Avoidant personality disorder is similar in many ways to social anxiety disorder. But what’s really at the root of this mental health condition?

It turns out that temperament may be a key cause of avoidant personality disorder.

In addition, both environmental and genetic factors could influence which temperaments are more likely to lead to avoidant personality disorder.

Avoidant personality disorder involves a strong fear of rejection, criticism, or embarrassment that makes you avoid social situations and taking risks.

People with avoidant personality disorder tend to have low self-esteem. You might feel like you miss out on many aspects of life — like job opportunities or relationships — because of it.

Just because you have avoidant personality disorder doesn’t mean you don’t value connection. Still, it’s common for people with this condition to have few connections outside of a small group of trusted people.

Avoidant personality disorder is a cluster C personality disorder. Around 1.5 to 2.5% of people could be living with avoidant personality disorder.

Although avoidant personality disorder is one of the most often diagnosed personality disorders, there’s not a lot of research about it.

Meanwhile, there’s a lot of research on social anxiety disorder, which has a lot in common with avoidant personality disorder. Some experts used to think that avoidant personality disorder only occurred in people with social anxiety disorder.

While there is a lot of overlap between the two — anywhere from 16 to 57% — this isn’t always the case. A social anxiety disorder diagnosis isn’t always the best fit for someone with avoidant personality disorder.

A 2018 research review suggests that many people with avoidant personality disorder have a history of:

  • neglect
  • abuse
  • overprotection
  • feeling rejected or unpopular with peers

The review also suggests that compared with a control group, people with avoidant personality disorder are more likely to view their parents as:

  • less affectionate
  • more rejecting
  • guilt-tripping
  • less encouraging of achievement

But how could parenting contribute to avoidant personality disorder?

When negative experiences with your parents are the norm in childhood, it can cause you to expect unpleasant interactions with others, too. Avoidance then becomes a coping strategy. And over time, this can easily become your go-to strategy.

In a 2015 study, researchers asked 411 adults to complete a survey on their mental health symptoms and childhood experiences.

The researchers found that people with symptoms of avoidant personality disorder also had:

  • depression and anxiety symptoms
  • been mistreated in childhood
  • been teased in childhood
  • overprotective parents

Older research shows that adults with avoidant personality disorder reported lower athletic performance in childhood. They also reported less popularity in their teen years than people with other personality disorders.

In addition, people with avoidant personality disorder reported more experiences of physical and emotional abuse. But other factors (like co-occurring conditions) could have influenced this finding.

Genetics are important when it comes to causing avoidant personality disorder, especially because they can influence temperament.

Since avoidant personality disorder overlaps with social anxiety disorder in a lot of ways, researchers have asked: How many genetic and environmental risk factors do these conditions have in common?

We’ve been able to shed light on some key genetic factors that could cause avoidant personality disorder.

For example, a 2015 twin study found temperamental traits that impact social interaction — like inhibition, or the tendency to stand back in new situations — were common in people with avoidant personality disorder.

And one difference between the conditions is that while anxiety is front and center when it comes to social anxiety disorder, avoidant behaviors are more closely tied to avoidant personality disorder.

In addition, a 2019 twin study found that avoidant personality disorder was connected to the genetic personality trait detachment.

Older research has also linked temperament in childhood to avoidant personality in adulthood. For example:

  • Children who were withdrawn had higher chances of having avoidant personality disorder symptoms as adults.
  • Children with “low ego resiliency,” or kids who had a harder time dealing with change, had higher chances of developing avoidant personality disorder.

But while genes are thought to influence temperament, it’s very possible that environment also played a role in some instances where children were withdrawn.

So, while there’s likely a strong genetic cause for avoidant personality disorder, researchers are still untangling where genetic causes end and environmental causes begin.

Attachment style could connect temperament, childhood experiences, and personality disorders.

Attachment starts in childhood as the bond between you and your primary caregiver. If you’re raised by parents who aren’t there for you emotionally, you might be more likely to have the anxious/avoidant attachment style.

And having an anxious/avoidant attachment style is linked to avoidant personality disorder.

People with this attachment style tend to report that their parents didn’t often express love or affection. Your parents might have been around physically, but felt distant when you reached out to them for closeness or support.

Adults with anxious/avoidant attachment are usually very independent. While they may have some friends, they tend to close themselves off as soon as the relationship becomes more serious and intimate.

People with an avoidant attachment style tend to avoid showing much emotion and affection. They may even look for reasons to cut off the relationship so they don’t have to get too close.

Evidence suggests that this attachment style is tied to a negative view of the self and a fear of close relationships.

This fearful attachment style — described as desiring intimacy while also not trusting people and fearing rejection — has been found to be common in people with avoidant personality disorder.

Like all personality disorders, avoidant personality disorder is diagnosed in adults. But many people with the condition have shown signs of shyness and inhibition throughout childhood.

Still, clinicians don’t diagnose avoidant personality disorder in childhood. This is because some of the symptoms are too close to typical childhood behaviors.

Avoidant personality disorder is a cluster C personality disorder. This cluster is characterized by anxious, fearful thinking and behaviors.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a diagnosis of avoidant personality disorder could apply if you show at least four of the following:

  • In your job, you avoid tasks that involve other people due to fears of rejection, criticism, or disapproval.
  • You don’t want to approach or talk with someone unless you’re 100% sure they like you.
  • You hold back in close relationships out of fear of being shamed or made fun of.
  • You’re often worried about being criticized or rejected.
  • You hold back in social settings due to feelings of inadequacy.
  • You feel socially awkward or less-than compared to others.
  • You avoid risks or doing new things out of fear of being embarrassed.

Therapy is one of the key ways to manage avoidant personality disorder. Research suggests the following therapy approaches could help:

  • Cognitive behavioral therapy (CBT) helps you identify and manage unhelpful thoughts and behaviors.
  • Metacognitive interpersonal therapy is an approach for personality disorders related to avoidance and inhibition.
  • Emotion-focused therapy (EFT) is based on attachment science. It’s often used with couples but can also help individuals.
  • Combo of acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT). ACT aims to promote psychological flexibility. DBT is helpful for mood disorders, suicidal ideation, and self-harm behaviors.
  • Interpersonal psychotherapy (IPT) is designed to help people with mood disorders improve their relationships.
  • Short-term dynamic psychotherapy is designed to help you deal with overwhelming or painful feelings.
  • Schema therapy combines elements of CBT, psychoanalysis, attachment theory, and emotion-focused therapy.

These approaches are meant to target some of the core issues related to avoidant personality disorder. It’s still not clear which type of therapy is the most effective.

You can learn more about managing avoidant personality disorder here.

If you think you might be living with avoidant personality disorder, support is available.

One common first step is finding a good therapist who can help you work through any feelings of anxiety, low self-esteem, and avoidant behaviors.

There are also many resources, from books and podcasts to forums and support groups.

While avoidant personality disorder can make life feel lonely, the right resources can support you in connecting with others.