Avoidant Personality Disorder vs. Social Anxiety Disorder

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Navigating social situations can be tough, especially for those with avoidant personality disorder (AVPD) or social anxiety disorder (SAD). While both conditions involve fear of social embarrassment and avoidance, they have distinct characteristics and treatments. This guide will help you understand the key differences between AVPD and SAD, including symptoms, causes, and treatment options.

What is avoidant personality disorder (AVPD)?

Avoidant personality disorder (AVPD) is a mental health condition marked by chronic social avoidance, intense feelings of inadequacy, and extreme sensitivity to criticism. 1

This avoidance can severely impact their personal and professional lives, making it difficult to form and maintain relationships. 

AVPD typically begins in early adulthood and goes beyond normal shyness or occasional social anxiety, affecting many aspects of a person’s daily life.

Symptoms of avoidant personality disorder?

Avoidant personality disorder (AVPD) presents with a range of symptoms that affect various aspects of a person’s life. Here are some common symptoms:

  • Extreme sensitivity to criticism: Individuals with AVPD are highly sensitive to negative feedback or disapproval from others.
  • Social inhibition: They often avoid social interactions and situations where they fear being judged or rejected.
  • Feelings of inadequacy: People with AVPD frequently feel inferior to others and have low self-esteem.
  • Reluctance to take risks: They may avoid new activities or take risks due to fear of embarrassment or failure.
  • Limited social relationships: AVPD can lead to a lack of close relationships, as individuals avoid forming bonds with others.
  • Avoidance of occupational activities: They may avoid job opportunities or professional settings that require significant interpersonal contact.

What is social anxiety disorder (SAD)?

Social anxiety disorder (SAD), also known as social phobia, is a mental health condition involving an intense fear of social situations where one might be judged, embarrassed, or scrutinized by others. 2

People with SAD often feel significant anxiety and discomfort in everyday interactions, such as speaking in public, meeting new people, or even eating in front of others.

This fear can lead to avoidance of social situations and severely impact a person’s daily life, work, and relationships. Unlike normal nervousness, SAD is persistent and can interfere with routine activities and overall quality of life.

Symptoms of social anxiety disorder?

Common symptoms of social anxiety disorder include:

  • Intense fear of social situations: People with social anxiety disorder experience overwhelming fear in social settings, worrying about being judged or embarrassed.
  • Avoidance behavior: They often avoid social interactions such as public speaking, attending parties, or meeting new people.
  • Physical symptoms: SAD can cause sweating, trembling, blushing, rapid heartbeat, and nausea.
  • Excessive self-consciousness: People with SAD are extremely self-aware and worried about their actions being negatively evaluated by others.
  • Fear of scrutiny: They often worry excessively about being watched, even during routine activities like eating or drinking in public.
  • Difficulty in daily activities: This intense fear and avoidance can interfere with everyday tasks, making it hard to go to work or school or engage in social activities.
  • Anticipatory anxiety: They may experience significant anxiety days or even weeks before upcoming social events.

How to tell the difference between social anxiety disorder and avoidant personality disorder

Avoidant personality disorder (AVPD) and social anxiety disorder (SAD) both involve fear and avoidance of social situations, making them easy to confuse. However, there are key differences that can help you distinguish between the two conditions:

Core fear

  • AVPD: People with AVPD fear rejection and believe they are fundamentally flawed. They think others will reject them if they show their true selves.
  • SAD: Those with social anxiety may fear specific social situations and worry about being embarrassed or judged by others.

Severity and scope

  • AVPD: Avoidant personality disorder (AVPD) affects many aspects of life and is long-lasting. People with AVPD have deeply ingrained habits of avoiding social situations and feeling inadequate.
  • SAD: Social anxiety disorder (SAD) is often more situational. Someone with SAD might fear specific situations, like public speaking, but can function well in other areas of life.

Self-perception

  • AVPD: People with avoidant personality disorder (AVPD) often think very poorly of themselves. They believe they are socially awkward and not worthy of others’ time, leading them to avoid many social interactions.
  • SAD: People with social anxiety disorder may fear certain social situations but don’t generally see themselves as unworthy. They might have good self-esteem outside of the situations that trigger their anxiety.

Relationships

  • AVPD: Forming and maintaining close relationships is hard because of the intense fear of rejection. They may want connections but avoid them to prevent rejection.
  • SAD: People with SAD avoid social interactions mainly due to fear of specific situations. They can form close relationships if they manage their specific fears.

Onset and duration

  • AVPD: Usually starts in early adulthood and affects various aspects of life continuously.
  • SAD: Can develop at any time, often starting in the teenage years. The severity of symptoms can vary over time, and it is often more responsive to treatment.

Treatment response

  • AVPD: Requires long-term therapy focusing on deep-seated self-esteem issues and avoidance patterns. It’s often more challenging to treat.
  • SAD: Often responds well to cognitive behavioral therapy (CBT) and medications like SSRIs, which help reduce specific fears and avoidance behaviors.

Signs you have both avoidant personality disorder and social anxiety disorder

Having both avoidant personality disorder and social anxiety disorder can be challenging, as their symptoms often overlap. Here are some indicators that you might have both conditions:

Intense fear of social situations

  • Avoiding all social interactions: You might avoid not just specific situations but almost all social interactions due to a deep fear of rejection and embarrassment.
  • Extreme discomfort in social settings: Even when you engage socially, you feel extremely anxious and uncomfortable, fearing negative judgment from others.

Negative self-image

  • Feeling fundamentally flawed: You believe that you are inadequate or unworthy, which makes you fear others will reject you if they get to know you.
  • Constant self-criticism: You frequently criticize yourself and believe others see you in the same negative light.

