Avoidant Personality Disorder in Women
The standard definition in the US for avoidant personality disorder comes from an organization called the American Psychiatric Association, which issues the "Diagnostic and Statistical Manual of Mental Disorders" (DSM), a comprehensive guide on all forms of medically defined mental illness. According to the latest version of the DSM available in 2012, doctors can issue an AvPD diagnosis for people who have at least four of seven specific symptoms. These symptoms include a preoccupying fear of social criticism and/or rejection; an abnormal reluctance to engage in any activity that can result in personal embarrassment; an abnormal reluctance to interact with people who can cause rejection or embarrassment; a self-image based on inferiority or inadequacy in relation to others; fear- or shame-based avoidance of intimate relationships; fear- or shame-based avoidance of jobs that require significant amounts of social interaction; and an inadequacy-based reluctance to make new friends.
Roughly 1 to 2 percent of all American adults have clinical symptoms of avoidant personality disorder. Unlike the approximately 40 percent of adults who have shy or introverted personalities, people with AvPD have social and/or interpersonal problems serious enough to limit active or meaningful participation in their communities. In severe cases, the effects of the disorder may trigger extreme forms of social withdrawal and more or less complete social isolation. Adults with AvPD commonly come from the 10 percent of toddlers who show a habitual tendency to withdraw from unfamiliar situations, people, or surroundings. While no one knows for sure why avoidant personality traits occur, potential underlying causes include genetic predisposition, abnormal function in a part of the brain called the amygdala, and abnormal levels of an important brain chemical called dopamine.
Equal Effects on Women and Men
As stated previously, most research indicates that roughly equal numbers of women and men develop AvPD. One prominent exception to these findings is a 2007 study published in the journal "Psychological Medicine," which indicates that women can develop the disorder about 75 percent more frequently than men. In addition, teenage girls may show slightly higher tendencies toward avoidant personality traits than teenage boys. However, teenagers as a whole are still developing their personalities, and no one can really tell if any particular traits that appear during adolescence will continue into adulthood. For this reason, doctors typically avoid making an AvPD diagnosis (or a diagnosis for any other type of personality disorder) in teenagers of either gender, even when teens have symptoms identical to those that occur in adults.
Certain other psychiatric disorders frequently appear in women and men who have AvPD. They include borderline personality disorder (BPD), a condition marked by impulsive behaviors and extreme mood swings; major depressive disorder, a condition marked by debilitating feelings of sadness, helplessness or similar emotional states; social phobia, a condition marked by symptoms of extreme self-consciousness and debilitating anxiety that occur during normally harmless social situations; and dependent personality disorder, a condition marked by an excessive or debilitating reliance on the judgments or decision-making abilities of others. In addition, people with avoidant personality disorder also frequently develop abusive patterns of drug and/or alcohol use. When any of these problems occur in people with AvPD, they can produce worse overall health outcomes than they would on their own. Doctors and researchers refer to this intensifying relationship between two or more conditions as a comorbid relationship.
In 2013, the American Psychiatric Association will make changes in the definition of AvPD that focus more tightly on specific ways in which the condition can cause impairments to personal and interpersonal function, as well as on ways in which the condition can create pathological (disease-producing) changes in an individual's personality. Importantly, the new definition will also help doctors distinguish the effects of an avoidant personality from other conditions or behaviors that can produce similar real-world symptoms.