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Avoidant Personality Disorder Diagnosis, classification and Differential Diagnosis

Avoidant Personality Disorder Diagnosis, classification and Differential Diagnosis

July 24, 2010
- Suzanne M. Sutherland, M.D.

Diagnostic Guidelines

Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

  1. markedly dysharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
  2. the abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;
  3. the abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
  4. the above manifestations always appear during childhood or adolescence and continue into adulthood;
  5. the disorder leads to considerable personal distress but this may only become apparent late in its course;
  6. the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

Avoidant Personality Disorder

For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required of the presence of at least three of the traits or behaviours given in the clinical description.

ICD-10 Criteria (Europe)

F60.6 Anxious (Avoidant) Personality Disorder

Personality disorder characterized by at least 3 of the following:

  1. persistent and pervasive feelings of tension and apprehension;
  2. belief that one is socially inept, personally unappealing, or inferior to others;
  3. excessive preoccupation with being criticized or rejected in social situations;
  4. unwillingness to become involved with people unless certain of being liked;
  5. restrictions in lifestyle because of need to have physical security;
  6. avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

The ICD-10 Classification of Mental and Behavioural Disorders
World Health Organization, Geneva, 1992

This disorder is characterized by a long-standing and complex pattern of feelings of inadequacy, extreme sensitivity to what other people think about them, and social inhibition. It typically manifests itself by early adulthood and includes a majority of the following symptoms:

    Schizophrenia

    Schizophrenia

    A common and serious mental disorder characterized by loss of contact with reality (psychosis), hallucinations (false perceptions), delusions (false beliefs), abnormal thinking

      Psychotic Disorders

      Psychotic Disorders

      Psychotic disorders are a collection of disorders in which psychosis ...

      Mood disorders

      Mood disorders

      Mood disorders are among the most common diagnoses in psychiatry ...

      Personality Disorders

      Personality Disorders

      The majority of people with a personality disorder never come ...

      Disorders of Childhood and Adolescence

      Disorders of Childhood and Adolescence

      Many disorders seen in adults can occur in children.

      Substance-Related Disorders

      Substance-Related Disorders

      Substance abuse is as common as it is costly to society...

      Cognitive Disorders

      Cognitive Disorders

      The cognitive disorders are delirium, dementia, and amnestic disorders ...

      Anxiety Disorders

      The term anxiety refers to many states in which the sufferer experiences a sense of impending threat ...

      Miscellaneous Disorders

      Miscellaneous Disorders

      Miscellaneous disorders does not refer to any official...

      Diagnostic criteria (DSM-IV-TR)

      • avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
      • is unwilling to get involved with people unless certain of being liked
      • shows restraint within intimate relationships because of the fear of being shamed or ridiculed
      • is preoccupied with being criticized or rejected in social situations
      • is inhibited in new interpersonal situations because of feelings of inadequacy
      • views self as socially inept, personally unappealing, or inferior to others
      • is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

      American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

      Differential Diagnosis

      In terms of differential diagnosis it is important to differentiate the avoidant personality disorder from Schizoid Personality Disorder, although that differential may be difficult. Essentially schizoids claim not to want any relationships and avoidant people claim to want them but to be frightened of them. Another important differential is between avoidant personality disorder and phobias of all kinds, because people who are agoraphobic, people who have simple phobias, people with social phobias, will have the same avoidant mechanisms. However, often these mechanisms are quite isolated. These are people who don't need the same kind of uncritical acceptance. These are not people who are as sensitive to perceived criticism as people with APD.

      • Panic Disorder (Anxiety Disorders)
      • Separation Anxiety and School Refusal (Anxiety Disorders)
      • Social Phobia and Selective Mutism (Anxiety Disorders)
      • Hearing Impairment
      • Depression (Mood Disorders)
      • Pervasive Developmental Disorder
      • Pervasive Developmental Disorder: Autism
      • Panic disorder with agoraphobia
      • Dependent personality disorder
      • Schizoid personality disorder
      • Communication disorders

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