Individuals with avoidant personality disorder avoid work activities that involve sig- nificant interpersonal contact because of fears of criticism, disapproval, or rejection (Cri- terion 1). Offers of job promotions may be declined because the new responsibilities might result in criticism from co-workers. These individuals avoid making new friends unless they are certain they will be liked and accepted without criticism (Criterion 2). Until they pass stringent tests proving the contrary, other people are assumed to be critical and dis- approving. Individuals with this disorder will not join in group activities unless there are repeated and generous offers of support and nurturance. Interpersonal intimacy is often difficult for these individuals, although they are able to establish intimate relationships when there is assurance of uncritical acceptance. They may act with restraint, have diffi- culty talking about themselves, and withhold intimate feelings for fear of being exposed, ridiculed, or shamed (Criterion 3).
Because individuals With this disorder are preoccupied with being criticized or re- jected in social situations, they may have a markedly low threshold for detecting such re- actions (Criterion 4). If someone is even slightly disapproving or critical, they may feel extremely hurt. They tend to be shy, quiet, inhibited, and “invisible" because of the fear that any attention would be degrading or rejecting. They expect that no matter what they say, others will see it as "wrong,” and so they may say nothing at all. They react strongly to subtle cues that are suggestive of mockery or derision. Despite their longing to be active participants in social life, they fear placing their welfare in the hands of others. Individuals with avoidant personality disorder are inhibited in new interpersonal situations because they feel inadequate and have low self—esteem (Criterion 5). Doubts concerning social actions with strangers. These individuals believe themselves to be socially inept, person- ally unappealing, or inferior to others (Criterion 6). They are unusually reluctant to take personal risks or to engage in any new activities because these may prove embarrassing (Criterion 7). They are prone to exaggerate the potential dangers of ordinary situations, and a restricted lifestyle may result from their need for certainty and security. Someone with this disorder may cancel a job interview for fear of being embarrassed by not dressing appropriately. Marginal somatic symptoms or other problems may become the reason for avoiding new activities.
Individuals with avoidant personality disorder often vigilantly appraise the movements and expressions of those with whom they come into contact. Their fearful and tense de- meanor may elicit ridicule and derision from others, which in turn confirms their self- doubts. These individuals are very anxious about the possibility that they will react to crit- icism with blushing or crying. They are described by others as being ”shy,” ”timid,” ”lonely,” and ”isolated." The major problems associated with this disorder occur in social and occupational functioning. The low self—esteem and hypersensitivity to rejection are associated with restricted interpersonal contacts. These individuals may become relatively crises. They desire affection and acceptance and may fantasize about idealized relation- ships with others. The avoidant behaviors can also adversely affect occupational function- ing because these individuals try to avoid the types of social situations that may be important for meeting the basic demands of the job or for advancement.
Other disorders that are commonly diagnosed with avoidant personality disorder in- clude depressive, bipolar, and anxiety disorders, especially social anxiety disorder (social phobia). Avoidant personality disorder is often diagnosed with dependent personality disorder, because individuals with avoidant personality disorder become very attached to and dependent on those few other people with whom they are friends. Avoidant per- sonality disorder also tends to be diagnosed with borderline personality disorder and with the Cluster A personality disorders (i.e., paranoid, schizoid, or schizotypal personality disorders).
Data from the 2001—2002 National Epidemiologic Survey on Alcohol and Related Condi- tions suggest a prevalence of about 2.4% for avoidant personality disorder.