Avoidant Personality Disorder

Diagnostic criteria: Social inhibition and feelings of inadequacy.

Avoidant Personality Disorder is distinguished by a pervasive pattern of social inhibition, profound feelings of inadequacy, and extreme hypersensitivity to negative eva luation.

For clinical diagnosis, this behavior must begin in early adulthood and manifest in a variety of contexts.

The core of the suffering is not a lack of desire to relate, but a paralyzing fear of rejection.

Imagine someone who systematically turns down invitations to corporate events not because he or she does not want to go, but because of the terror of saying the wrong thing and being judged by his or her superiors. At least four indicators are required to confirm the disorder.

These individuals avoid work activities that involve significant interpersonal contact for fear of criticism or disapproval.

They are reluctant to engage with people unless they are absolutely certain of being accepted, which severely restricts their social circle.

In intimate relationships, they maintain a remarkable reserve for fear of being embarrassed or ridiculed if they expose themselves emotionally.

They live constantly worried about the possibility of being rejected in social situations, feeling socially inept, unattractive or inferior to others.

In addition, they tend to be reluctant to take personal risks or to participate in new activities that may be embarrassing, showing a marked behavioral rigidity.

Differentiation with Social Phobia and Schizoid Disorder

It is critical to differentiate this disorder from other conditions with similar presentations.

It is often confused with Generalized Social Phobia due to overlapping symptoms such as avoidance of group situations.

The key distinction, although subtle, lies in motivation and severity: whereas in social anxiety the fear is usually focused on performance or embarrassment before specific acts (eating in public, speaking), in avoidance disorder the fear is deeper, linked to a global rejection of the person for who they are ("I am inadequate"), and the symptoms are more chronic and pervasive in personality structure.

On the other hand, the differentiation with Schizoid Disorder is clearer based on the desire for affiliation.

The schizoid person isolates himself because he prefers solitude and lacks interest in social ties; he is indifferent to praise or criticism.

In contrast, the individual with avoidance disorder desperately craves connection and relationships, but refrains from them because of an intense and painful fear.

Their solitude is imposed by anxiety, not chosen by preference.

Treatment: Gradual exposure and restructuring

The therapeutic approach seeks to reduce sensitivity to criticism and increase interpersonal confidence.

Since these patients fear being judged even by the therapist, building a strong and trusting therapeutic alliance is a crucial first step.

Cognitive-behavioral techniques are the treatment of choice, focusing on social skills training to improve competence in real interactions.

Gradual exposure is a powerful tool: a hierarchy of feared situations is designed (from greeting a neighbor to speaking at a meeting) and the patient is accompanied in the progressive coping of t