Psych · General adult psychiatry — personality disorders
Avoidant personality disorder
Also known as AVPD · Anxious personality disorder · Cluster C avoidant · Avoidant PD · Socially inhibited personality
Exam-exhaustive fellowship reference on avoidant personality disorder — DSM-5-TR and ICD-11 criteria, continuum with social anxiety disorder, epidemiology, cognitive-attachment mechanisms, differentials (schizoid, ASD, depression, dependent), assessment, CBT and schema therapy, SSRI treatment of comorbidity, prognosis. FRANZCP-primary, globally tagged.
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Target exams
FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
- Suicidal ideation after rejection, job loss, or forced social humiliation — same-day risk review, means restriction, documented safety plan
- Severe isolation with self-neglect, inability to attend care, or functional collapse — escalate setting and reassess depression, substance use, ASD, medical illness
- Alcohol or benzodiazepines as the only social 'anxiolytic' — dual diagnosis, dependence risk, do not replace alcohol with unsupervised high-dose benzodiazepines
- Late-onset 'avoidant' withdrawal with weight loss, cognitive change, or neurology — exclude organic and severe mood disorders before a lifelong PD label
- Missed major depression, autism spectrum disorder, or body dysmorphic disorder while attributing all morbidity to personality
- Akathisia or marked activation after antidepressant start/titration — reassess risk and regimen immediately
Meet the patient
A 33-year-old librarian has turned down two promotions because both involved running meetings. She rehearses small talk in the mirror, apologises four times in your first five minutes together, and describes weekends spent alone "because people would see how boring I am." She is not content with this. She is lonely, and she wants in.[1][2]
The examiner's question is a single sentence: does she want connection and fear it, or does she not want it at all? Everything in this topic hangs off that distinction — and off the number four.[1][3][18]
References20ShowHide
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- [2]Weinbrecht A, Schulze L, Boettcher J, Renneberg B Avoidant Personality Disorder: a Current Review Curr Psychiatry Rep, 2016.PMID 26830887
- [3]Frandsen FW, Simonsen S, Poulsen S, Sørensen P, et al. Social anxiety disorder and avoidant personality disorder from an interpersonal perspective Psychol Psychother, 2020.PMID 30656823
- [4]Reichborn-Kjennerud T, Czajkowski N, Torgersen S, et al. The relationship between avoidant personality disorder and social phobia: a population-based twin study Am J Psychiatry, 2007.PMID 17974938
- [5]Cox BJ, Pagura J, Stein MB, Sareen J The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey Depress Anxiety, 2009.PMID 19031488
- [6]Ralevski E, Sanislow CA, Grilo CM, et al. Avoidant personality disorder and social phobia: distinct enough to be separate disorders? Acta Psychiatr Scand, 2005.PMID 16095476
- [7]Bamelis LL, Evers SM, Spinhoven P, Arntz A Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders Am J Psychiatry, 2014.PMID 24322378
- [8]Bamelis LL, Arntz A, Wetzelaer P, Verdoorn R, et al. Economic evaluation of schema therapy and clarification-oriented psychotherapy for personality disorders: a multicenter, randomized controlled trial J Clin Psychiatry, 2015.PMID 26579561
- [9]Gjerde LC, Czajkowski N, Røysamb E, Orstavik RE, et al. The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire Acta Psychiatr Scand, 2012.PMID 22486635
- [10]Lenzenweger MF, Lane MC, Loranger AW, Kessler RC DSM-IV personality disorders in the National Comorbidity Survey Replication Biol Psychiatry, 2007.PMID 17217923
- [11]Grant BF, Hasin DS, Stinson FS, Dawson DA, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions J Clin Psychiatry, 2004.PMID 15291684
- [12]Stein MB, Stein DJ Social anxiety disorder Lancet, 2008.PMID 18374843
- [13]Mayo-Wilson E, Dias S, Mavranezouli I, Kew K, Clark DM, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis Lancet Psychiatry, 2014.PMID 26361000
- [14]Katzman MA, Bleau P, Blier P, Chokka P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders BMC Psychiatry, 2014.PMID 25081580
- [15]Stein MB, Liebowitz MR, Lydiard RB, Pitts CD, et al. Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial JAMA, 1998.PMID 9728642
- [16]Van Ameringen MA, Lane RM, Walker JR, Bowen RC, et al. Sertraline treatment of generalized social phobia: a 20-week, double-blind, placebo-controlled study Am J Psychiatry, 2001.PMID 11156811
- [17]Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, et al. Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome Arch Gen Psychiatry, 1998.PMID 9862558
- [18]Lugnegård T, Hallerbäck MU, Gillberg C Personality disorders and autism spectrum disorders: what are the connections? Compr Psychiatry, 2012.PMID 21821235
- [19]Connor KM, Davidson JR, Churchill LE, Sherwood A, et al. Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale Br J Psychiatry, 2000.PMID 10827888
- [20]Blanco C, Bragdon LB, Schneier FR, Liebowitz MR The evidence-based pharmacotherapy of social anxiety disorder Int J Neuropsychopharmacol, 2013.PMID 22436306