How Is Avoidant Personality Disorder Different From Social Anxiety?

Avoidant personality disorder (AVPD) and social anxiety disorder (SAD) are both conditions that involve discomfort and withdrawal in social settings. They share several characteristics but are classified differently.

AVPD is a personality disorder in which avoidance is used to cope with feelings of personal inadequacy. This condition affects an estimated 1.5 to 2.5% of the population.

SAD is classified as an anxiety disorder in which a person has a heightened fear of interaction in social settings due to worry over potential scrutiny. An estimated 6.8% of the U.S. population is affected by SAD.

According to some research, 32 to 50% of people with AVPD also suffer from SAD.

Read on to learn more about the ways in which AVPD and SAD are similar and the key differences of these conditions.

A woman sits with her back to a group of friends chatting.

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What Is Avoidant Personality Disorder?

Avoidant personality disorder (AVPD) is a personality disorder characterized by extensive avoidance of social interaction because of fears of rejection and feelings of personal inadequacy.

People with AVPD expect to be rejected by others, and they believe this perceived rejection reflects inferiority on their part. They are also highly sensitive to criticism. To cope with this, people with AVPD engage in widespread avoidance of social interaction.

This pattern of behavior makes it very difficult for people with AVPD to form and maintain relationships (including friendships). It also can interfere with other areas of their life such as employment.

Symptoms of AVPD

The hallmark characteristics of AVPD are:

  • Social inhibition
  • Feelings of inadequacy
  • Sensitivity to criticism or rejection

To meet the criteria for AVPD laid out by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person must exhibit those characteristics and at least four of the following:

  • Avoiding activities involving significant interpersonal contact, due to fears of criticism, disapproval, or rejection
  • Not willing to get involved or interact with people unless certain of acceptance
  • Holding back within intimate relationships out of fear of shame or ridicule
  • Worrying excessively about being criticized or rejected in social situations
  • Being inhibited in new interpersonal situations because they feel inadequate
  • Considering themselves to be inferior to others, socially inept, or personally unappealing
  • Being extremely reluctant to take personal risks or to engage in activities for fear they may become embarrassed

Symptoms can range from mild to extreme.

AVPD is not typically diagnosed before age 18, but symptoms of AVPD are often present in childhood and adolescence.

How Are AVPD and SAD Similar?

AVPD and SAD involve discomfort and anxiety in social settings.

People with either condition tend to avoid situations where they may feel judged, criticized, or embarrassed. They don't like to be the focus of attention.

What Is Social Anxiety?

Social anxiety disorder (SAD), also called social phobia, is a persistent and irrational fear of social situations because of the potential for scrutiny or judgment by others.

This worry can start well ahead of—even weeks before—the situation. The anxiety from SAD can interfere with work, school, activities, and relationships (including friendships).

Some situations that commonly cause significant distress and anxiety for people with SAD include:

  • Eating around people
  • Public speaking
  • Talking on the phone
  • Talking to people they don't know
  • Making eye contact
  • Using public bathrooms

Symptoms of Social Anxiety

Symptoms of SAD include:

  • Physical symptoms such as blushing, sweating, trembling, nausea, and rapid heart rate
  • Rigid body posture, making little eye contact, and/or speaking with an overly soft voice
  • Feeling anxious, worried, and/or uncomfortable being around or speaking to others
  • Feeling very self-conscious, embarrassed, and awkward in front of other people
  • Fearing they will be judged by others
  • Avoiding places where there will be other people or social interaction

Do People With AVPD and SAD Want to Be Around People?

While people with AVPD and SAD actively avoid interacting with others, they often long for closeness with others. The avoidance stems from the anxiety they feel about the potential of being judged or from feeling inadequate, not from a lack of desire to be around people or form relationships.

How Are AVPD and SAD Different?

AVPD and SAD are similar in a lot of ways, but there are several distinctions between them.

Classification

AVPD is a personality disorder. Personality disorders are patterns of behavior and inner experiences that are significantly different from what is expected in an individual's culture. These patterns are consistent and long term, not fleeting or occasional.

SAD is an anxiety disorder. Anxiety disorders mean a person responds to certain items or situations with disproportionate worry and fear that it interferes with their ability to function or causes significant distress.

Insight

People with SAD are usually at least somewhat aware that their fears of harsh judgment are irrational, even if they can't control them.

People with AVPD may genuinely believe themselves to be inferior, and that the perceived criticism they feel is justified.

Childhood History

While parental abuse and/or neglect are risk factors for both AVPD and SAD, a 2015 study found that the risk was more pronounced with AVPD.

Motivation

SAD is rooted in performance anxiety, namely that they will say or do something that will be embarrassing or cause scrutiny.

