibition and feelings of inadequacy. They believe they are incompetent, socially inept and don’t measure up to others which often lowers their self-esteem.

Restricted social life and lack of close friends. Due to their overwhelming fear, they avoid developing close relationships that result in loneliness and isolation.

Dependency and preoccupation with being left out of social groups. There is a persistent need to impress others which results in preoccupation with being criticized or rejected.

Feelings of isolation and loneliness despite the desire for intimacy. While craving social connections, their intense anxiety keeps them from establishing meaningful relationships.

Shyness even in situations familiar to them. They feel nervous and uncomfortable even around familiar people, often putting off things to avoid embarrassment or criticism.

The table below summarizes some key signs and symptoms of AvPD:

Signs and SymptomsDescription
Social anxietyExtreme fear and anxiety in social situations or performance situations
HypersensitivityHypersensitive to any form of criticism or rejection
Feelings of inadequacyFeelings of inadequacy, incompetence and lack of self-worth
Avoidance of social interactionsAvoidance of social situations, activities, relationships due to fear
Lack of close relationshipsDifficulty establishing and maintaining close relationships
Dependency needsNeed for reassurance, preoccupied with being disapproved
Loneliness and isolationPersistent feelings of loneliness and isolation
Generalized shynessShyness and reserve in social interactions

Diagnosing Avoidant Personality Disorder

Diagnosing Avoidant-fullpersonality

To be diagnosed with AvPD, an individual must exhibit patterns of avoidance, social inhibition, feelings of inadequacy and hypersensitivity in multiple contexts dating back to early adulthood and present in a variety of situations according to DSM-5 criteria (APA, 2013).

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  • Avoidance of social and occupational activities that involve significant interpersonal contact due to fear of criticism, disapproval or rejection.
  • Feeling uneasy and incompetent in new social situations as they easily feel humiliated, degraded or embarrassed.
  • Restraint in intimate relationships due to fear of being shamed or ridiculed.
  • Preoccupation with being criticized or rejected in social comparisons.
  • inhibition, feelings of inadequacy and extreme sensitivity that cause significant distress or impairment in social, occupational or other areas.
  • The presence of at least four symptoms including social anxiety, feelings of inadequacy, hypersensitivity to criticism and restricted friendships or social life.
  • The disturbance is not due to another medical condition or attributable to substance use.

Diagnosis of AvPD is made through a complete mental health assessment including a clinical interview to rule out other disorders with similar symptoms like social anxiety disorder or schizoid personality disorder. There are no laboratory, blood or neuroimaging tests for AvPD.

Causes Of Avoidant Personality Disorder

The exact causes of AvPD are still unknown but believed to involve a complex interplay of genetic, biological and environmental factors.

Genetic factors: Twin and family studies show AvPD is moderately heritable which means genetic predisposition could play a role.

Brain abnormalities: Research indicates people with social anxiety disorders like AvPD have overactive amygdala (fear center) and abnormal activity in the prefrontal cortex which regulates emotions.

Early life experiences: Negative childhood experiences like abuse, neglect, overprotective or chaotic upbringing are linked to higher risk for developing social anxiety and avoidance traits later in life.

Learning and modeling: Observing parents or siblings exhibiting socially avoidant behaviors can influence a child’s social skills development and their own risk for AvPD later on.

Temperament: Children predisposed to high levels of shyness, sensitivity and neuroticism are at greater risk of developing AvPD. Environmental events then determine if it manifests.

Medical conditions: Some medical conditions involving the endocrine and brain regions involved in social cognition can increase AvPD risk as well.

While the exact causes remain unknown, AvPD likely stems from a complex interplay between genetic predispositions and adverse environmental or social experiences during early development.

Prevention Of Avoidant Personality Disorder

Prevention Avoidant-fullpersonality

Since AvPD is influenced by genetic, biological and environmental factors, prevention aims to modify risk factors:

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  • Promoting secure attachments and nurturing relationships during childhood through sensitive parenting reduces negative outcomes.
  • Identifying and treating other childhood disorders like social anxiety early through therapy reduces longer term risks.
  • Providing social skills training from a young age and encouraging children to overcome shyness prevents behaviors from becoming ingrained.
  • Treating medical conditions influencing social cognition regions early can lower biological vulnerability.
  • Addressing adverse experiences through trauma-focused therapy if needed can help reduce effects on development.
  • Monitoring temperamentally shy children for escalating avoidance and anxiety signs, providing psychotherapy aims to prevent disorders.
  • Universal school-based programs teaching emotional regulation and social skills help all children to some degree.

While complete prevention may not be possible due to genetic components, modifying environmental risks through parenting, treatment and skills building programs can significantly lower AvPD development over the long term. Early identification and intervention yields best results.

