Avoidant Personality Disorder vs. Social Anxiety – PsychCentral.com

From the outside, social anxiety and avoidant personality disorder can look alike. But these conditions are distinct and often have different roots.

Ever been craving connection but you can’t bring yourself to go to a party where you barely know anyone? Social situations can be uncomfortable for anyone. But for some, it can be such a difficult situation that most invitations are met with a firm “no.”

Social anxiety disorder and avoidant personality disorder are both characterized by an overwhelming fear of being judged or embarrassed in social situations.

Since the two disorders look alike and can co-occur, it’s common for one to be mistaken for the other.

Both conditions have distinct features and different roots. Knowing the differences can help you in being better able and more comfortable in working with a professional to get the right diagnosis and treatment.

No matter your diagnosis, a tailored treatment plan based on your needs, which may involve therapy, medication, or a combination treatment plan, can be helpful in coping with your condition.

Social anxiety disorder, or social phobia, is a type of anxiety disorder characterized by a significant fear of being embarrassed or judged by others.

It’s one of the most common anxiety disorders, affecting about 12.1% of adults in the United States during their lifetime, according to the National Institute of Mental Health.

The National Alliance on Mental Health reports that it’s also the most common psychiatric condition after major depression and alcohol dependence.

A person with social anxiety often worries about social interactions, such as meeting or having a conversation with someone they don’t know well.

They may also be extremely self-conscious about being observed by others, such as when they’re eating, talking, or walking across a room.

These symptoms go beyond shyness. They interfere with daily life and cause significant mental distress.

Social anxiety disorder may include these mental and physical symptoms:

  • fear of humiliation, embarrassment, or judgment
  • fear of interacting with strangers
  • difficulty with eye contact
  • blushing, trembling, sweating
  • may feel like their mind is going “blank” in social situations
  • active avoidance of social situations or of getting attention
  • ruminating over mistakes made in conversations

Avoidant personality disorder (AVPD) is considered to be a persistent set of characteristics that involve an intense fear of being judged or embarrassed.

Symptoms are driven by feelings of personal inadequacy and the belief that others feel the same way about them. These symptoms cause significant distress and disability in daily life for the 1.5 to 2.5% of the population living with the condition.

Common symptoms of avoidant personality disorder include the following:

  • feelings of inferiority, shame, incompetence, or self-loathing
  • few to no close friendships
  • avoidance of activities or jobs involving contact with others
  • reluctant to get involved with others
  • highly sensitive to criticism or disapproval
  • fear of doing something wrong
  • extremely reserved in intimate relationships
  • magnification of potential problems
  • reluctant or unwilling to try new things due to fear of embarrassment

Both conditions revolve around an intense fear of being judged, rejected, or embarrassed. From the outside, these disorders can manifest in similar symptoms, such as low self-esteem or avoidance of social situations.

But the symptoms of these disorders may be driven by different factors.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), social anxiety disorder is an anxiety disorder, meaning it involves high levels of anxiety. Those with social anxiety disorder recognize that their fears may be disproportionate.

In contrast, those with avoidant personality disorder may lack this insight. Instead, their fears are driven by overwhelming feelings of worthlessness. They believe these core beliefs are true, so they think others also believe they’re inadequate.

Still, there are many similarities between the two disorders, and experts have differing opinions on how they should be diagnosed.

One school of thought suggests that the two disorders exist on a continuum, with avoidant personality disorder essentially being a more severe variant of social anxiety disorder.

Other evidence, as outlined in a research article from 2018, strongly suggests they’re distinct diagnoses. For instance, avoidant personality disorder is not always seen as more severe than social anxiety disorder, and it often occurs in the absence of social anxiety.

One clear differentiation is avoidant personality disorder involves avoidance of most or all social areas of life, while social anxiety may only involve avoidance of a few specific situations (e.g., walking to the front of a classroom or going to a party).

A 2015 study compared the two conditions and looked at how childhood experiences impacted them.

The research showed that while both conditions are both linked to negative childhood experiences, those with avoidant personality disorder reported more severe childhood neglect than those with social anxiety disorder. This primarily took the form of physical neglect.

Avoidance might be a childhood coping mechanism that becomes a more permanent part of the personality.

Social anxiety disorder and avoidant personality disorder commonly occur together. Rates of co-occurrence have ranged from 21–89% over the last two decades.

It was originally believed that avoidant personality disorder only occurred with social anxiety disorder. Now, a considerable amount of research conducted as community studies and highlighted in a 2018 article has shown that about two-thirds of those with avoidant personality disorder consistently do not meet the criteria for social anxiety disorder.

In a 2005 study involving people with major depression with and without personality disorder, 29% of those diagnosed with avoidant personality disorder did not meet the criteria for social anxiety disorder.

Social anxiety disorder is commonly treated with cognitive behavioral therapy (CBT), a type of psychotherapy that teaches you how to identify and challenge negative and false beliefs.

A specific type of CBT, called exposure therapy, may be used to help you progressively face your fears so you can engage in social activities.

Another approach, called acceptance and commitment therapy (ACT), is designed to help enhance your psychological flexibility to improve your willingness to approach challenging and yet meaningful social situations via mindfulness skills and behavior-change strategies.

It may sound counterintuitive to encourage a person with social anxiety to move outside of their comfort zones during therapy, but CBT group therapy, according to a 2019 study, has been found to help reduce social anxiety symptoms.

People with social anxiety disorder may also be prescribed antidepressants and antianxiety medication, specifically serotonin-specific reuptake inhibitors (SSRIs) or serotonin noradrenaline reuptake inhibitors (SNRIs). These medications are also effective for comorbid depression.

Research into the treatment of avoidant personality disorder by itself is currently limited. But approaches generally focus on helping you rebuild a more positive sense of self and discovering fulfilling relationships.

Similar to social anxiety, people with avoidant personality disorder are typically treated with:

  • cognitive behavioral therapy (CBT)
  • exposure therapy
  • acceptance and commitment therapy (ACT)
  • schema therapy
  • psychodynamic therapy
  • social skills training

For some people, it can be uncomfortable to interact socially with a therapist, especially surrounding intimate topics. It can help to know that therapists are trained to offer a safe, nonjudgmental space to work through self-doubt and other distressing core beliefs.

Medications are not considered very effective in personality disorders, but in this case, antidepressants and antianxiety medication may help reduce sensitivity to rejection.

Research suggests that treating social anxiety symptoms in a person with both conditions helps lessen avoidant personality disorder symptoms as well.

Social anxiety disorder is an anxiety disorder, driven by high levels of fear surrounding social situations. Avoidant personality disorder is a personality disorder driven by feelings of inferiority and the assumption that others feel the same.

These conditions may occur separately or together. When left untreated, both disorders can be quite debilitating, but with proper treatment, you can go on to live a fulfilling life.

Therapy can’t cure personality disorders. But people living with avoidant personality disorder can learn how to cope with their distress and start opening up to others.

If you think you might have either of these conditions, don’t hesitate to reach out to a mental health care professional.