Rewritten Criteria for Avoidant Personality Disorder
An alternative set of criteria for avoidant personality disorder, written by a person with avoidant personality disorder.
These criteria were written with the intention of reflecting a community-based understanding of avoidant personality disorder which focuses on the internal experiences of the individual, rather than a psychiatry-based understanding focused on external presentation.
Disclaimer: The creator of the criteria listed here is not a medical or mental health professional. The criteria listed here are not official or institutionally recognized. Anyone who uses them as a self-evaluation tool should do so with the understanding that they are not official or written by an expert.
If you have questions about the criteria, or want to provide feedback to improve the criteria, contact @avpdpossum.
Section I
Must have ALL of the following
- View of self as inadequate, socially inept, personally unappealing, incompetent, inferior to others, or otherwise "wrong" in some way.
- Prominent fear of negative evaluation (i.e. being criticized, embarrassed, disapproved of, rejected).
- General life dissatisfaction associated with the perceived presence of negative evaluation.
- Hypervigilance to possible signs of negative evaluation. Tendency to perceive neutral or even positive responses as negative. May have difficulty paying attention to the situation at hand due to a preoccupation with searching for and preventing such signs.
- Heightened emotional sensitivity to perceived negative evaluation. Intense emotional distress/dysregulation upon experiencing perceived negative evaluation, characterized primarily by feelings of shame and potentially activating a fight/flight/freeze/fawn arousal response.
Section II
Must have TWO or more of the following, one of which MUST be the first item
- Social avoidance (e.g. belief that people are typically critical and disapproving, leading to a refusal to interact without repeated assurance that there will be no negative evaluation; inhibition in social situations and/or intimate relationships due to feelings of inadequacy and fear of negative evaluation; refusal to be the first to initiate contact; delayed responding to others' messages)
- Behavioral avoidance (e.g. reluctance to take personal risks or engage in new activities because they may prove embarrassing; reluctance to take part in academic and/or occupational activities because they may lead to negative evaluation, to the detriment of one's academic or occupational career; restrictions in lifestyle due to a need for physical security)
- Mental avoidance (e.g. frantic attempts to distract self from painful and otherwise negative thoughts/emotions; difficulty identifying own emotions; difficulty putting thought processes into words; sense of being separated from own thoughts/emotions, especially positive ones; intellectualization of emotions)
Section III
Must have FOUR or more of the following
- Inability to fully engage in and enjoy positive experiences; sense of being distant, numb, distracted, or otherwise not entirely engaged at times when engagement and positive emotions would be expected.
- Chronic feelings of tenseness and apprehension, often with especially intense anxiety and panic in response to social situations.
- Preoccupation with everything that could go wrong in a given situation and the negative effects it could have; exaggeration of an activity or event's potential danger.
- Fear of flaws being exposed to others (e.g. "they'll hate me once they know what I'm really like").
- Generalization of negative evaluation (e.g. "I was wrong and they corrected me, so I must be stupid"; "they didn't want to hang out with me, so no one could ever enjoy being around me").
- Decrease in comfort associated with increased closeness in relationships (e.g. the closer a relationship becomes, the less comfortable it feels; the more frequently a person is encountered, the more feared/avoided they are).
- Intense longing for connection with other people, coupled with an inability to initiate and/or sustain such a connection.
- Discomfort and distress even when alone, typically due to preoccupation with past or future negative evaluation and/or negative self-concept leading to negative self-evaluation.
Section IV
Must have ALL of the following
- The traits must be present by early adulthood (i.e. approximately 18 years or earlier).
- The traits must be present in a variety of contexts (e.g. alone, at home, with intimate partners, with friends, with acquaintances, with strangers, at work, at school).
- The traits must be relatively stable across time and consistent across situations.
- The traits must be demonstrable by multiple concrete examples of times when the individual experienced/displayed them.
- The traits must not be better understood as normative for the individual's developmental stage or sociocultural background/environment.
- The traits must not be better explained by another psychiatric diagnosis, with special attention paid to anxiety disorders and other personality disorders.
- The traits must not be solely due to the direct physiological effects of a substance (e.g. recreational drugs, prescribed medication) or a general medical condition (e.g. severe head trauma).
Associated Features
Not required, but increase diagnostic confidence
- Fear of being unable to control physical expressions of emotion such as crying, blushing, or laughing.
- Described by others to be "shy", "quiet", "timid", "withdrawn", "lonely", "isolated".
- One "safe person" or a small number of "safe people" who are viewed as less threatening, more readily interacted with, and heavily depended on.
- Social isolation, with few social contacts and a small or nonexistent social support network.
- History of issues with academic or occupational settings due to avoidance behaviors getting in the way of performance in such settings.
- History of passing up or missing out on positive/desired opportunities because they could fail and were therefore avoided.
- Shy demeanor and/or fear of new people/situations since infancy or childhood.
- Sense of alienation, isolation, and/or "never fitting in" since childhood.
- Difficulty with empathy, potentially due to warped perception of others' feelings and/or issues connecting to others.
- Development of a set of "rules" for conduct in social situations (e.g. not speaking unless spoken to, not singing or dancing around others, not mentioning certain interests or opinions).
- Reliance on fantasies to fulfill needs that are otherwise unmet, especially reliance on fantasies about idealized relationships to fulfill need for social connection.
- Engagement in forms of escapism other than fantasizing (e.g. heavy consumption of fictional media).
- Use of hostile behavior as a way to cut off interactions and create distance from others.
- Insistence on doing things independently, even when asking for help is warranted.
- Obliviousness to positive social cues (e.g. flirting) despite acute awareness of negative social cues.
- Difficulty taking compliments and/or discomfort caused by being complimented.
- Idealization of other people, potentially to an unrealistic degree.