If you are hypersensitive to rejection and avoid it at all costs, you might have avoidant personality disorder

• Avoidant personality disorder causes sensitivity to rejection, criticism, and embarrassment.
• It may lead to avoiding social situations, a negative self-image, and an intense fear of ridicule.
• It's usually caused by genetic factors, intense bullying at school, or early childhood trauma.

Avoidant personality order is estimated to affect about 2.4% of the U.S. population.

People with this disorder may shy away from engaging with others and experience an excessive fear of rejection, says Michele Goldman, Psy.D, a licensed clinical psychologist for the Hope for Depression Research Foundation.

Living with avoidant personality disorder can be challenging, but therapy can help address feelings of inadequacy and encourage social connection.

What is avoidant personality disorder?

Avoidant personality disorder is a type of personality disorder included in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5). It is marked by feelings of nervousness, fear, and an intense sensitivity to judgment from others.

Signs and symptoms of avoidant personality disorder include:

• Avoiding activities that involve significant interpersonal contact due to fears of criticism, rejection, or disapproval
• An unwillingness to form deep relationships with others
• Holding back on expressing emotions or thoughts within intimate relationships due to fear of rejection or ridicule
• A preoccupation with being criticized or rejected in social situations
• A narrow view of oneself as socially inept, personally unappealing, or inferior to others
• A reluctance to take personal risks or to engage in any new activities that may prove to be embarrassing

Individuals with an avoidant personality disorder might present as shy or quiet and have a negative self-image, says Paul Poulakos, MD, a board-certified psychiatrist with a private practice.

"These folks might refuse to join in group situations unless offered tremendous amounts of support and nurturance," Goldman says. "They are highly critical of themselves and withhold from others in order to avoid being shamed or ridiculed."

The causes of avoidant personality disorder

The causes of avoidant personality disorder are complex and thought to be a mix of genetic and environmental factors, Poulakos says.

Biological factors and life experiences that can contribute to this disorder include:

• A genetic predisposition to shyness and fear of strangers
• A family history of avoidant personality disorder or other personality disorders
• A family history of social anxiety disorder
• Repeated experiences of rejection from peers, such as bullying at school
• Early childhood trauma, such as emotional or physical abuse and neglect
• Experiencing frequent criticism and rejection in childhood from caregivers

Diagnosis and treatment

Avoidant personality disorder is diagnosed by a medical or mental health professional, Goldman says. Psychiatrists and psychologists who conduct these evaluations might include a specifically designed interview or another assessment tool to consider different elements of a person's personality and make the diagnosis.

It can take several sessions with a professional to receive a diagnosis because the mental health provider needs to determine a pattern of behavior that happens across multiple settings, is pervasive, and has a negative impact on your functioning, Goldman says.

The primary treatments for avoidant personality disorder include:

• Cognitive-behavioral therapy. This type of therapy addresses the thinking patterns that influence your feelings and behaviors, which can help you build the skills needed to navigate social situations and develop coping mechanisms for dealing with anxiety and stress, Goldman says.
• Medication, such as antidepressants. Medication isn't used to treat personality disorders specifically, Goldman says, but might be used alongside therapy to address symptoms of anxiety or depression that stem from an avoidant personality disorder.

Effectiveness of treatment

People with avoidant personality disorder have ingrained patterns of thinking that have existed for many years, and it can take months or even years to adequately treat symptoms.

"Treatment for personality disorders is a long process," Goldman says. "You can't expect immediate change since you did not develop avoidant personality disorder overnight."

Measuring improvement is also hard to generalize since everyone receiving treatment for avoidant personality disorder will have different skillsets and environmental barriers, Goldman says.

"Improvement [for one person] might be going to a physical social gathering while it might be maintaining eye contact for another person," she says. "Progress might seem small for some but significant in the overall process of treatment."

According to Goldman, some signs you may be improving with treatment include:

• You spend less time in social isolation
• You feel more comfortable taking personal risks
• You are more likely to spend time one-on-one with another person
• You initiate more conversations with others

Your willingness and motivation for change will have a significant impact on how well you respond to treatment, Goldman says. Those with support from friends and family also usually demonstrate greater progress in therapy.

Insider's takeaway

Avoidant personality disorder is a type of personality disorder characterized by feelings of inadequacy and fear of rejection. A family history of personality disorders as well as experiencing rejection from caregivers or peers as a child can increase your risk of developing an avoidant personality disorder.

This disorder is typically treated with therapy and sometimes medication, but it can take months or years to see improvement in symptoms.

"As with many personality disorders, instilling long-term change takes a great deal of persistence and commitment," Poulakos says, "One can expect that if they put in the work, the extent to which the disorder interferes with one's daily life will drastically diminish."