Last reviewed:
Feb 14th 2023
LCPC
Avoidant personality disorder and social anxiety are separate mental conditions that are characterized by an intense fear of social situations. Whilst these two conditions present very similar symptoms, there are some important differences. It is important that you receive an accurate diagnosis as they can be treated in different ways.
People with avoidant personality disorder suffer from feelings of inadequacy, social inhibition, and fear of negative judgment [1]. They fear rejection and believe that social rejection reflects their own inferiority.
Because of this people with avoidant personality disorder will often completely remove themselves from social situations. This can negatively impact work, school, friendships, and close relationships.
Social anxiety disorder is a constant and irrational fear of social situations that may involve scrutiny by others or being singled out for a period of time, such as making a speech or a presentation or meeting new people [2].
People with social anxiety disorder will also avoid social situations that cause these negative feelings. However, when they cannot these situations will cause a lot of stress and they will often spend weeks in advance worrying about the event and things they think may go wrong [3].
The main difference between the symptoms experienced by those with avoidant personality disorder and those with social anxiety is the feelings of inferiority and inadequacy [4][5]. People with social anxiety can often recognize that their fears are irrational, and don’t experience the same levels of worthlessness or self-loathing.
As social anxiety is an anxiety disorder (compared to avoidant personality disorder being a personality disorder) then people with it are more likely to suffer from other anxiety disorders such as panic disorder and phobias [4].
Social anxiety disorder also presents itself through more physical symptoms. These include: [2]
Some clinicians argue that avoidant personality disorder is a more severe type of social anxiety, and therefore the symptoms are very similar and only differ in the severity that people experience them [6]. People with social anxiety may be able to better manage their symptoms than those with avoidant personality disorder.
Severe childhood neglect has been identified as a cause of both avoidant personality disorder and social anxiety. However, people with avoidant personality disorder tend to report more serious neglect in their childhood [1].
Being socially isolated in childhood has been linked to the development of both avoidant personality disorder and social anxiety. This is because they have not developed the normal social skills needed to participate in society.
Abuse, and especially emotional abuse, can cause self-esteem and trust issues from a young age. Emotional abuse in childhood by parents can cause the feelings of worthlessness and inadequacy that people with avoidant personality disorder display, as well as making it more difficult to be emotionally vulnerable with close friends and partners. Like neglect, abuse in childhood has a greater link with avoidant personality disorder [1].
Genetic factors may play a part in the way we deal with stressful situations and how introverted or extroverted we are. You may also be more likely to develop avoidant personality disorder or social anxiety if one of your parents also suffers from them.
There has been little concrete research providing clear treatment plans for people with avoidant personality disorder. Treatment is usually based on the current understanding of social anxiety treatment; however, they do differ slightly when it comes to approved medication for an avoidant personality disorder diagnosis [7].
Cognitive behavioral therapy (CBT) has been shown as an effective treatment for both avoidant personality disorder and social anxiety [7]. CBT works by helping people with both disorders to recognize their symptoms and to rationalize them, helping them to overcome feelings of dread and anxiety when faced with social situations.
Schema therapy can help to address the feelings of self-doubt and worthlessness that people with avoidant personality disorder suffer with. This therapy addresses the negative beliefs that people hold about themselves and potentially identify their cause.
Group therapy provides a controlled and welcoming environment for people with either disorder. This works similarly to CBT; however, the group aspect means people can practice speaking in a social setting and opening up to others with the reassurance of a safe environment for them to do it.
Exposure therapy involves either imagining yourself in a situation you know causes anxiety or gradually exposing yourself to anxiety-inducing situations. Working with a healthcare professional can help you to develop coping mechanisms and ways to reduce your anxiety and deal with the situation calmly [2].
Many people respond well to therapy alone, however, there are some medications approved to treat social anxiety disorder. These include: [3]
There are currently no FDA-approved medications for the treatment of avoidant personality disorder. However, your doctor may be able to prescribe medication alongside therapy to treat comorbid symptoms and diagnoses.
While it is thought that avoidant personality disorder is just a more severe type of social anxiety, they do have some differences which make them useful as separate diagnoses [4].
It is estimated that between 32% and 50% of people with avoidant personality disorder also have social anxiety [9]. Therefore, whilst they are separate disorders, it is quite common for people to suffer from both at the same time.
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