The avoidant behavior often starts in infancy or childhood with shyness, isolation, and fear of strangers and new situations. Although shyness in childhood is a common precur- sor of avoidant personality disorder, in most individuals it tends to gradually dissipate as they get older. In contrast, individuals who go on to develop avoidant personality disor— der may become increasingly shy and avoidant during adolescence and early adulthood, when social relationships with new people become especially important. There is some evidence that in adults, avoidant personality disorder tends to become less evident or to remit with age. This diagnosis should be used with great caution in children and adoles- cents, for whom shy and avoidant behavior may be developmentally appropriate.
There may be variation in the degree to which different cultural and ethnic groups regard diffidence and avoidance as appropriate. Moreover, avoidant behavior may be the result of problems in acculturation following immigration.
Avoidant personality disorder appears to be equally frequent in males and females.
Anxiety disorders. There appears to be a great deal of overlap between avoidant person- ality disorder and social anxiety disorder (social phobia), so much so that they may be alternative conceptualizations of the same or similar conditions. Avoidance also character- izes both avoidant personality disorder and agoraphobia, and they often co-occur.
Other personality disorders and personality traits. Other personality disorders may be confused with avoidant personality disorder because they have certain features in com- mon. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to avoidant personality dis- order, all can be diagnosed. Both avoidant personality disorder and dependent personal- ity disorder are characterized by feelings of inadequacy, hypersensitivity to criticism, and a need for reassurance. Although the primary focus of concern in avoidant personality disorder is avoidance of humiliation and rejection, in dependent personality disorder the focus is on being taken care of. However, avoidant personality disorder and dependent personality disorder are particularly likely to co—occur. Like avoidant personality disor- der, schizoid personality disorder and schizotypal personality disorder are characterized by social isolation. However, individuals with avoidant personality disorder want to have relationships with others and feel their loneliness deeply, whereas those with schizoid or schizotypal personality disorder may be content with and even prefer their social isola- tion. Paranoid personality disorder and avoidant personality disorder are both character- ized by a reluctance to confide in others. However, in avoidant personality disorder, this reluctance is attributable more to a fear of being embarrassed or being found inadequate than to a fear of others’ malicious intent.
Many individuals display avoidant personality traits. Only when these traits are in- ﬂexible, maladaptive, and persisting and cause significant functional impairment or sub- jective distress do they constitute avoidant personality disorder.
Personality change due to another medical condition. Avoidant personality disorder must be distinguished from personality change due to another medical condition, in which the traits that emerge are attributable to the effects of another medical condition on the central nervous system.
Substance use disorders. Avoidant personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.
Diagnostic Criteria 301.6 (F60.7)
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life.