Social anxiety and avoidant personality disorder share some common features, but they are separate mental health conditions. Because the two conditions appear similar in many ways, it’s not uncommon for people to mistake one for the other.
Sometimes simply getting help is more important than having a specific diagnosis. But some people also find it beneficial to know what’s affecting them. In some cases, the best approach to treatment differs for separate mental health issues, so misdiagnosis can affect treatment and make it harder for a person to improve.
Social anxiety, or social phobia, is a specific type of anxiety characterized by a fear of social situations. People with social anxiety worry about embarrassing themselves in public or doing something that will cause others to judge them negatively. It’s fairly common for people to feel nervous about doing something embarrassing in public, but the feelings of fear and anxiety that occur with social phobia can become so distressing they cause difficulty at work, school, or other parts of daily life. About 75% of people with social anxiety are between the ages of 8 and 15 when diagnosed.
Avoidant personality disorder is a cluster C personality disorder. Personality disorders are a specific kind of mental health issue where patterns of thought and behavior affect daily life, and those with personality disorders often experience difficulty in professional and personal life because they have a hard time understanding other people and common situations.
Levana Slabodnick, LISW-S, a therapist in Columbus, Ohio, notices one difference between social anxiety and avoidant personality may lie in how a person views their own experience. She explains, “A fundamental difference between social anxiety disorder and avoidant personality disorder relates to how the sufferer perceives their own pain. Those with anxiety understand on a basic level that their anxiety is irrational and that the world doesn’t judge them as harshly as they judge themselves. Those with APD, on the other hand, lack this insight. They hold deep rooted feelings of insecurity and worthlessness that they believe to be factual.”
People with avoidant personality often feel socially awkward and inferior to others. They tend to be very sensitive to criticism and rejection and often avoid making friends or participating in social events unless they are sure of their welcome. Feelings of shame or self-loathing are more strongly associated with avoidant personality than social anxiety. This condition is not often diagnosed in children, though it often develops in childhood.
Avoidant Personality Disorder vs. Social Anxiety
Social anxiety and avoidant personality share an intense fear of being embarrassed or judged in social situations. People might describe a person with either condition as shy, timid, awkward, or fearful.
Fear associated with these conditions can present in many ways, such as:
- Avoiding social situations
- Avoiding interactions with strangers
- Low self-esteem
- Shyness or timidity around other people
- Isolation from others or complete social withdrawal
Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts. According to the fifth edition of the DSM, these issues are often diagnosed together and can overlap to the point where they might seem like different presentations of the same concern. But while avoidant personality typically involves patterns of avoidance in most or all areas of life, social anxiety may only involve avoidance in a few specific situations. The DSM continues to categorize them separately.
Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts.
The two issues continue to share similarities when it comes to risk factors. Genetic and environmental factors can contribute to the development of either condition. Avoidance can be a learned response. People might begin to avoid social situations after a negative experience, for example. Being shy as a child can also increase the likelihood a person will go on to develop social anxiety or avoidant personality, though being shy does not necessarily mean a person will develop either issue for certain.
Experiencing abuse, trauma, bullying, or other negative events in childhood can increase risk for both social anxiety and avoidant personality. But neglect, particularly physical neglect, is a significant risk factor for avoidant personality. A 2015 study comparing the two conditions found that having disinterested caregivers, feeling rejected by caregivers, or not having enough affection in childhood was more common in people with avoidant personality.
Certain risk factors do differ between the two conditions:
- Some research has suggested avoidant personality may be more likely when someone’s physical appearance changes after illness.
- Research suggests brain structure may contribute to anxiety. If your amygdala, which is believed to help regulate your response to fear, is very active, you may experience greater anxiety in certain situations than other people do.
- Having a parent or sibling with social anxiety makes it 2-6 times more likely a person will develop the condition, according to the DSM-5.
Should I Get Treatment for Social Anxiety or APD?
Therapy is generally recommended for both avoidant personality and social anxiety. Only a mental health professional can diagnose mental health issues. If you think you might have symptoms of either avoidant personality or social anxiety, making an appointment with a qualified therapist or counselor can be a good place to start.
