A DSM-5 Definition of Avoidant Personality Disorder

avoidant personality disorder

Avoidant personality disorder is especially prevalent in people with anxiety disorders, social anxiety in particular.

Avoidant Personality Disorder (APD) is in the newest American diagnostic manual (DSM-5) characterized by impairments in two domains of personality functioning: self and interpersonal functioning.

With respect to self functioning, people with APD have a low self-esteem and a negative self-appraisal, which may provide excessive feelings of shame. They have unrealistic standards for interpersonal contact, i.e. they exaggerate the potential social costs, which makes them feel inadequate.

With respect to interpersonal functioning, people with APD are characterized by a preoccupation with, and a hypersensitivity to, others’ negative evaluations or criticism. They show a reluctance to get involved with people unless they are certain of being liked.

People with APD show detachment and negative affectivity, two pathological personality traits. The detachment is characterized by withdrawal from social situations, intimacy avoidance and anhedonia, i.e. deficits in the ability to feel pleasure. The negative affectivity is characterized by anxiousness, often in reaction to social situations (social anxiety).

They worry about the negative effects of past experiences, and they worry about possibly negative future experiences. They feel threatened by uncertainty, and they fear embarrassment.

The above-mentioned impairments in personality functioning, and personality traits, are relatively stable across time and situations, and the impairments are not better understood as normative for the individual’s developmental stage or socio-cultural environment. This means that the impairments exceed what we consider as “normal” deviations (read more here).

At last, the impairments must not be solely due to the physiological effects of substances or a general medical condition (American Psychiatric Association, 2013).

Image: Gene Lin
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    • Thank you.
      I am glad that you found my blog useful, and I really appreciate your subscription. The next post will be about music and how it affects us. I write about topics related to mental health as well as “popular” psychology. Please tell me if you have any suggestions for future articles.
      Simon

  • This is really interesting. I haven’t had a chance yet to look over the new DSM and I’m curious to see what changes have been made. A counselor I know told me that Adjustment Disorder has been removed, as well as many of the NOS diagnoses. This makes me almost glad I’m no longer working in the field. It seems kind of ridiculous to remove NOS diagnoses because when you do an initial intake eval on someone you don’t always get a complete picture of their disease progression, either because they are uncomfortable disclosing information or they downplay past issues, or they’re unable to properly express their history (especially if they’re very symptomatic during the eval). So it makes more sense to go with an NOS diagnosis until you’ve had enough time to properly gauge their symptoms. Unfortunately many practitioners will lazily use whatever diagnosis was previously given to a person, especially if that person states that they were diagnosed as such. So they may disclose that they were diagnosed with Major Depression or Euthymic Disorder, when really they have Bipolar I and only notice their episodes of depression and don’t realize that they’ve had hypomanic or manic episodes. Yeah, we can ask questions to try to determine whether a person has had a manic or hypomanic episode, but plenty of people do not always remember their life history in great detail, or will not readily admit to the summer when they went on a wild gambling spree. And sometimes, especially with hypomania, the symptoms may be subtle. The person may assume they just felt euphoric and energetic and were more active because they weren’t depressed for a change. It’s bad news to give commonly prescribed antidepressants to a person with a history of manic or hypomanic episodes.
    But anyway…back to the diagnosis in your article. It says that the person will experience these symptoms pretty much throughout their lifespan, but as I read the description it was like a peek into my childhood. I was painfully shy, extremely anxious around new people, but desperate to fit in and seek others’ approval. I avoided many social situations in order to avoid any social gaffes on my part, which happened quite frequently due to my heightened level of anxiety. It lasted pretty much from the time I could remember (age 3 or so) and followed me through my teens. However, in my teen years and early adulthood I began to care far less what other people thought. Yes, sometimes the awkwardness and anxiety would rear its ugly head, but as I aged I grew more confident and less anxious. Today, the only holdover from my childhood anxiety and extreme fear of new people is my inability to make eye contact with people unless I know them very well. Even then, often eye contact, to me, feels very intimate, and is often reserved only for extremely important dialogues. The weird thing is, when I was at work, meeting new clients or teaching psycho-ed classes, or even doing trainings for other professionals, this was never an issue. It’s only an issue in my personal life.
    So what do you think? Do you believe it’s possible for a person to overcome this illness on their own without the assistance or intervention of professionals, or do you believe that they’re stuck with it for life and no matter how closely my younger life’s issues matched those described here, perhaps I’ve just fallen prey to Horoscope Syndrome? :p

    • Hi there,

      Indeed, there are some changes to DSM-V, but it still differentiates personality disorders from mental disorders (clinical syndromes): axis I and axis II disorders, respectively. So the same kind of categorization and dichotomization are used. The official list of changes can be found here: http://dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
      From the viewpoint of DSM, avoidant personality disorder, and personality disorders in general, are characterized by its long-standing pattern. This is what distinguishes personality disorders from mental disorders. Personality disorders are more rigid to change than mental disorders. That said, change or improvement is possible, with or without professional help. I believe that most people can overcome most illnesses on their own, however, assistance or professional help can facilitate this process. Some people might get stuck, especially in the case of anxiety disorders where avoidance is a prevalent symptom. This particular symptom hinders the improvement of anxiety, so this group of people may benefit much from assistance. If a person’s anxiety is related to his or her personal life (compared to his professional life), it seems to me that the anxiety is more related to intimacy than social contact in general. In this case, intimacy skills training would be advantageous.

      Best regards,
      Simon