Avoidance behavior

  • Avoiding new opportunities: You avoid new experiences or opportunities (like a new job or social event) because you fear failing or being judged.
  • Social withdrawal: You tend to withdraw from friends, family, and colleagues, not just because of specific social fears but because of a broader sense of inadequacy and rejection.

Physical symptoms of anxiety

  • Physical signs of anxiety: You experience symptoms like sweating, trembling, blushing, or nausea in almost any social situation.
  • Anticipatory anxiety: You feel intense anxiety days or even weeks before a social event, fearing negative outcomes.

Difficulty forming relationships

  • Struggling with close relationships: You find it hard to form or maintain close relationships due to your fear of rejection and criticism.
  • Limited social network: Your social circle is very small because you avoid interactions that could lead to deeper connections.

Impact on daily life

  • Difficulty at work or school: Your fear of social interactions and negative self-image make it hard to participate in meetings, classes, or group activities.
  • Routine disruptions: Daily activities, like going to the grocery store or attending a family gathering, become highly stressful and often avoid tasks.

Persistent and pervasive symptoms

  • Long-lasting issues: These symptoms are not occasional but persistent, affecting multiple areas of your life for an extended period.
  • Deeply ingrained patterns: Avoidance and fear are not just situational but part of a long-term pattern that affects many aspects of life.

Recognizing these signs can help you understand whether you might have both AVPD and SAD. If you notice these patterns in your behavior, seeking professional help can provide you with the support needed to manage both conditions.

Avoidant personality and social anxiety disorder treatment

Treating avoidant personality disorder (AVPD) and social anxiety disorder (SAD) involves a combination of therapies and sometimes medication. 

Psychotherapy

Cognitive-behavioral therapy (CBT)

  • AVPD: CBT helps individuals challenge negative thoughts and beliefs about themselves, improving self-esteem and social skills. It can also address avoidance behaviors by gradually exposing individuals to feared social situations in a safe and controlled manner. 3
  • SAD: CBT also helps people with social anxiety by changing thought patterns that cause anxiety and gradually exposing them to situations that make them anxious to reduce fear over time.

Dialectical behavior therapy (DBT)

  • AVPD: DBT can help manage intense emotions and improve interpersonal effectiveness, making it easier to form and maintain relationships.
  • SAD: DBT techniques can also be beneficial for managing the intense fear and anxiety associated with social interactions. 4

Schema therapy

  • AVPD: Schema therapy focuses on identifying and changing deeply ingrained patterns and beliefs formed during childhood. It helps individuals understand how these schemas influence their behavior and emotions. 5
  • SAD: While less common for SAD, schema therapy can still be useful in addressing underlying patterns that contribute to social anxiety.

Medication

Antidepressants

  • SSRIs and SNRIs: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed to reduce symptoms of both AVPD and SAD. They help by balancing neurotransmitters in the brain that affect mood and anxiety.

Anti-anxiety medications

  • Benzodiazepines: These can be prescribed for short-term relief of severe anxiety symptoms. However, they are generally not recommended for long-term use due to the risk of dependence.
  • Beta-Blockers: These can help manage physical symptoms of anxiety, such as rapid heartbeat and trembling, often used for situational anxiety in SAD.

Support groups

Group therapy

  • AVPD: Group therapy provides a safe environment for practicing social skills and receiving support from others with similar experiences.
  • SAD: Group therapy can help individuals with SAD feel less isolated and provide a platform to practice social interactions in a supportive setting.

Peer support groups

  • AVPD and SAD: Joining a support group can provide a sense of community and understanding. Sharing experiences and coping strategies with others who face similar challenges can be incredibly beneficial.

Lifestyle changes

  • Physical activity can reduce anxiety and improve mood, benefiting both AVPD and SAD.
  • Eating a balanced diet can support overall mental health and reduce symptoms of anxiety.
  • Practices such as meditation, yoga, and deep breathing exercises can help manage anxiety symptoms and improve overall well-being.

Professional help

If you suspect you have AVPD, SAD, or both, it’s important to seek professional help. A mental health professional can provide a comprehensive evaluation and create a personalized treatment plan tailored to your specific needs. With the right support and treatment, it is possible to manage these conditions and improve your quality of life.

Final thoughts

Living with avoidant personality disorder (AVPD) or social anxiety disorder (SAD) can be very isolating and challenging. Seeking help can make a significant difference in managing symptoms and improving your quality of life.

If you need support personalized to your unique situation, our anxiety treatment program might be right for you. We help you find the care and understanding you need to start feeling better and connecting more with others.

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Sources

1. Fariba, K. A., Torrico, T. J., & Sapra, A. (2024, February 12). Avoidant personality disorder. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559325/

2. National Institute of Mental Health. (2022). Social anxiety disorder: More than just shyness (NIH Publication No. 22-MH-8083). U.S. Department of Health and Human Services, National Institutes of Health. Retrieved from https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness

3. Rees, C. S., & Pritchard, R. (2013). Brief cognitive therapy for avoidant personality disorder. Psychotherapy (Chic), 52(1), 45-55. https://doi.org/10.1037/a0035158

4. Villalongo Andino, M., Garcia, K. M., & Richey, J. A. (2024). Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review. Frontiers in Psychology, 14, Article 1331200. https://doi.org/10.3389/fpsyg.2023.1331200

5. Johnson, L. (n.d.). Schema therapy part 1: Avoidant personality disorder and how schema therapy helps [Video]. National Social Anxiety Center. Retrieved from https://nationalsocialanxietycenter.com/social-anxiety-self-help-videos/schema-therapy-part-1-avoidant-personality-disorder-and-how-schema-therapy-helps/