On this page, you'll find three sets of officially published diagnostic criteria for AVPD. Two are from the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, and the third is from the International Classification of Diseases (ICD), published by the World Health Organization.
To jump to a specific section, click the corresponding link in the list below.
- DSM-5 Classic Diagnostic Criteria: These are the seven criteria you'll most likely find from a simple Google search. If you live in the US, these are also most likely the criteria a psychiatrist would use to diagnose you.
- DSM-5 Alternative Diagnostic Criteria: This alternative set of criteria is proposed in the DSM-5. It is not intended to replace the classic criteria at this time, although some people feel that it should. This set of criteria reflects the belief that personality disorders are not distinct clinical syndromes, as suggested by the classic criteria, but are actually maladaptive variants of natural personality traits which are intertwined with an individual's other personality traits; this is referred to as the "dimensional model of personality disorders".
- ICD-10 Diagnostic Criteria: While the ICD-10 is not the most recent edition of the ICD, it is the most recent edition that contains AVPD as separate disorder. In the most recent edition, the ICD-11, all personality disorders have been merged into one diagnosis, meaning there are no specific criteria for AVPD.
DSM-5 Classic Diagnostic Criteria
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:
- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
- Is unwilling to get involved with people unless certain of being liked.
- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
- Is preoccupied with being criticized or rejected in social situations.
- Is inhibited in new interpersonal situations because of feelings of inadequacy.
- Views self as socially inept, personally unappealing, or inferior to others.
- Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
This pattern...
- Is inflexible and pervasive across a broad range of personal and social situations.
- Leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Is stable and of long duration, and its onset is traced back at least to adolscence or early adulthood.
- Is not better explained as a manifestation or consequence of another mental disorder.
- Is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another mental condition (e.g. head trauma).
Associated features supporting diagnosis:
- Vigilant appraisal of the movements and expressions of others.
- Fearful and tense demeanor which elicits ridicule and derision from others, confirming pre-existing self-doubts.
- High anxiety about the possibility of reacting to criticism with crying or blushing.
- Described by others as being "shy", "timid", "lonely", and "isolated".
- Restricted interpersonal contacts; lack of a large support network to call on in times of crisis.
- Fantasies about idealized relationships with others.
DSM-5 Alternative Diagnostic Criteria
Moderate or greater impairment in personality functioning, manifest by characteristic difficulties in two or more of the following four areas:
- Identity: Low self-esteem associated with self-appraisal as socially inept, personally unappealing, or inferior; excessive feelings of shame.
- Self-direction: Unrealistic standards for behavior associated with reluctance to pursue goals, take personal risks, or engage in new activities involving interpersonal contact.
- Empathy: Preoccupation with, and sensitivity to, criticism or rejection, associated with distorted inference of others' perspectives as negative.
- Intimacy: Reluctance to get involved with people unless certain of being liked; diminished mutuality within intimate relationships because of fear of being shamed or ridiculed.
Three or more of the following four pathological personality traits, one of which must be (1) Anxiousnesss:
- Anxiousness (an aspect of Negative Affectivity): Intense feelings of nervousness, tenseness, or panic, often in reaction to social situations; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of embarrassment.
- Withdrawal (an aspect of Detachment): Reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.
- Anhedonia (an aspect of Detachment): Lack of enjoyment from, engagement in, or energy for life's experiences; deficits in the capacity to feel pleasure or take interest in things.
- Intimacy avoidance (an aspect of Detachment): Avoidance or close or romantic relationships, interpersonal attachments, and intimate sexual relationships.
General personality disorder requirements:
- The impairments in personality functioning and the individual's personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations.
- The impaurments in personality functioning and the individual's personality trait expression are relatively stable across time, with onsets that can be traced back to at least adolescence or early adulthood.
- The impairments in personality functioning and the individual's personality trait expression are not better explained by another mental disorder.
- The impairments in personality functioning and the individual's personality trait expression are not solely attributable to the physiological effects of a substance or another medical condition (e.g. severe head trauma).
- The impairments in personality functioning and the individual's personality trait expression are not better understood as normal for an individual's developmental stage or sociocultural environment.
Specifiers. Trait and level of personality functioning specifiers can be used to record additional personality features that may be present in avoidant personality disorder. For example, other Negative Affectivity traits (e.g. depressivity, separation insecurity, submissiveness, suspiciousness, hostility) are not diagnostic criteria for avoidant personality disorder but can be specified when appropriate.
ICD-10 Diagnostic Criteria
Personality disorder characterized by at least three of the following:
- Persistent and pervasive feelings of tension and apprehension;
- Belief that one is socially inept, personally unappealing, or inferior to others;
- Excessive preoccupation with being criticized or rejected in social situations;
- Unwillingness to become involved with people unless certain of being liked;
- Restrictions in lifestyle because of need to have physical security;
- Avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.
Associated features may include hypersensitivity to rejection and criticism.