Avoidant Personality Disorder vs Social Anxiety

What is avoidant personality disorder?

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.

What is social anxiety disorder?

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].

Avoidant personality disorder vs social anxiety disorder: Symptoms

Similarities

• Avoidance of social situations that they are unfamiliar with and cause stress and anxiety
• Fear of rejection and embarrassment in situations such as working on a presentation or group project with colleagues
• Avoidance of close or intimate relationships, and fear of opening up to close friends or partners
• Expecting that others will dislike you for no obvious reason
• Reluctant to take risks or put themselves into uncomfortable situations

Differences

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]

• Blushing
• Difficulty talking
• Nausea
• Sweating
• Trembling

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.

Avoidant personality disorder vs social anxiety disorder: Causes

Neglect

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].

Social Isolation

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

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].

Genetics

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.

Avoidant personality disorder vs social anxiety disorder: Treatment

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

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

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

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

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].

Medication

Many people respond well to therapy alone, however, there are some medications approved to treat social anxiety disorder. These include: ^[3]

• Anti-anxiety medication
• SSRIs
• Benzodiazepine
• SNRIs

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.

Can you have avoidant personality disorder and social anxiety at the same time?

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.