Personality Disorder Characterized by Anxious or Fearful Behavior: Avoidant, Schizotypal


Avoidant Personality Disorder.

Anxious (Avoidant) Personality Disorder is a condition characterized by extreme shyness, feelings of inadequacy, and sensitivity to rejection. These individuals feel inferior to others. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This diagnosis should be used with great caution in children and adolescents for whom shy and avoidant behavior may be appropriate.

Avoidant personality disorder (APD) is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Individuals who meet the criteria for avoidant personality disorder are often described as being extremely shy, inhibited in new situations, and fearful of disapproval and social rejection.

Similar to other personality disorders, avoidant personality disorder becomes a major component of a person’s overall character and a central theme in an individual’s pattern of relating to others. Also similar to other personality disorders, the diagnosis is rarely made in individuals younger than 18 years, even if the criteria are met. The literature regarding childhood avoidant personality disorder is extremely limited.

Diagnostic Criteria for Avoidant Personality Disorder.

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.


  • Extreme shyness
  • Sensitivity to criticism and rejection
  • Low self-esteem and feelings of inadequacy
  • A desire for closeness with others but difficulty forming relationships with people outside of immediate family.
  • Avoidance of social situations, including those related to school or work.
  • Person avoids occupational activities
  • Person is reluctant to participate in any social involvement.
  • Person is preoccupied with criticized or rejected psychological disorders

Causes of Avoidant Personality Disorder.

The cause of avoidant personality disorder is not clearly defined, and may be influenced by a combination of social, genetic, and biological factors. Avoidant personality traits typically appear in childhood, with signs of excessive shyness and fear when the child confronts new people and situations.

These characteristics are also developmentally appropriate emotions for children, however, and do not necessarily mean that a pattern of avoidant personality disorder will continue into adulthood. Many persons diagnosed with avoidant personality disorder have had painful early experiences of chronic parental criticism and rejection.

The need to bond with the rejecting parents makes the avoidant person hungry Personality Disorders for relationships but their longing gradually develops into a defensive shell of self-protection against repeated parental criticisms.

Treatment for Avoidant Personality Disorder.

1. Psychodynamically oriented therapies: These approaches are usually supportive; the therapist empathizes with the patient’s strong sense of shame and inadequacy in order to create a relationship of trust. Therapy usually moves slowly at first because persons with avoidant personality disorder are mistrustful of others.

2. Cognitive-behavioral therapy: Cognitive-behavioral therapy (CBT) may be helpful in treating individuals with avoidant personality disorder. This approach assumes that faulty thinking patterns underlie the personality disorder, and therefore focuses on changing distorted cognitive patterns by examining the validity of the assumptions behind them.

3. Group therapy: It may provide patients with avoidant personality disorder with social experiences that expose them to feedback from others in a safe, controlled environment. They may, however, be reluctant to enter group therapy due to their fear of social rejection.

4. Family and marital therapy: Family or couple therapy can be helpful for a patient who wants to break out of a family pattern that reinforces the avoidant behavior.

5.Medications: The use of monoamine oxidase inhibitors (MAOIs) has proven useful in helping patients with avoidant personality disorder to control symptoms of social unease and experience initial success.

Schizotypal Personality Disorder

American psychological association refers Schizotypal Personality Disorder as a personality disorder characterized by various oddities of thought, perception, speech, and behavior that are not severe enough to warrant a diagnosis of schizophrenia. Symptoms may include perceptual distortions, magical thinking, social isolation, vague speech without incoherence, and inadequate rapport with others due to aloofness or lack of feeling.

People with classic schizotypal personalities are apt to be loners. They feel extremely anxious in social situations, but they’re likely to blame their social failings on others. They view themselves as alien or outcast, and this isolation causes pain as they avoid relationships and the outside world. People with schizotypal personalities may ramble oddly and endlessly during a conversation.

They may dress in peculiar ways and have very strange ways of viewing the world around them. Often they believe in unusual ideas, such as the powers of ESP or a sixth sense. At times, they believe they can magically influence people’s thoughts, actions and emotions. In adolescence, signs of a schizotypal personality may begin as an increased interest in solitary activities or a high level of social anxiety.

Diagnostic Criteria for Schizotypal Personality Disorder.

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizoid personality disorder (premorbid).”


  • Incorrect interpretation of events, including feeling that external events have personal meaning
  • Indifferent thinking, beliefs or behavior
  • Belief in special powers, such as telepathy
  • Perceptual alterations, in some cases bodily illusions, including phantom pains or other distortions in the sense of touch
  • Idiosyncratic speech, such as loose or vague patterns of speaking or tendency to go off on tangents
  • Suspicious or paranoid ideas
  • Flat emotions or inappropriate emotional responses
  • Lack of close friends outside of the immediate family
  • Persistent and excessive social anxiety that doesn’t abate with time.

Schizotypal personality disorder can easily be confused with schizophrenia, a severe mental illness in which affected people lose all contact with reality (psychosis), While people with schizotypal personalities may experience brief psychotic episodes with delusions or hallucinations.

Causes of Schizotypal Personality Disorder.

The schizoid personality disorder has its roots in the family of the affected person. These families are typically emotionally reserved, have a high degree of formality, and have a communication style that is aloof and impersonal. Parents usually express inadequate amounts of affection to the child and provide insufficient amounts of emotional stimulus. This lack of stimulus during the first year of life is thought to be largely responsible for the person’s disinterest in forming close, meaningful relationships later in life.

People with schizoid personality disorder have learned to imitate the style of interpersonal relationships modeled in their families. In this environment, affected people fail to learn basic communication skills that would enable them to develop relationships and interact effectively with others. They often communicate vaguely and fragmented which generally confuse others and so they are being misunderstood.

Treatments for Schizotypal Personality Disorder.

1. Psychodynamically oriented therapies: A psychodynamic approach would typically seek to build a therapeutically trusting relationship that attempts to counter the mistrust most people with this disorder intrinsically hold. More highly functioning schizotypals who have some capacity for empathy and emotional warmth tend to have better outcomes in psychodynamic approaches to treatment.

2. Cognitive-behavioural therapy: Cognitive approaches will most likely focus on attempting to identify and alter the content of the schizotypal’s thoughts. Distortions that occur in both perception and thought processes would be addressed.. This would relax some of the social anxiety felt in most interpersonal relationships and allow for some exploration of the thought processes.

3. Interpersonal therapy: Treatment using an interpersonal approach would allow the individual with schizotypal personality disorder to remain relationally distant while he or she “warms up” to the therapist. Gradually the therapist would hope to engage the patient after becoming “safe” through lack of coercion.


David H. Barlow, V. Mark Durand. Abnormal Psychology, An Integrative Approach. (7th ed).

Millon, Theodore and Seth, Grossman. (2002). Personality Disorders In Modern Life ,John Wiley and Sons, NY

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