Classification Classification of personality disorders differs significantly between the two most prominent frameworks for
classification of mental disorders, namely: the
Diagnostic and Statistical Manual of Mental Disorders and the
International Classification of Diseases, the most recent editions of which are the
DSM-5-TR and
ICD-11, respectively. While personality disorders, including AvPD, are diagnosed as separate entities in the DSM-5; in the
ICD-11 classification of personality disorders, they are assessed in terms of severity levels, with trait and pattern specifiers serving to characterize the particular style of pathology. There is also a hybrid model, called the
Alternative DSM-5 model for personality disorders (AMPD), which defines AvPD and five other PDs through disorder-specific combinations of pathological traits and areas of overall impairment. AvPD is described as "[a] pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation",
operationalized through seven criteria, at least four of which must be met. This system of classification has several limitations, such as each category capturing a
heterogeneous set of presentations. – in terms of a description of the disorder; the characteristic manner in which the disorder impacts personality functioning, i.e. identity, self-direction, empathy and intimacy (criterion A); as well as a listing and description of the pathological
personality traits associated with the disorder (criterion B). At least two of the elements of personality functioning must have a "moderate or greater impairment", manifesting in, for example, the following being true for the identity domain: "[l]ow self-esteem associated with self-appraisal as socially inept, personally unappealing, or inferior; excessive feelings of shame". Severity is assessed based on the pervasiveness of impairment in several areas of functioning, as well as on the level of distress and harm caused by the disorder, while trait and pattern specifiers are used for recording the manner in which the disturbance is manifested. PD diagnoses. In contrast to social anxiety disorder, a diagnosis of avoidant personality disorder (AvPD) also requires that the
general criteria for a personality disorder be met. It is contended by some that they are merely different conceptualizations of the same disorder, where avoidant personality disorder may represent the more severe form. In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalized social phobia alone. Another difference is that social phobia is the
fear of social circumstances whereas AvPD is better described as an
aversion to intimacy in relationships. Another personality disorder diagnosis could be more suitable for a presentation considered for a diagnosis of AvPD; however, these can also be diagnosed alongside AvPD, provided that the requirements for diagnosis are met for all of them (see ). Specific features may indicate which diagnosis of several is the most suitable.
Social isolation is also a prominent feature of
schizoid and
schizotypal PDs; the significant difference between these and AvPD is that people with the former disorders may not experience discomfort stemming from it, whereas people with AvPD are likely to suffer from this isolation. Moreover, there are differences in what gives rise to the "feelings of inadequacy, hypersensitivity to criticism, and [...] need for reassurance" that AvPD shares with
dependent personality disorder; while people with the former disorder worry excessively about being rejected and humiliated, those with the latter disorder experience a need of nurturance. Lastly, "reluctance to confide in others", which is also a feature of paranoid PD, "is attributable more to a fear of being embarrassed or being found inadequate than to a fear of others' malicious intent", as in the latter disorder. Avoidant personality disorder must also be differentiated from
autism spectrum disorder.
Subtypes Millon's subtypes Psychologist
Theodore Millon notes that because most patients present a mixed picture of symptoms, their personality disorder tends to be a blend of a major personality disorder type with one or more secondary personality disorder types. He identified four adult subtypes of avoidant personality disorder.
Others In 1993,
Lynn E. Alden and
Martha J. Capreol proposed two other subtypes of avoidant personality disorder: ==Treatment==