Treatment For Avoidant Personality Disorder

There is no single treatment and an individualized approach based on severity of symptoms works best. The most common treatments for AvPD include (Mayo Clinic, 2020):

Psychotherapy: Psychotherapy is the primary treatment for AvPD. Two of the most effective psychotherapies include:

Cognitive behavioral therapy (CBT): Focuses on changing negative thought and behavior patterns by setting attainable socialization goals and anxiety hierarchy exposure tasks.

Psychodynamic therapy: Aims to address relationship patterns and childhood experiences influencing core beliefs by improving understanding of oneself and relationships through talk therapy.

Medications: While medications alone are not sufficient, they are sometimes used as an adjunct with therapy to help reduce social anxiety symptoms. SSRIs (Prozac, Zoloft etc.), SNRIs or other anti-anxiety medications may be prescribed.

Group therapy: Learning social skills, becoming comfortable through guided social exposure and gaining support from others experiencing similar struggles helps boost self-esteem.

Family therapy: Helps understanding family dynamics, gaining family support and improving communication skills by addressing relationship patterns together.

Self-help strategies: Maintaining a social calendar, joining clubs or groups of interest, using relaxation techniques for social events helps with exposure-based practice between therapy sessions.

Expressive arts therapy: Includes dance, art, music or drama-based therapies that facilitate nonverbal emotional expression and social interaction.

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The treatment course depends on symptom severity and underlying factors but generally aims for long-term improvement in self-esteem, social skills and interpersonal relationships through a multi-pronged approach. Combination of psychotherapy, social skills training and medications yields best results for AvPD.

Self-Care For Avoidant Personality Disorder

While formal treatment helps the most, self-care strategies can provide ongoing support:

  • Learn relaxation techniques like deep breathing, yoga or meditation to manage anxiety physically and mentally.
  • Identify and reframe negative thoughts that trigger social anxiety using a journal.
  • Set small, achievable social goals instead of avoiding and overcome them with exposure practice.
  • Engage in hobbies and solo activities that provide a sense of accomplishment.
  • Build a supportive social network even if small through online communities of shared interests initially.
  • Practice positive affirmations to improve self-esteem and boost confidence with socializing.
  • Establish daily routines to maintain balance and healthy habits which improves mood.
  • Prioritize self-care through a healthy diet, exercise sleep and relaxing activities to reduce stress.
  • Monitor progress slowly over time with a supportive therapist using cognitive diaries.
  • Seek crisis or relapse support services when needed to minimize downward spirals in symptoms.

With regular practice, self-care strategies help manage symptoms, reduce stress and boost ability to overcome social fears while psychological treatment provides structure and long term management tools for AvPD.

Helping Someone With Avoidant Personality Disorder

Helping Someone With-fullpersonality

Supporting a loved one with AvPD requires patience and understanding of their condition:

  1. Educate yourself on the signs and symptoms to better understand their behaviors from their perspective.
  1. Accept that change comes slowly with many relapses and don’t force social interactions on them.
  1. Gently encourage them to step out of their comfort zone but don’t criticize or overwhelm them with pressure.
  1. Express care and concern for them as a person rather than pushing for changes alone.
  1. Communicate that you find value in them beyond surface-level social interactions.
  1. Help arrange low-key social outings and ease them into it but also accept refusal at times.
  1. Be respectful of their physical space needs without seeing it as rejection of you.
  1. Don’t react negatively if they cancel plans but maintain supportive contact in between.
  1. Attend therapy sessions together if possible to learn how to support their therapeutic process.
  1. Refer them to online forums/support groups if reluctant for face-to-face help initially.
  1. Lead an active social life of your own to reduce their social responsibilities and anxiety.

With compassion and patience, family and friends can play a crucial role in the recovery of those with AvPD.

Conditions Related To Avoidant Personality Disorder

AvPD commonly co-occurs with other conditions due to overlapping symptoms, genetics and environments influencing several mental health issues concurrently (DSM-5, 2013):

  • Social anxiety disorder (SAD): Shyness and social fears are a core component of both but AvPD involves pervasive patterns while SAD symptoms are situational.
  • Major depressive disorder: About 50% of people with AvPD also experience depression at some point likely linked to social isolation and negative thoughts.
  • Generalized anxiety disorder: Excessive worries and fears extend from social to non-social realms in AvPD + GAD comorbidity due to heightened negativity and vulnerability.
  • Substance use disorders: Self-medicating to cope with negative emotions often sees addictive disorders arise alongside AvPD increasingly over time without treatment.
  • Other personality disorders: There can be overlap between AvPD and dependent, paranoid or schizoid personality disorder traits as well complicating presentation and management.
  • Post traumatic stress disorder: Adverse early life experiences like abuse, bullying that often underlie AvPD can directly lead to development of PTSD as well.

