Some mental health disorders mark such a stark departure from “normal” human experiences that it can be difficult for people who don’t suffer from the condition to imagine what it’s even like. Most, however, are not foreign entities, but are an intensification of emotional and behavioral experiences so common they can be considered nearly universal. Social anxiety is perhaps the most obvious example of this phenomenon; you would be hard-pressed to find someone who has not felt some form of social fear, whether transient or enduring, specific or generalized. As such, most people exist somewhere along the spectrum of social anxiety that ranges from common, non-pathological expressions of social worry to paralyzing manifestations of all-encompassing social phobia that severely impair everyday function. When extreme social fear coalesces with overwhelming insecurity and feelings of inadequacy, it moves beyond the realm even of social anxiety disorder and takes on a new name: Avoidant Personality Disorder.

Understanding Avoidant Personality Disorder

Avoidant Personality Disorder (APD) is a mental health disorder defined by extreme social anxiety combined with a distorted and painful self-image that violently disrupts everyday function. While people with social anxiety disorder may experience difficulties with social interaction to varying degrees, social anxiety disorder itself does not require the presence of a specific type of relationship with oneself; even generally confident people with healthy self-esteem and reality-based self-images can struggle with the condition. In contrast, people with Avoidant Personality Disorder have fundamental feelings of inadequacy and inferiority that drive them toward extreme social inhibition as they seek to avoid rejection, embarrassment, and judgment.

Symptoms of Avoidant Personality Disorder include:

• Low self-esteem and self-loathing
• Overwhelming feelings of inadequacy
• Extreme shyness and social anxiety, even with people close to you
• Self-imposed isolation
• Hypersensitivity to criticism
• Constant fear of rejection
• Avoidance of social interactions, work, and school
• Feelings of social ineptness
• Believing that you are unwelcome in social situations regardless of whether such feelings have any basis in reality.

The symptoms of APD can wreak havoc on your ability to live a normal life and even the most basic tasks of everyday living, such as holding a job or interacting with family, can feel impossible. As Samantha Gluck writes:

Avoidant Personality Disorder permeates every aspect of a person’s life. People suffering from it cannot stop dwelling on their own perceived shortcomings. They rarely form relationships, but when they do, they only interact with people they strongly believe will not reject them. Rejection and embarrassment are so intensely painful for people with avoidant personality that they choose loneliness rather than take the risk.

However, people with Avoidant Personality Disorder are not misanthropes or simply loners; you want and even crave social connection, but your disorder keeps you from being able to participate in healthy social interactions.

Finding the Roots of Avoidant Personality Disorder

The causes of APD are not fully understood, but researchers believe that biological and experiential factors both play a role in the development of the disorder. As noted by the Cleveland Clinic:

The fact that avoidant personality disorder occurs more often in certain families suggests that a tendency to develop the disorder might be passed on in families through their genes. The disorder itself is likely triggered by environmental influences such as parental or peer rejection, which can impact a person’s self-esteem and sense of worth.

Studies on twins have revealed that “genetic factors account for half the variance in Avoidant Personality Disorder.” For many, however, painful formative experiences of trauma, neglect, and rejection by family members or peers appear to lie at the heart of the condition. People diagnosed with Avoidant Personality Disorder report high rates of childhood physical and emotional abuse, which can disrupt healthy psychological development and impair your ability to form healthy, strong attachments while simultaneously causing you to internalize criticism and shaming. Gluck explains:

Children naturally want to bond with their parents, but due to the constant parental rejection and ridicule, it’s virtually impossible for a healthy bond to form. This leaves these children hungry for close relationships, yet lacking the skills to form and maintain them. They begin to develop a protective psychological shell that shields them from further parental ridicule and rejection. The resulting social awkwardness may cause peers to tease and ridicule them as well, contributing to the intense fear of social interactions.

In other words, Avoidant Personality Disorder is a form of self-preservation in response to overwhelming distress and the a lack of healthy alternatives. This phenomena goes some way towards explaining why Avoidant Personality Disorder typically emerges in childhood or adolescence and intensifies with time as maladaptive patterns strengthen and become deeply integrated into your psychological makeup. It also clarifies the high rate of comorbidity with PTSD.

Finding Hope and Healing

Although deeply distressing, Avoidant Personality Disorder is a treatable illness; individual psychotherapy, group therapies, holistic therapies, and psychotropic medications may all provide significant benefits to disrupt the damaging cognitive, emotional, and behavioral patterns that characterize the illness. As noted by Dr. Allan Schwartz:

Cognitive Behavioral Therapy (CBT) is most useful with the social phobias and avoidant disorders because the emphasis is on changing thinking patterns as well as modifying behavior. The emphasis is on helping the patient face and become desensitized to the stimuli (social situations) that cause them the most trouble.

While CBT is often the mainstay of Avoidant Personality Disorder, comprehensive and individually designed treatment plan allows you to experience the benefits of a range of therapeutic practices to create multiple avenues toward healing.

However, the symptoms of Avoidant Personality Disorder itself can create significant barriers to healing, as treatment requires the very social interaction you desperately seek to avoid; although intensive residential treatment is often the best course of action to facilitate healing, the prospect of immersion within a social space can be profoundly intimidating. As such, carefully considering the specific program in which to recover is paramount to ensuring that your treatment experience is positive and allows you to participate in the therapeutic process to the fullest extent possible. In order to facilitate healing, consider the following when selecting a treatment program:

• Program Size: A small, intimate treatment program can help you feel more at ease and avoid being overwhelmed by social interaction. At Bridges to Recovery, we take a maximum of only six clients at each location to ensure that each individual receives the care and attention they need while promoting the formation of a strong, close-knit healing community.

• Compassionate and Experienced Clinicians and Staff: Seeking treatment in a program where both the clinicians and staff have the experience and compassion to understand both your individual needs and the unique qualities of Avoidant Personality Disorder itself can be critical to making you feel comfortable. A program like Bridges to Recovery combines the highest standard of clinical care with the human elements of love, empathy, and respect to form strong therapeutic alliances and ensure that you feel safe and welcome throughout the treatment process.

• Variety of Therapies: Often, people with Avoidant Personality Disorder find that nonverbal therapies such as art therapy, pottery, and drumming are particularly useful in early treatment, as they offer you the emotional space and safety to explore and express yourself without the expectation of overt social interaction. As your thinking begins to shift and you become more confident, you can increase engagement in other therapeutic forms. Additionally, if your Avoidant Personality Disorder is informed by experiences of trauma, specialized trauma-focused treatments such as EMDR and Somatic Experiencing can be essential to promoting complete healing.

With the right supports in the right environment, you can begin a process of true transformation that nurtures the development of positive self-image, teaches you how to form and maintain meaningful relationships, and removes the barriers keeping you from living life to its fullest.

Bridges to Recover offers comprehensive residential treatment for people struggling with Avoidant Personality Disorder as well as co-occurring mental health disorders, substance abuse, and process addictions. Contact us to learn more about our renowned program and how we can help you or your loved one start the journey toward healing.

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