Letting any potential counselors know your particular symptoms and describing your specific experience can help them decide whether they’re qualified to help you. Not every therapist has experience treating every mental health condition, but an ethical therapist will always let you know if they think another therapist might be more helpful.
Social anxiety is often treated with cognitive behavioral therapy (CBT). This therapy helps you identify thoughts that cause distress and affect you negatively. Once you identify them, you learn how to change them. You can do CBT alone, but some people find group therapy helpful.
Exposure-based CBT is a specific approach to CBT where you slowly expose yourself to feared situations. This approach often involves skills practice or role-playing techniques, both of which can help people get more comfortable interacting with others in the safe space of therapy.
According to a 2015 study, performing random acts of kindness for others led to a decrease in symptoms of social anxiety in study participants after 4 weeks.
While therapy can have great benefit, sometimes social anxiety doesn’t improve right away. If you are working with a counselor and still experience significant difficulty in your daily life, a psychiatrist may recommend medication, such as:
Anxiety medication can help relieve some symptoms of social anxiety, but it’s a good idea to continue with therapy at the same time, as therapy helps you learn how to cope with what you’re experiencing. This can have a more lasting effect on your symptoms.
Many people believe personality disorders are not treatable, but this isn’t the case. They can be difficult to treat, especially if you’ve had symptoms for a long time. But therapy can still be very helpful. People with avoidant personality often seek treatment when they experience loneliness and distress as a result of being unable to participate in social events.
Research has shown people with avoidant personality may do better in therapy if they have the support of family members.
Any kind of talking therapy can be helpful for avoidant personality. CBT is commonly used to treat this condition, but other helpful approaches include family and group therapy. Research has shown people with avoidant personality may do better in therapy if they have the support of family members. Group therapy can help people learn how to develop relationship and communication skills in a safe space, and it’s often recommended for treating personality disorders.
There’s no specific medication used to treat avoidant personality. However, antidepressants and anti-anxiety medications may help relieve some severe symptoms.
Social anxiety and avoidant personality have some similarities, and some approaches to treatment may be similar. Regardless of which condition you have, therapy can help. It’s important to reach out for help if you’re struggling with social situations. When social anxiety or avoidant personality go untreated, complications like depression, isolation, and substance abuse can develop. Some people may experience significant loneliness and distress.
Talking to a therapist can help you get a diagnosis. But you’ll also begin to learn ways to cope with the feelings you experience and explore methods of overcoming these feelings. Therapy can help you become more used to the company of others. In time, you may find it easier to participate in social situations.
If you need help finding a counselor in your area, our therapist directory is a good place to start. Remember, you aren’t alone!
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 103-110.
- Anxiety disorders. (2017, December 15). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
- Avoidant personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9761-avoidant-personality-disorder
- Eikenaes, I., Egeland, J., Hummelen, B., & Wilberg, T. (2015, March 27). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLoS One, 10(5). doi: 10.1371/journal.pone.0122846
- Kvarnstorm, E. (2016, April 6). Avoidant personality disorder goes beyond social anxiety. Bridges to Recovery. Retrieved from https://www.bridgestorecovery.com/blog/avoidant-personality-disorder-goes-beyond-social-anxiety
- Lampe, L. (2016). Avoidant personality disorder as a social anxiety phenotype: Risk factors, associations and treatment. Current Opinion in Psychiatry, 29(1), 64-69. doi: 10.1097/YCO.0000000000000211
- Personality disorders. (2016, September 23). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
- Smith, K. (2018, November 19). Avoidant personality disorder. Retrieved from https://www.psycom.net/avoidant-personality-disorder
- Social anxiety disorder (social phobia). (2017, August 29). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
- Trew, J. L., & Alden, L. E. (2015, June 5). Kindness reduces avoidance goals in socially anxious people. Motivation and Emotion, 39(6), 892–907. Retrieved from https://link.springer.com/article/10.1007/s11031-015-9499-5
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