Avoidant Personality Disorder and Social Anxiety
June 26th, 2006 by Ryan Oelke
Many of us, myself included, might meet the diagnoses for Avoidant Personality Disorder (APD) and Social Anxiety. When looking at the criteria for both, you’ll see that while they’re not identical, they do seem to be in the same ballpark. As a person who does fit both disorders, I wonder if they should be treated similarly or separately? Does one have different implications over the other? Let’s take a look at these two disorders, and as we go I’ll share a little about my own experiences. (You’ll notice little footnotes throughout the post. Click on the number to get more information.)
Thankfully, the DSM-IV1 acknolwedges the similarity between APD and SAD:
There appears to be a great deal of overlap between Avoidant Personality Disorder and Social Phobia, Generalized Type, so much so that they may be alternative conceptualizations of the same or similar conditions.
When I read over the criteria2 for APD, everything hit right on the mark and described my experiences perfectly: avoiding social situations and interpersonal contact for fear of criticism, disapproval, rejection; unless certain of being liked; restraint in intimate relationships out of fear of being shamed or ridiculed; preoccupied with criticism and rejection; inhibited in new interpersonal relationships because of feelings of inadequacy; views self as socially inept; reluctant to take personal risks/engage in new activities3. Read my intro post and you’ll notice the connections.
You might wonder how APD is any different from SAD, if it is at all. I went back to the criteria of SAD and what I noticed is that APD seems to be a more specified description of SAD. Some researchers conclude that APD is a more intense version of SAD, but I disagree, based on my own experience. I think that its entirely possible that the most intense cases of SAD will also be diagnosed with APD, but not all cases APD are intense versions of SAD. I say this because, as I mentioned in my intro post, most folks don’t know I even have SAD and would never suspect it. Also, I don’t feel like an “intense” version4. However, APD hits the nail on the head and is even more to the point about my struggles than is SAD.
The next question is whether these disorders should have entirely different paths of treatment. I think not. Both seem to have the same roots and patterns: cognitive behavioral5. I have found the techniques from the Social Anxiety Workbook to be tremendously helpful and get right to the heart of my struggles, so I see no need to have an APD Workbook. I suspect the “Social Anxiety” has taken on a more popularized quality and probably sounds a bit more appealing to the average person than “Avoidant Personality”6.
I’m still in the midst of exploring APD and have found a great website appropriately titled, Avoidant Personality. They list a couple of online message groups, as well as some relevant books. What is your experience? Is APD helpful in understanding your experience of SA (or if you are a mental health practioner, helpful in working with individuals)? Do you think they are of the same disorder, or distinctly separate?
- The DSM-IV is the “Diagnostic and Statistical Manual of Mental Disorders”. The current edition is the Fourth Edition-Text Revision, or DSM-IV-TR. This is the “official” manual used by mental health practitioners and is required by many health insurance providers. [back]
- Every mental health disorder in the DSM includes certain criteria that an individual must meet in order to be diagnosed with that disorder. This is very important because all of us meet some/a few of the criteria for some/a few of the disorders, for example Generalized Anxiety Disorder. [back]
- Wikipedia has a nice page on APD, including full criterion. [back]
- For example, not being able to leave the house, severe occupational interference, etc. [back]
- Cognitive behavioral theory and therapy maintain that our emotional struggles stem from the thought patterns that we hold and are reinforced by our behavior. Treatment involves examining our thought patterns, challenging and changing them, and creating more accurate thoughts, and to engage in new behaviors supporting our new thoughts and desired outcomes [back]
- An Amazon.com search of “Avoidant Peronality Disorder” reveals a grand total of zero books [back]
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8 Responses to “Avoidant Personality Disorder and Social Anxiety”
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Francis wrote on 06/28/06 at 3:35 pm :
I have not looked into APD in much detail, but I will read your links and try to understand more about it. From a mere cursory look, I think they are different as you suggest, though they have a lot in common.
