Do you know someone who seems rather shy and awkward socially? Do they avoid situations where they have to be close to people? Do they have chronically low self-esteem and a tendency to focus intently on their own shortcomings – as well as a huge fear of embarrassing or shaming themselves.

These traits in themselves don’t automatically mean the person has an avoidant personality disorder. It’s only if these behaviours are intense, extreme, ongoing – and are significantly affecting the person’s functioning in everyday life – that there may be in issue.

Like all psychiatric conditions, a personality disorder needs to be diagnosed by a psychiatrist according to behaviours and symptoms listed in the DSM-5 diagnostic manual. The criteria for avoidant personality disorder include significant impairments in personality functioning shown through impairments in self functioning and interpersonal functioning.

Self-functioning impairments can include:

• Identity: This involves feelings of low self-esteem and believing themselves to be socially inept, personally unappealing, or feeling inferior to others. They may also experience excessive feelings of shame or inadequacy.
• Self-direction: They may have unrealistic standards for behaviour related to their reluctance to pursue goals, take personal risks, or engage in new activities involving interpersonal contact.

Impairments in interpersonal functioning can include:

• Empathy:  They can become preoccupied with, and sensitive to, criticism or rejection, and they normally infer other people’s perspectives of them to be negative.
• Intimacy: They can be reluctant to become involved with people unless they’re certain of being liked. They find intimate relationships incredibly difficult because of their fear of being shamed or ridiculed.

Avoidant Personality Disorder diagnosis

To be diagnosed with avoidant personality disorder, the following pathological personality traits need to be present:

• • Detachment, characterised by:
    • Withdrawal, including reticence in social situations, avoiding social contact and activity, and lack of initiating social contact.
    • Avoiding intimacy in close or romantic relationships, interpersonal attachments, and intimate sexual relationships.
    • Anhedonia, which is a lack of enjoyment from, engagement in, or energy for life’s experiences; there’s an inability to feel pleasure or take interest in things.
  • Negative affectivity, characterised by anxiousness: intense feelings of nervousness, tenseness, or panic, often in reaction to social situations; worrying about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; and fears of embarrassment.

To be diagnosed, the impairments in personality functioning and personality traits have to be relatively stable across time and consistent across situations; they are not ‘normal’ for the person’s life developmental stage or environment; and they’re not due to the effects of a substance or medication.

To support someone with avoidant personality disorder, it may help to understand what the symptoms are and to know that the person may have developed these behaviours and traits to help them survive a childhood where their needs weren’t met. Be sensitive to their fear of criticism and don’t expose them to social situations that could potentially be scary and shaming, but instead let them decide for themselves if they want to come along. Also, don’t take their behaviour personally if they come across as awkward or rejecting. You may want to encourage them to seek support, such as seeing their GP, if their life is becoming unmanageable – or talking to a therapist.

If you or someone you know feels ready to seek support for avoidant behaviour, or if they have avoidant traits that are making life difficult, then get in touch with us at The Awareness Centre. We have a team of counsellors, psychotherapists and psychologists offering sessions seven days a week from our centres in Clapham and Tooting. Email us on info@theawarenesscentre.com or call 020 8673 4545.