Comprehensive evaluation and treatment of comorbidities alongside AvPD brings optimal improvement in overall functioning and well-being for the individual. An integrated treatment approach proves most effective.

Getting Diagnosed With Avoidant Personality Disorder

Getting diagnosed properly is the first step to treating AvPD and living a happier, healthier life. It involves understanding both self-functioning and interpersonal impairments caused by this condition.

Self-functioning Impairments

Individuals with AvPD tend to experience impairments in their own self-perceptions and behaviors, including:

  • Extremely low self-esteem and feelings of inadequacy
  • Overly critical self-scrutiny and self-blame
  • Pessimistic views about themselves and own abilities
  • Distorted body image and feeling uncomfortable in own skin
  • Avoidance of opportunities for self-expression and achievement
  • Tendency towards inertia and procrastination of life goals
  • Dependence on others for major life decisions and lack of independence
  • Difficulty recovering from setbacks and failures

Interpersonal Functioning Impairments

In relationships, people with AvPD face impairments like:

  • Avoidance of meeting new people and cultivating friendships
  • Difficulty confiding in or becoming close to others
  • Conflicts sustaining a long-term relationship or being emotionally intimate
  • Hypersensitivity to any perceived flaws and always fearing rejection
  • Proclivity to people please at the cost of own needs
  • Difficulty asserting needs and asking for help from others
  • Problems receiving feedback or engaging in conflict resolution

Understanding these self and interpersonal functioning domains forms a key part in diagnosing AvPD by a licensed mental health professional. A diagnosis provides legitimacy and access to tailored treatments that can help overcome impairments to function better.

Spotting And Supporting Avoidant Personality Disorder

Spotting And Supporting -fullpersonality

While AvPD affects around 2-3% of the population, there exists a subset with less overt symptoms called high-functioning AvPD. They experience distress but can sustain some relationships and careers, requiring a nuanced understanding.

Signs Of High-Functioning Avoidant Personality Disorder

  1. Preference for jobs involving individual work and limiting interactions
  2. Difficulty accepting praise or compliments due to self-doubt
  3. Perfectionism and taking on too much work to feel validated
  4. Keeping very few select friends they feel safest with
  5. Avoiding social media and new people as much as possible
  6. Using humor, politics or hobbies to deflect talking about themselves
  7. Appearing calm but experiencing distress in crowded situations

How To Help Someone With Avoidant Personality Disorder

  • Recognize avoidance behaviors don’t mean lack of care or not wanting help
  • Appreciate efforts made joining activities and don’t pressure them past ability
  • Casually spend one-on-one time with them in comfortable environments
  • Communicate value lies with who they are, not what they do socially
  • Respect need for alone time and don’t take refusals of plans personally
  • Motivate without judgment and sympathize with social fears openly
  • Learn triggers and provide alternatives satisfying need for space or control
  • Seek treatment as a supportive partner assisting their therapeutic process

With patience and compassion, those with high-functioning AvPD too can accept help addressing distress causing symptoms to function well.

Managing Avoidant Personality Disorder

Once diagnosed, the next important step involves proactively managing AvPD symptoms to mitigate impacts on life. A personalized approach combining different strategies works best.

How Can Avoidant Personality Disorder Be Managed?

  1. Long-term psychotherapy to identify and replace negative thought-patterns
  2. Graded exposure tasks combined with cognitive restructuring techniques
  3. Learning assertiveness, social and relationship building skills training
  4. Mindfulness meditation to improve self-awareness and reduce anxiety
  5. Addressing any underlying trauma, emotional needs or family dynamics
  6. Spending time with supportive family/friends in comfortable environments
  7. Self-help resources like mobile apps, journals, and online support groups
  8. Lifestyle management including healthy habits, hobbies, and stress reduction
  9. Consider adjuvant medications temporarily for severe anxiety or mood issues
  10. Receive crisis counseling, avoid unhelpful coping strategies like substances
  11. Develop realistic life goals and routine to foster independence and interests

Therapy For Avoidant Personality Disorder

The following evidence-based therapies are commonly used depending on individual factors:

Cognitive Behavioral Therapy (CBT): Helpful for changing negative thought patterns and beliefs by practicing concrete steps and social exposure assignments.

Psychodynamic Therapy: Focuses on core unmet emotional needs, dysfunctional relationship patterns, and past experiences creating rigid defenses.

Schema Therapy: Identifies early maladaptive schemas and uses experiential techniques to facilitate emotional processing and learn effective coping.

Group and Family Therapy: Valuable combined approach to gain social skills, see others’ perspectives, and address relationship and communication patterns.