For example, I don’t know if I have much APD, as I do go out and do things. I sometimes avoid situations, but in the last three years, after getting mostly of Codependency, I’ve been able to focus on me and what I enjoy, instead of what someone else enjoys. And since then I have not avoided many situations. However, when I am in the situation, I have some nasty SAD that grabs me and holds on pretty tight.
Francis wrote on 06/28/06 at 3:37 pm :
…sorry got distracted.
My husband, on the other hand, has a great deal of APD. He will avoid situations a great deal. He has SAD as well, but his APD is more pronounced. This has held him back from finding a decent job.. he’s smart as a whip but he’s unable to go to interviews. It’s unfortunate, and I hate to see him suffer, but as I learned in CoDA, he’s the only one who can fix himself.
Ryan Oelke wrote on 06/28/06 at 3:54 pm :
Hey Francis, thanks for sharing. Actually, there are a few diagnoses that seem to be very similar, one of them being Dependent personality disorder. It would be interesting to read some research on how they might interact with each other.
As for APD, see I do fit the description, but I don’t avoid things that much, BUT I have those feelings. And there’s a difference, imo, between having behavior and feelings. Matter of fact, in the DSM, they say that folks with APD might deal with there problems by denying they exist. So, the real heart of SAD and APD is what’s going on internally. That’s why I think that APD is not merely a stronger intensity of SAD. Maybe it is though? Maybe all those who have APD are the stronger cases of SAD?
And in the end, does it involve different treatments, or simply different levels of treatment?
Ansela wrote on 02/9/07 at 11:31 am :
It sounds to me that the main difference is how people deal with their social anxiety primarily. Do they primarily avoid….or do they stay in the fight, ‘feel the fear and do it anyway’. I’ve been on both sides of the fence. When I worked and I was forced into the fray and it was good for me. When I moved and had to go to the interviews…I did it until I couldn’t take the rejection anymore. Then gave up and went back to school which has left my time wide open. Not Good. I got depressed, gained weight, and now I avoid going to the grocery store or even the MAIL BOX on days I don’t have classes. Avoidance is a Monster. Give it an inch and it takes a mile. If you identify with the feelings but haven’t fallen into its clutches, consider yourself lucky (and brave).
Lisa wrote on 11/6/07 at 8:35 am :
Im beginning to study avoidant personality disorder. I took a test at a very thorough and professional website, I had to reach back into childhood to remember how I was, and I managed to get that I have some avoidant personality problems. I am not surprised as I was extemely shy as a child to the point of ridiculousness. I also had an episode with my mother at the age of 5 where I THOUGHT she had rejected me, that has stayed with me all my life. I also have this tremendous need and urge to sing, and I can sing, but for the life of me I cannnot bring myself to sing at karaoke, and its really upsetting me, because there are so many people who suck that get up there and I can sing well, but I am fixed to my seat, and keep my mouth shut and only smile.
I will read blogs as I feel that is the best way to learn about this. I do feel though that I have kept myself back my entire life..avoided my true destiny, etc. I do not however feel that I am “inferior to others” at all.
Lisa wrote on 11/6/07 at 8:38 am :
Im curious if this is more of an emotional problem than a mental illness..
Lawrence wrote on 01/2/08 at 6:14 am :
From what I have read the main difference between
SAD and AvPD is that most persons afflicted with SAD tend to monitor and focus upon their own reactions for perceived mistakes whereas the AvPD crowd will move on to monitor and obsess over the reaction of others as well.
In short, SAD has a mostly inward focus where the individual expends most of their emotional energy
monitoring only themselves. The AvPD behaves in a similar fashion ( inward focus ) but also obsesses and monitors the reactions of others ( outward focus )
The AvPD diagnosis fits me most accurately but the bottom line IMO is that they are both severe anxiety disorders that differ little in every day experience.
Thompson wrote on 08/25/08 at 3:56 pm :
I also suffer from SAD and AvPD. If anyone is interested in cognitive therapy here is a course that you can do online which has me alot. It’s called Moodgym:
moodgym.anu.edu.au
Sorry if I am off topic but I came accross this blog while googling