Avoidant personality disorder: symptoms, causes and treatment

The NHS says symptoms vary depending on the type of personality disorder. For avoidant personality disorder, Rethink Mental Illness describes the following experiences. These are long-standing patterns rather than reactions to a particular event or period of stress.

NHS inform also lists other symptoms that can occur across personality disorders, including avoiding other people, being overwhelmed with feelings like anxiety or distress, feeling empty, and difficulty maintaining stable and close relationships. The NHS adds that someone with a personality disorder may also have other mental health problems, such as depression and drug addiction.

• Feeling anxious, tense, insecure and inferior.

• Feeling uncomfortable in social situations.

• Not liking criticism, and worrying a lot.

• Having low self-esteem.

• Wanting affection but worrying that you will be rejected.

Rethink Mental Illness explains that everyone has different ways of thinking, feeling and behaving, which make up our personality traits, and that these sit along a scale. Everyone feels emotional, gets jealous or wants to be liked at times. If these traits cause significant problems for you and others, you may be diagnosed as having a personality disorder, which can affect your emotions, how you cope with life and how you manage relationships.

Under the DSM-5 classification, Rethink says avoidant personality disorder is one of the group C personality disorders, whose shared theme is strong feelings of fear or anxiety (the others are dependent and obsessive-compulsive personality disorder). The ICD-11 no longer diagnoses separate types, but rates a personality disorder as mild, moderate or severe with trait patterns, and the NHS notes that diagnosis is changing in this direction.

Research cited by Rethink suggests around 1 in 20 people live with a personality disorder.

Avoidant personality disorder and social anxiety disorder share a great deal, and the same person can have both. The NHS says social anxiety is more than shyness: it is a fear that does not go away and affects everyday activities, self confidence, relationships and work or school life. The table sets out how the sources describe each, but only a professional assessment can tell them apart.

The NHS says it is not clear exactly what causes personality disorders, but they are thought to result from a combination of the genes a person inherits and early environmental influences, for example a distressing childhood experience such as abuse or neglect. NHS inform similarly says personality disorders may be connected to genetics and upbringing, and that severe distress or fear during childhood can contribute.

Rethink adds that many people diagnosed with personality disorders have experience of trauma, but that not everyone who experiences trauma will develop one.

Rethink says only a psychiatrist can diagnose a personality disorder, and you can see your GP to begin with. A GP might refer you to an NHS personality disorder team or an NHS community mental health team, where psychiatrists work. NHS inform says diagnoses are made by specialist mental health services after a GP referral.

The assessment is a conversation about your symptoms and experiences, feelings, thoughts and actions, physical health, relationships, use of drugs or alcohol and past experiences. Rethink stresses it is not a test or exam, and that being open helps the psychiatrist reach the right diagnosis. They will also look at whether physical health concerns could be causing the symptoms.

The NHS says treatment for a personality disorder usually involves a talking therapy, and can also include other types of therapy and medicine. Treatment can last several months or years depending on the severity and other problems. Rethink says therapy is usually long term and often involves some group therapy, and that you and your doctor or healthcare team should agree a treatment plan that works best for you.

Rethink describes several types of talking therapy that may be offered, including dialectical behaviour therapy (DBT), cognitive analytic therapy (CAT), mentalisation-based therapy (MBT) and psychodynamic therapy. It notes that NICE only has guidelines for borderline and antisocial personality disorder, so the choice of therapy for avoidant personality disorder depends on the clinicians and what is available locally.

The NHS says therapeutic communities, where people visit or stay for intensive group therapy over weeks or months, may be offered to some people. Rethink says there is no recommended medication for personality disorders, but a doctor may offer medicine for symptoms such as anxiety, low mood or psychosis, and should explain how it should help and its side effects.

See a GP if feelings of anxiety, avoidance or low self-worth are taking over daily life. The NHS says that for personality disorders you will usually need a GP to refer you for talking therapies.

The NHS says to get advice from 111 or an urgent GP appointment if you need urgent help for your mental health, and you can call 111 and select the mental health option. Call 999 or go to A&E now if someone's life is at risk, or if you do not feel you can keep yourself or someone else safe. The NHS also points to Samaritans, a free listening service.

The NHS says many people with a personality disorder recover over time, and that there is no single approach that suits everyone. Having a personality disorder can have a big effect on the person's life and on family and friends, but support is available. The NHS points to Mind, Rethink Mental Illness and the Royal College of Psychiatrists for information, and says a GP can help you find support groups.

NHS inform also offers self-help guides for anxiety, problem solving and self-esteem. If you are pregnant or have recently had a baby, the NHS says you may need extra support and can speak to a GP, midwife or health visitor.

On the NHS, access is usually through a GP referral to a community mental health team or a specialist personality disorder service where one exists locally. Availability varies by area, and therapy is often long term.

Some people choose private psychological therapy to start sooner. It is sensible to check that the therapist is registered with a recognised professional body and has experience of long-standing relationship and anxiety difficulties, and to tell your GP so that care is joined up. A diagnosis of personality disorder still requires assessment by a psychiatrist.