Medications for Avoidant Personality Disorder

While psychotherapy is primary, short term medications under medical guidance may augment treatment of severe, impairing anxiety or mood symptoms linked to AvPD:

  • Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine, paroxetine, sertraline are commonly tried options.
  • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Duloxetine, Venlafaxine help anxiety, depression.
  • Benzodiazepines: Short term use of alprazolam, clonazepam controls panic attacks.
  • Buspirone: Partial 5-HT1A agonist anti-anxiety medication with fewer side effects.

Medications provide temporary relief of distressing symptoms to aid engaging more fully with core psychotherapy addressing underlying cognitive patterns.

Beginning Mental Health Treatment In Nashville, Tn

Beginning Mental Health-fullpersonality

For those seeking mental health treatment for AvPD in Nashville, Tennessee, here are some top options to consider:

Arbor Wellness Center

Offering comprehensive services including individual and group therapy, family therapy, psychiatry and case management with expertise treating mood, trauma and personality disorders. Accepts most insurance plans.

Centerstone Tennessee

Largest behavioral healthcare non profit in the region known for expertise in co-occurring disorders and community-based treatment. Has affiliations for inpatient services if needed. Accepts Medicaid.

Anchor Psychiatry

Convenient private practice offering medication management and psychotherapy by experienced psychiatrists, nurse practitioners. Specializes in anxiety, depression and personality disorders. Accepts most insurance.

Tennessee Addiction & Mental Health Institute (TAMHI)

State-funded facility with excellent residential programs for complex mental health and substance use conditions.Provides integrated treatment on affordability scale based on income.

Cumberland Heights Drug and Alcohol Treatment

Highly regarded private residential program located just outside Nashville known for treating dual diagnosis. Helps overcome co-occurring substance use issues and personality disorders. Offers financial assistance.

A compassionate mental health evaluation can accurately diagnose AvPD and design an individualized, evidence-based course of treatment aiming for long-term fulfillment and management of impairing symptoms. Choosing a reputed provider is an important first step in the recovery journey.

Understanding High-Functioning Avoidant Personality Disorder Traits

While AvPD affects functioning, a subset called high-functioning AvPD is able to adapt certain traits productively if understood as coping mechanisms rather than defects. With support, they can channel strengths effectively.


Able to adjust style quickly based on changing contexts like work assignments. Good at diverse solo projects needing flexibility, focused effort.

Lone Wolf

Work independently, avoid being constrained by bureaucracy. Excel at self-motivated work requiring autonomy and individual contribution.

Social Skills

Converse articulately one-on-one to acquire and share knowledge. Prefer quality over quantity, able to connect cordially with acquaintances.


Insightful about intricacies of human interactions, spend time in reflective observation. Notice subtle social and emotional cues others may miss.


Immerse deeply into individual tasks, tackle complex problems methodically ignoring distractions. Have high standards of excellence and persistence.


Self-sufficient, disciplined lifestyle. Manage schedule for optimum alone time to recharge. Find contentment within, without needing external validation.

Selectively Social

Form few meaningful bonds, mentor others sincerely. Spend time cultivating long-term relationships on your own preferred terms productively.

Internal Distress

Channel discomfort towards continual self-education. Possess humility and compassion due to understanding common humanity. Contribute ideas behind the scenes.


Prone to stress if masking vulnerabilities for long work periods. Must practice preventive self-care regularly of adequate down-time, detachment from demanding roles.

With support, high-functioning AvPD traits can complement focused careers immensely when used judiciously. Therapy helps identify dysfunctional patterns to live most fulfilling lives.


What are the 7 traits of avoidant personality disorder?

The 7 traits are social anxiety, hypersensitivity to criticism, feelings of inadequacy, avoidance of social interactions, lack of close relationships, dependency needs, and loneliness and isolation.

Do avoidant personalities fall in love?

They can experience love but find intimacy difficult without treatment due to fears.

What happens if AVPD is left untreated?

Left untreated, symptoms worsen leading to isolation, low self-esteem, depression and impaired quality of life.

What does a person with avoidant personality disorder look like?

They appear anxious, self-conscious in social situations and have poor eye contact while desiring yet fearing socializing due to feelings of inadequacy.


Avoidant Personality Disorder causes immense struggles for those who live with its symptoms each day. Characterized by debilitating social anxiety, fears of rejection and feelings of inadequacy, AvPD can isolate sufferers and impair their ability to form relationships.

Without treatment, symptoms often worsen over time leading to depression, substance abuse and generally poorer quality of life outcomes. However, there are evidence-based treatment options available that have been shown to effectively manage AvPD. Psychotherapies like CBT aim to change fearful thought patterns and behaviors through graded exposure tasks.

Medications may also help reduce distressing physical symptoms of anxiety. With long-term recovery-oriented treatment and self-care strategies, individuals can gain a greater understanding of their avoidant tendencies and learn new social skills. 

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