Avoidant Personality Disorder and Childhood Neglect

It’s no secret that childhood experiences, especially those that involve our parents, can have a significant impact on our adult personality traits and ability to form and sustain connections. For people diagnosed with avoidant personality disorder, interpersonal relationships can be very tough to navigate. What is the link, if any, between events that occur during our formative years and the way in which we relate to others later in life?

First, it’s important to understand the basics of avoidant personality disorder. While most people may occasionally worry that others don’t like them, someone with avoidant personality disorder lives with a deeply ingrained sense of inadequacy. They will go out of their way to avoid situations in which they feel they will be judged, from social events to work-related ones, according to the Cleveland Clinic. They may skip parties where they will be exposed to new people out of fear that strangers will think they’re socially awkward, and they may even turn down job promotions because they can’t bear to have coworkers think they don’t have the ability to handle new responsibilities.

It may be that childhood trauma directly causes personality disorder in adults. But can the disorder always be traced to absent or neglectful parenting?

“The jury’s still out,” says Roberto Sanchez, PsyD, clinical director of a counseling center in Miami. “It doesn’t have to be that a person has had a specific childhood event.”

While there are a number of cases that can be traced back to experiences during the early years, Sanchez believes much also depends on whether someone is genetically predisposed to have the disorder.

For instance, avoidant personality disorder is more common in people who are anxious and tend toward depression. Parental emotional neglect certainly can play a part in exacerbating these issues, and sexual and physical abuse also can give rise to the disorder.

“Particularly if there’s parental discord and the child is put between the parents, you’re going to see this type of disorder more frequently,” he noted.

Parents who are themselves in distress may knowingly or unwittingly reject and marginalize a child, not allowing them to be validated. The result?

“The child pulls back from everyone because their initial relationships are so painful,” Sanchez says.

Adults with avoidant personality disorder do have a desire to be near people, but their anxiety overrides that urge because they’re so afraid of getting hurt—and they flee when intimacy or conflict begin to develop.

But while avoidant personality disorder occurs in people whose parents are abusive and neglectful, it also shows up in people whose parents are loving and involved. Even “good” parents can have children with the disorder if there’s an inborn tendency toward it.

The American Psychological Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) advises at least four of these criteria need to be present to indicate avoidant personality disorder:

• At work, avoiding people and interpersonal contact due to a fear of rejection.

• Not pursuing a relationship with someone unless you’re sure they like you.

• Obsessing about whether people like you.

• Perceiving yourself as inadequate or socially inferior.

• Clamming up when around people because they might ridicule what you say.

• Being hypersensitive to criticism.

• Not taking risks or trying anything new because of potential embarrassment.

Symptoms must begin by early adulthood and be persistent in order to be classified as avoidant personality disorder.

Avoidant personality disorder is not the same as avoidant-dismissive attachment style, a personality trait that according to the APA involves a person having a positive view of and high expectations of themselves (not so much of others) and a high degree of independence. A person with avoidant personality disorder, by contrast, harbors intense feelings of inferiority, which is at the heart of their avoidance of other people.

Avoidant personality disorder has some overlap with two other disorders: social anxiety disorder and schizoid personality disorder. A trained clinician can help distinguish between avoidant personality disorder and another disorder.

Social Anxiety Disorder

Although the difference is subtle, social anxiety disorder tends to be more specific to a particular situation, such as speaking in public or getting up on stage, while avoidant personality disorder sufferers may experience more persistent anxiety and avoidance. Social anxiety disorder often occurs along with avoidant personality disorder.

Schizoid Personality Disorder

This condition also involves social isolation. The difference is that people with schizoid personality disorder are uninterested in other people. People with avoidant personality disorder want connection with others but isolate themselves due to excessive fear of rejection or criticism.

The therapist’s job is to establish trust and rapport by clearly explaining treatment protocols such as psychotherapy and cognitive behavioral therapy, which has proven effective for most psychological disorders.

Patients with avoidant personality disorder typically are “shut down” socially, according to Sanchez. They are typically shy and exhibit social and relationship anxiety. Because past relationships are likely to have been damaged by their isolating behavior, the goal is to allow the patient to gain insight and discover that they can, in fact, have a healthy relationship, often beginning with the therapist.

Overcoming childhood emotional traumas and neglect can be done, but it takes work.

“If it’s just a straight avoidant personality disorder, success rates are going to be high,” Sanchez says. These patients “do well if they’re consistent in treatment.”

Treatment can take 18 months or more, although it doesn’t necessarily need to stretch on to years, Sanchez says. However, not everyone with avoidant personality disorder suffers from only that condition; people with the disorder often have other issues such as severe generalized anxiety disorder or panic disorder, which can make recovery tougher.

Studies show that avoidant personality disorder also is associated with substance abuse, another possible hurdle to overcome in treatment.

In addition to cognitive behavioral therapy, supportive psychotherapy, and psychodynamic therapy (in which underlying conflicts are addressed), people with avoidant personality disorder may benefit from anti-anxiety drugs and antidepressants such as selective serotonin reuptake inhibitors (SSRIs).