Can Autism Lead to Avoidant Personality Misdiagnosis?

PostedNovember 13, 2025

UpdatedNovember 13, 2025

ByMy Patient Advice

Author: Beatrice Holloway, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Yes, autism vs avoidant personality disorder (AvPD) is a common diagnostic confusion, particularly in adults who present with extreme social discomfort or isolation. Both conditions can include avoidance of eye contact, reluctance to engage socially, and a strong preference for routine but the root causes differ.

For autistic individuals, these behaviours often arise from sensory overload or a need for predictability. In contrast, AvPD is driven by intense fear of rejection and feelings of inadequacy. These diagnostic similarities can lead clinicians to overlook autism, especially in people who have learned to mask traits or who were not assessed in childhood.

Shared Signs That Can Mislead Diagnosis

Both autism and AvPD involve some level of withdrawal, but context matters. Here are three areas where differences are important:

Social Avoidance

Autistic people may avoid social settings due to sensory discomfort or not understanding social rules. In AvPD, it’s more about overwhelming social anxiety and deep-rooted self-doubt.

Emotional Expression

People with autism may struggle to express emotions or read others’ cues. Those with AvPD may be more emotionally sensitive but keep it hidden due to fear of humiliation.

Communication Style

Autistic individuals often communicate in a literal or flat tone. Those with AvPD may speak hesitantly, constantly fearing judgement.

For clarity in diagnosis, a full developmental history is key. Visit providers like Autism Detect for personal consultations grounded in accurate, individualised evaluation.

For a deeper dive into the science, diagnosis, and full treatment landscape,read our complete guide to misdiagnosis and differential diagnosis.

Beatrice Holloway, MSc

Author

Beatrice Holloway is a clinical psychologist with a Master’s in Clinical Psychology and a BS in Applied Psychology. She specialises in CBT, psychological testing, and applied behaviour therapy, working with children with autism spectrum disorder (ASD), developmental delays, and learning disabilities, as well as adults with bipolar disorder, schizophrenia, anxiety, OCD, and substance use disorders. Holloway creates personalised treatment plans to support emotional regulation, social skills, and academic progress in children, and delivers evidence-based therapy to improve mental health and well-being across all ages.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.