Is avoidant disorder part of the social phobia spectrum in a referred sample of Brazilian children and adolescents?

Abstract

The diagnosis of avoidant disorder was deleted from the Diagnostic and Statistical Manual of Mental disorders -fourth edition (DSM-IV) based on a 'committee decision' suggesting that avoidant disorder is part of the social phobia spectrum. The objective of the present study was to examine the nature of this clinical association in a referred sample of Brazilian children and adolescents. We assessed a referred sample of 375 youths using semi-structured diagnostic interview methodology. Demographic (age at admission to the study and sex) and clinical (level of impairment, age at onset of symptoms and pattern of comorbidity) data were assessed in subsamples of children with avoidant disorder (N = 7), social phobia (N = 26), and comorbidity between both disorders (N = 24). Although a significant difference in the male/female ratio was detected among groups (P = 0.03), none of the other clinical variables differed significantly among subjects that presented each condition separately or in combination. Most of the children with avoidant disorder fulfilled criteria for social phobia. Thus, our findings support the validity of the conceptualization of avoidant disorder as part of the social phobia spectrum in a clinical sample.

Social anxiety disorders in clinical practice: differentiating social phobia from avoidant personality disorder

“…The earliest awareness of such feelings is consistently reported as being around the age of 5-6 years; an even younger age was reported from a small study of adolescents in which the median age at onset was 36 months (compared to a median age at onset of SAD symptoms of 66 months). 13 In contrast, most patients with SAD report that their problems began in high school, with a mean age at onset of around 13 years. 25,26 A third key feature from a clinical perspective relates to the conceptualisation of rejection.…”

“…10 Similar results have been reported from an outpatient sample, 11 although there is some support for an earlier age at onset for AVPD. 12,13 The failure of some studies to find more severe distress and impairment in samples with AVPD without comorbid SAD suggests the possibility that it may not simply be a more severe variant of SAD.…”