Borderline and Avoidant Personality Disorders

The Co-Occurrence of BPD and AVPD

Avoidance
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Borderline personality disorder (BPD) and avoidant personality disorder (AVPD) co-occur so frequently that in some samples, 43 percent to 47 percent of individuals with BPD also meet criteria for AVPD.

Understanding Avoidant Personality Disorder

AVPD is one of ten personality disorders recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It's an overwhelming and life-interfering feeling of not being good enough, fearing that others view you negatively, and being extremely shy and worried about rejection.

Symptoms of Avoidant Personality Disorder

You must have four or more signs or symptoms to be diagnosed with AVPD, which could include any of the following:

  • Avoidance of social interactions due to fears of criticism
  • Preoccupation with rejection
  • Not becoming involved in relationships with people unless you're positive they like you and holding back when you do become involved
  • Being extremely sensitive to disapproval or criticism
  • A negative attitude; for instance, seeing potential problems as worse than they actually are
  • Inhibition in unfamiliar social situations
  • Low self-worth

People with AVPD might be described as being extremely shy, socially anxious, self-conscious, and self-critical. This pattern of behavior rises to the level of a clinical disorder when it significantly interferes with your relationships, occupation, or other important areas of your life.

Borderline and Avoidant Personality Disorders Co-Occurring

The research findings of the co-occurrence of borderline and avoidant personality disorders vary depending on the characteristics of the study sample.

In a treatment sample, meaning a sample of individuals with BPD who were in treatment, 43 percent of patients with BPD also met the diagnostic criteria for AVPD. In another study that used a community sample, over 11 percent of people who met BPD criteria in their lifetime also met criteria for AVPD in their lifetime.

Why AVPD and BPD Occur Together so Frequently

We don't know why so many people with BPD also meet criteria for AVPD, but experts have speculated about two main causes for this comorbidity. First, BPD and AVPD share a key symptom: both are associated with intense fear of criticism and rejection. It may be that having this trait increases an individual's chances of meeting criteria for both disorders.

Additionally, it may be that people with BPD have such intense emotional pain in their relationships that a subset may withdraw from relationships altogether in order to reduce this pain.

Treatment for AVPD and BPD

There are currently no published clinical trials that have examined treatments for co-occurring AVPD and BPD. However, cognitive behavioral therapy (CBT) appears to be effective for the treatment of AVPD and a variation of CBT, called dialectical behavior therapy (DBT), is the BPD treatment with the strongest research support.

Another successful treatment for BPD is mentalization-based therapy (MBT), which helps you understand and recognize how both you and others are feeling apart from your or their behavior. 

A recent study concludes that borderline personality disorder rarely occurs on its own and effectively treating the BPD often helps treat the symptoms of the co-occurring disorder(s) as well.

For instance, if you have both BPD and major depressive disorder (MDD), your MDD will likely respond better to the BPD treatment than it will to antidepressants alone.  

Sources:

Biskin RS, Paris J. Comorbidities in Borderline Personality DisorderPsychiatric Times. January 9, 2013.

Choi-Kain LW, Unruh BT. Mentalization-Based Treatment; A Common-Sense Approach to Borderline Personality DisorderPsychiatric Times. March 31, 2016.

MedLine Plus. Avoidant Personality Disorder. U.S. National Library of Medicine. Updated December 5, 2017.

Tomko RL, Trull TJ, Wood PK, Sher KJ. Characteristics of Borderline Personality Disorder in a Community Sample: Comorbidity, Treatment Utilization, and General FunctioningJournal of Personality Disorders. 2014;28(5):734-750. doi:10.1521/pedi_2012_26_093.