APD and SAD Differences and Treatments

APD shares similarities with SAD.
People with APD may resemble those with SAD. Getty / Fadhi Muhammed / EyeEm

Avoidant personality disorder (APD) is usually first noticed in early adulthood and is present in a variety of situations. People with APD have many of the same characteristics as those with social anxiety disorder (SAD); however, the severity of the symptoms is greater.

If you have been diagnosed with avoidant personality disorder

  • you tend to have low self-esteem, strong feelings of inadequacy and a sensitivity to rejection.
  • In new social settings, you will become extremely self-conscious, shy or inhibited and will be preoccupied with being criticized or rejected.
  • You tend to view yourself as socially inept, personally unappealing or inferior to others.
  • In interpersonal relationships, you will show restraint.
  • You tend not to trust others and avoid relationships unless you are certain of being liked. Often, people with APD become socially isolated as a result of this avoidance.

Avoidant personality disorder often interferes with occupational functioning. People with the disorder will avoid work that requires interpersonal contact and are reluctant to take risks or engage in new activities.

In general, personality disorders are diagnosed when there is impairment in personality functioning (self and interpersonal), and the impairment is stable across time and situations.

People with APD also display detachment characterized by withdrawal (being reticent in social situations, avoiding social contact, failing to initiate social contact), avoidance of intimacy (avoidance of close or romantic relationships, interpersonal attachment, or intimate sexual relations), and anhedonia (lack of enjoyment or failure to engage in life's experiences; trouble experiencing pleasure or taking an interest in things).

Finally, they also experience negative affect characterized by anxiousness, nervousness, tenseness or panic, often related to social situations; worrying about past and present experiences; fear of uncertainty; and fear of being embarrassed.

Similarity to SAD

Research has found few differences between the kinds of symptoms that people with social anxiety disorder and APD have.

Because of the similarities between social anxiety disorder and avoidant personality disorder, people are often diagnosed as having both disorders (estimated between 16 to 57% of the time).

Like SAD, the central fear of people with APD is rejection, ridicule and humiliation by others. However, people with avoidant personality disorder have a broader range of symptoms, and the symptoms are more severe. In this way, APD has more to do with a person's personality and may appear more stable over time and from one situation to another, while SAD tends to separate itself from the personality, may come and go depending on the situation, and may be easier to change or treat.

Genetic Basis

A twin study conducted in 2007 found that those with social anxiety disorder and APD had the same underlying genetic vulnerabilities. These findings indicated that environmental factors may play a role in determining who develops social anxiety disorder versus avoidant personality disorder. For example, a critical or ridiculing parent may instill lifelong feelings of inadequacy that could push what might otherwise be SAD into the more severe APD. In addition, APD might evolve from an earlier untreated case of SAD.

Treatment of APD

APD is treated in much the same way as social anxiety disorder.

Each of the following has been shown to have some impact on the disorder:

However, it is sometimes difficult for people with avoidant personality disorder to trust their therapist enough to complete treatment. This is true of many personality disorders, as lack of trust, paranoia, and inability to see reality clearly become interfering issues during treatment.

Indeed, trust may be one of the more important defining factors between SAD and APD. While those with SAD tend to fear judgment by others, those with APD go so far as to be wary and distrustful of the motives of others—a characteristic shared by other personality disorders grouped on Axis II in the classification of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

A Word From Verywell

If you believe you or someone you know may be suffering with the symptoms of APD or SAD, speak to a professional as soon as possible. If left untreated, avoidant personality disorder can lead to impairment in functioning in most areas of a person’s life.

Sources:

Cox BJ, Pagura J, Stein MB, Sareen J. The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey. Depress Anxiety. 2009;26:354-362.

Hales RE, Yudofsky, SC. (Eds). The American Psychiatry Publishing Textbook of Clinical Psychiatry. Washington, DC: American Psychiatric; 2003.

Hummelen B, Wilberg T, Pederson G, Karterud S. The relationship between avoidant personality disorder and social phobia. Comprehensive Psychiatry. 2007;48(4):348-356.

Reich J. Avoidant personality disorder and its relationship to social phobia. Curr Psychiatry Rep. 2009;11:89-93.

Reichborn-Kjennerud T, Czajkowski N, Torgersen S et al. The relationship between avoidant personality disorder and social phobia: a population-based twin study. Am J Psychiatry. 2007;164:1722-8.

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