There’s more to avoidant personality disorder than being shy and avoiding others. Do you know what the diagnostic criteria look like?
Suzy’s felt this anxiety for as long as she can remember. It’s always there at the back of her mind—the fear of rejection, of criticism, of humiliation, so strong that it smothers her when she’s around others. The only way she knows how to deal with it is avoidance.
Take the time when she was nine. A classmate waved to her across the playground and that anxiety fluttered through her like a storm of agitated butterflies. What if the girl didn’t really like her? What if she waved back and the girl laughed? What if the girl’s friends made fun of her too? Suzy didn’t wave back.
Then there was the time when she was fifteen. Usually, when she was invited to parties, she turned down the offer, but she really wanted to push herself this time. All those hours spent getting ready, making herself look perfect—surely no one could criticise her or laugh at how she looked? But when she got there, those anxious butterflies in her stomach turned into angry wasps. She spent the night in a corner and barely said a word, terrified that she’d say something stupid and that everyone would be there to hear it.
Anxiety and inhibiting herself around others defined Suzy’s childhood and adolescence, but it was only when she was older that she found out a name for what she had felt all her life: avoidant personality disorder.
To Keep in Mind:
The information in this post comes from the DSM-5 (see ‘Further Reading’). Please do not use it to diagnose yourself or others. It isn’t intended to be a substitute for professional advice so do consult a qualified clinical professional if you have any questions about the diagnosis criteria. Feel free to use this information to diagnose your characters, however.
Suzy is an example of a character with avoidant personality disorder (AvPD), a Cluster C personality disorder characterised by its pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation.
Observers typically describe people with AvPD as shy, timid and lonely, but that doesn’t mean that these people want to be isolated. In fact, they often desire affection and acceptance, fantasising about idealised relationships with others; their fear of rejection gets in the way of forming these relationships, however. It’s this fear and anxiety around social situations and interactions with others that can cripple people with AvPD in occupational and personal settings.
How Is Avoidant Personality Disorder Diagnosed?
To be diagnosed with AvPD, your character must display four or more of the following characteristics:
- Avoids occupational activities that require significant contact with others, like job promotions and taking on more responsibility, for fear of criticism, disapproval or rejection.
- Is unwilling to become involved with people unless he or she is certain of being liked.
- Shows restraint in intimate relationships due to fear of being shamed or ridiculed.
- Is preoccupied with thoughts of criticism or rejection in social situations.
- Is inhibited in new interpersonal situations because of his or her feelings of inadequacy.
- Views himself or herself as socially inept, personally unappealing or inferior to others.
- Is reluctant—unusually so—to take personal risks or take part in any new activities as they might prove embarrassing.
The characteristic features of AvPD can’t be fleeting or one-offs. Personality disorders are inflexible, pervasive and enduring—that is, they affect your character in all situations, at all times, for a long period of time. This is very important to remember when writing about a character with a personality disorder. You can’t just show one or two glimpses of the criteria in the story; the symptoms will pervade your character’s thoughts, their perceptions, their behaviour, all the way throughout the novel. But more on that in Inadequacy and Inhibition: Writing About Avoidant Personality Disorder.
How Does Avoidant Personality Disorder Develop?
Shyness in children isn’t unusual. As they get older, that shyness gradually dissipates in most cases, allowing them to build relationships with new people. In individuals with AvPD, the shyness they feel in childhood tends to get worse during adolescence and early adulthood, which can make them avoidant of others at a time when forming social relationships becomes particularly important. Keep this in mind if you decide to write about a character with AvPD.
AvPD and Other Disorders
It could well be that a character with AvPD has other mental health disorders also. Avoidant personality disorder has similar features to other disorders and can co-occur with them, but it’s important to know how AvPD differs from other disorders before you start writing about them. Let’s take a brief look now.
AvPD and Anxiety
There’s an awful lot of overlap between avoidant personality disorder and social anxiety disorder (i.e., social phobia). In fact, the DSM admits that they may well be different conceptualisations of the same or similar conditions. Therefore, if you have a character with AvPD, it’s worth reading up on social anxiety disorder too—many of the characteristic features may correspond. AvPD can also co-occur with agoraphobia, depressive and bipolar disorders.
AvPD and Dependent Personality Disorder
Both are characterised by feelings of inadequacy, a hypersensitivity to criticism and a need for reassurance. They differ in their primary concern, however; while AvPD’s focus is on avoiding humiliation and rejection, the focus of dependent personality disorder is on being taken care of. The two are often diagnosed together, as individuals with AvPD can become very dependent on the select few people they’re friends with.
AvPD, Schizoid and Schizotypal Personality Disorders
Schizoid and schizotypal personality disorders (part of Cluster A) are characterised by social isolation, as is AvPD. The two differ from avoidant personality disorder in intent, though. Whereas people with schizoid or schizotypal personality disorder are content with—or even prefer—their social isolation, people with AvPD feel their loneliness keenly and want relationships with others. It’s their fear of criticism and rejection that gets in the way.
AvPD and Paranoid Personality Disorder
While both AvPD and paranoid personality disorder (also part of Cluster A) feature a reluctance to confide in others, the distinction lies in the reason for this reluctance. People with AvPD fear being embarrassed or deemed inadequate and so avoid confiding in others, whereas people with paranoid personality disorder fear others’ malicious intent.
Remember: if your character meets the criteria for one or more personality disorders, they can be diagnosed with all of them. (For example, avoidant and borderline personality disorders can co-occur.) Just make sure the characteristic features fit together and have a basis in reality before you decide which disorders will co-occur.