Social anxiety vs. avoidant personality disorder: How can you tell them apart?
Key takeaways
Social interaction and close relationships are fundamental aspects of human nature, but they don’t come easily to everyone. For many people, the simplest social interactions can be extremely anxiety-inducing. Some people might even avoid relationships altogether for fear of rejection and getting hurt.
Two mental health disorders that cause trouble with socializing and relationships are social anxiety disorder and avoidant personality disorder. Both conditions share many features, which can make it tricky to distinguish which one you or a loved one might have.
Read on to learn about the symptoms of social anxiety disorder, and avoidant personality disorder, as well as their similarities and differences.
What is social anxiety disorder?
Social anxiety disorder, sometimes called social phobia, is an anxiety disorder revolving around social interactions. Although most people experience some anxiety in certain social situations from time to time, people with social anxiety disorder feel an intense, irrational level of anxiety that makes it extremely hard to socialize.
It’s more than just shyness as a personality trait. There’s a major fear of being judged, rejected, or embarrassed. It can affect any social interaction, ranging from going to parties, dating, eating in front of people, or even just talking to an employee in a store.
Symptoms of social anxiety disorder are emotional, physical, and behavioral.
Emotional symptoms include:
- Intense fear and anxiety surrounding social interactions
- Fear of embarrassing yourself, being judged, or getting rejected
- Feeling self-conscious and worried about how people perceive you
- Worry that other people will notice your anxiety
Physical symptoms include:
- Blushing
- Nausea
- Dizziness
- Fast heartbeat
- Trembling
- Chest pain
- Shortness of breath
- Sweating
Behavioral symptoms include:
- Trouble making eye contact with others
- Avoidance of social situations
- Difficulty talking or talking very quietly
- Missing obligations like work or school due to anxiety
- Feeling like you need to drink alcohol or consume another substance before social situations
- Rigid posture
Symptoms of social phobia can start as early as late childhood or early teen years and continue into adulthood, especially if not treated.
What is avoidant personality disorder?
If you have a personality disorder, the way you think, feel, and act cause you to have trouble functioning and cause you significant distress. In the case of avoidant personality disorder (AVPD), there are a few key distinguishing characteristics, including:
- Having ongoing social anxiety
- Hypersensitivity to criticism and fear of criticisms
- Intense fear of rejection
- Persistent feelings of inadequacy
- Desire for deep connections with others
Due to their severe social anxiety and fear of rejection, they often avoid new relationships, even though they do want to experience meaningful, close relationships. If you have AVPD, this creates a tough dynamic because while you want to connect with others, your intense fear of being judged or rejected keeps you away, and this in turn can leave you feeling isolated and lonely.
Some other signs of avoidant personality disorder
- Social inhibition (holding back in social situations)
- Trouble trusting overs
- Extreme avoidance of social situations or relationships where rejection or embarrassment could occur
- Avoiding intimate relationships for fear of getting hurt
- Intense feelings of inadequacy that go beyond poor self-esteem
Symptoms typically appear in early adulthood, but childhood experiences such as severe childhood neglect are thought to play a part in the development of the personality disorder.
Can you have both?
Yes, you can have both social anxiety disorder and avoidant personality disorder. Research has found that many people with social anxietyalso have AVPD. It’s estimated that at least 36% of people with AVPD also have social anxiety.
People with both disorders at once have more debilitating symptoms and experience more impairment in their lives.
It can be very difficult to tell the difference between these two disorders, which is why it’s so important to work with a qualified, experienced mental health professional who can provide an accurate diagnosis. They can determine if you have AVPD, social phobia, or both.
There are specific diagnostic criteria for these disorders, outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To get diagnosed with any mental health condition, you’ll have to meet a certain number of symptoms. Your provider will take your history, ask about your family history of mental health conditions, and ask about all your symptoms. From here, they’ll determine if you meet the DSM-5 criteria for a diagnosis.
Social anxiety disorder vs avoidant personality disorder: Overlap and differences
As you can see, there are many similarities between social phobia and AVPD. The main similarities include:
- Social anxiety: Both disorders involve intense social anxiety in social settings, along with a fear of being rejected, embarrassed, or judged.
- Avoidance behaviors: Individuals with both disorders tend to avoid social interactions to avoid the anxiety and distress these situations cause.
- Impact on daily life: Both disorders significantly impact day-to-day life. They can make it hard to form and maintain relationships, interact with people, and go to work or school.
- Emotional distress: Both disorders involve a high level of emotional distress related to social interactions and self-perception.
Some facets of the disorders are so similar that some experts in the field argue that AVPD is just a more extreme form of social anxiety while others argue that they are two distinct conditions.
See the chart below to see some of the differences between the disorders.
What are the treatment options?
With treatment, people with social anxiety disorder and AVPD can live less anxious, more fulfilling lives. Here’s an overview of popular treatment options for these disorders.
Social anxiety disorder treatment
A form of talk therapy called cognitive behavioral therapy (CBT) is a common treatment for social phobia. You will learn to identify unhealthy, unhelpful thought patterns that fuel your social anxiety. You’ll learn to challenge these thoughts and replace them with more realistic and positive ones to help you feel less anxious in social situations.
Exposure therapy is also important, which involves exposing yourself to triggering social situations on purpose, in a gradual way. A therapist will help you determine the best plan to do this. By doing these exposures, you’ll gain confidence, boost social skills, and learn that you can be more comfortable with social interactions. You’ll also decrease avoidance behaviors that fuel your anxiety.
Medication can also play a role in recovery. Some medications used for social anxiety are:
- Antidepressants such as Paxil (paroxetine), Zoloft (sertraline) or Effexor (venlafaxine) which are FDA-approved for social phobia
- Anti-anxiety medications such as benzodiazepines, which are typically only prescribed short-term and as-needed due to risk for physical dependence
- Beta-blockers like propranolol, prescribed off-label and as needed (off-label means prescribed for something other than it’s FDA-approved use, based on scientific studies)
Avoidant personality disorder treatment
There isn’t as much research surrounding AVPD treatment compared to social anxiety treatment treatment, however, CBT and exposure therapy can also theoretically help AVPD by addressing social anxiety, distorted thoughts, and poor self-esteem.
Another type of therapy used for personality disorders is psychodynamic therapy, which is based on the premise that your unconscious thoughts impact your behavior. This type of therapy focuses on finding the root causes of why you feel and think the way you do. By diving deep into your childhood, past experiences, and relationships, psychodynamic therapy helps you uncover the root of your avoidant behavior and how it is causing similar patterns in the present day. From there, you can develop healthier ways to view yourself and relate to others.
There isn’t any FDA-approved medication to treat AVPD. However, if you have co-occurring social anxiety disorder or any other mental health conditions, taking medications can help reduce your symptom load overall and improve general well-being.
If you think you might have social anxiety disorder or avoidant personality disorder, it’s important to get help from a mental health professional to get an accurate diagnosis and determine a treatment plan.
Looking for a psychiatrist who can help you with a diagnosis and treatment? Consider Talkiatry. We’re a national psychiatry practice that treats a variety of mental health conditions, including social anxiety disorder and avoidant personality disorder. We provide virtual, in-network services so you can get the care you need from home. To get started, complete our free online assessment to get matched with a psychiatrist.
The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.
