674 Personality Disorders
“lonely,” and “isolated.” The major problems associated with this disorder occur in social
and occupational functi oning. The low self-esteem and hy persensitivity to rejection are
associated with restricted in terpersonal contacts. These individuals may become relatively
isolated and usually do not have a large social support ne twork that can help them weather
crises. They desire affection and acceptance and may fantasize about idealized relation-
ships with others. The avoidant behaviors can also adversely affect occupational function-
ing because these individuals try to avoid the types of social situations that may be
important for meeting the basic dema nds of the job or for advancement.
Other disorders that are commonly diagnosed with avoidant personality disorder in-
clude depressive, bipolar, and anxiety disorders,  especially social anxiety disorder (social
phobia). Avoidant personality disorder is often diagnosed with dependent personality
disorder, because individuals with avoidant pe rsonality disorder become very attached to
and dependent on those few other people wi th whom they are friends. Avoidant per-
sonality disorder also tends to  be diagnosed with borderline personality disorder and with
the Cluster A personality disorders (i.e., paranoid, schizoid, or schizotypal personality
disorders).
Prevalence
Data from the 2001–2002 National Epidemio logic Survey on Alcohol and Related Condi-
tions suggest a prevalence of about 2.4% for avoidant personality disorder.
Development and Course
The avoidant behavior often st arts in infancy or childhood with shyness, isolation, and
fear of strangers and new situations. Although  shyness in childhood is a common precur-
sor of avoidant personality disorder, in most individuals it tends to gradually dissipate as
they get older. In contrast, individuals who go on  to develop avoidant personality disor-