AVPD is rooted in negative self-evaluation compared to others. They are highly critical of themselves and have a poor self-image, which they project onto others, assuming others view them the way they view themselves.

Scope of Avoidance

A person with SAD tends to avoid specific situations, such as meeting new people, and public speaking.

A person with AVPD typically experiences a level of avoidance that affects all areas of their life.

People with AVPD can also try to protect themselves by suppressing their emotions. Usually, this is sadness and anger, but some people with AVPD don't show amusement either, even when it is socially expected in the situation. This emotional suppression often occurs in close relationships, not just publicly or with new people.

How Are AVPD and SAD Diagnosed?

Diagnosis for both AVPD and SAD typically begins with a visit to your primary healthcare provider.

The healthcare provider will:

  • Discuss symptoms and ask questions
  • Ask for a medical and family history
  • Likely do a physical exam
  • Run other tests to look for or rule out potential medical contributions to the symptoms
  • Make a referral to a mental health professional, if necessary

A mental health professional will do a more detailed assessment to determine a precise diagnosis.

How Are AVPD and SAD Treated?

While treatment for SAD has been studied widely, there is very little quality research on treatment of AVPD, particularly without a comorbid (co-occurring) diagnosis of SAD. Much of the treatment recommended for AVPD is an extension of treatment for SAD, but some nuance does exist.

Therapy

Psychotherapy (talk therapy) is the first-line treatment for both AVPD and SAD.

A 2019 study showed that group therapy combined with individual therapy was beneficial to people with SAD both with and without comorbid AVPD, though the group therapy showed more promise for those with SAD only.

Cognitive behavioral therapy (CBT) is the most common therapy for both AVPD and SAD. CBT involves identifying problematic thinking processes and behaviors and changing them into healthy, productive ones.

Based on the principles of CBT, an approach called schema therapy may help people with AVPD. Schema therapy uses cognitive, behavioral, and emotion-focused techniques to change long-held, entrenched, self-defeating life patterns.

What Is a Schema?

A schema is a mental concept that uses information provided by life experiences stored in the memory to tell a person what to expect from experiences and situations. Schemas act as a shortcut to make it easier to navigate new situations and encounters that are similar to those we have encountered before.

When normal, healthy developmental needs are not met in childhood, maladaptive schemas (those not appropriate to the situation) can develop, affecting thoughts and behavior into adulthood.

Medication

Medications used to treat SAD include:

  • Antidepressants: Take several weeks to start working; often used long-term
  • Anti-anxiety medications: Work right away; meant for short-term use
  • Beta-blockers: Help block the physical symptoms of anxiety

Medication is not typically the primary treatment for AVPD. Some medications may be given for certain symptoms of the disorder or for co-occurring conditions such as antidepressants for depression.

When to See a Healthcare Provider

If you are experiencing symptoms of either AVPD or SAD, see a healthcare provider. With treatment, both conditions can improve, but neither is likely to go away without help.

Both conditions are associated with other comorbid mental health conditions, and people with AVPD are at a higher risk of suicidal thoughts and actions.

Help Is Available

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 800-273-8255 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Summary

AVPD and SAD are different conditions with similar characteristics. They often occur together.

People with either condition may avoid and feel uncomfortable in social situations. People with SAD do so because they fear judgment from others. People with AVPM have a negative self-view and are sensitive to rejection and criticism, even if just perceived.

CBT is a recommended treatment for both disorders. Schema therapy is an emerging treatment for AVPD.

Medications such as antidepressants may be prescribed for SAD, but they are not usually a primary treatment for AVPD unless there is a comorbid condition that also needs to be treated.

A Word From Verywell

If you regularly experience anxiety in, or avoidance of, social situations, speak with your healthcare provider to see if SAD or AVPD may be at play. With help, symptoms of both conditions can improve and help you find a path to enjoying social situations and building meaningful relationships.

Frequently Asked Questions

  • How can you help someone with avoidant personality disorder?

    A person with AVPD needs professional help, so don't try to help them alone. You can support their treatment by letting them know you value them and you understand they are struggling, by learning about their condition, and by encouraging them to seek and follow treatment.

  • How do you know if you have social anxiety?

    Regularly feeling a high level of anxiety in social settings or with social interaction is an indication that you may be experiencing SAD. For a diagnosis, see your healthcare provider.

  • How can you help someone with social anxiety?

    Some of the ways you can help someone with SAD are to learn about their condition, encourage them to seek and follow treatment, praise small accomplishments, be patient, and listen to them.

  • Is social anxiety a mental health illness?

    SAD is an anxiety disorder, which is a recognized mental health illness.

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