Personality Functioning in Patients With Avoidant Personality Disorder and Social Phobia

Abstract

Avoidant personality disorder (APD) and social phobia (SP) are closely related, such that they are suggested to represent different severity levels of one social anxiety disorder. This cross-sectional study aimed to compare patients with APD to patients with SP, with particular focus on personality dysfunction. Ninety-one adult patients were examined by diagnostic interviews and self-report measures, including the Index of Self-Esteem and the Severity Indices of Personality Problems. Patients were categorized in three groups; SP without APD (n = 20), APD without SP (n = 15), and APD with SP (n = 56). Compared to patients with SP without APD, patients with APD reported more symptom disorders, psychosocial problems, criteria of personality disorders, and personality dysfunction regarding self-esteem, identity and relational problems. These results indicate that APD involves more severe and broader areas of personality dysfunction than SP, supporting the conceptualization of APD as a personality disorder as proposed for DSM-5.

Attachment styles in patients with avoidant personality disorder compared with social phobia

“…In the study of Eikenaes et al . (), both AvPD and SP were associated with being cold, but not dominant. At present, the extent of dismissiveness in patients with SP and AvPD seems unclear and should be studied further.…”

“…As hypothesized, the AvPD group had higher scores on the Anxiety dimension than the SP group, indicating more attachment problems among patients in the AvPD group. This is in line with theoretical, clinical, and research indices showing that close relationships and intimacy are more troublesome to patients with AvPD than those with SP (American Psychiatric Association, , ; Eikenaes et al ., ; Hummelen et al ., ; Marques et al ., ; Millon, ).…”

“…Although some contradiction exists (Lampe & Sunderland, ), this choice was supported by previous findings in a large clinical PD sample (Ralevski et al ., ), and partially by the results of an epidemiological study (Cox et al ., ) as well as a clinical study by Eikenaes et al . (), suggesting that SP in subjects with AvPD does not add to the overall severity of the condition.…”

“…() found that the presence of more AvPD criteria was associated with a higher perceived risk of intimacy, lower social support, and more emotional guardedness. In addition, a previous study of the present sample (Eikenaes et al ., ) found patients with AvPD reported higher levels of relational problems compared with SP, especially regarding mistrust, intimacy, the capacity for enduring relationships, and the ability to feel recognized by others. Such indications of intimacy problems suggest that attachment difficulties could be significant for AvPD and SP, and probably most pronounced for AvPD.…”

Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study.

“…Another possibility is that the unique components of AvPD reflect a general risk factor for personality pathology, as underlying risk factors for are shared between various PDs (Kendler, Aggen, et al, 2008). Difficulties in interpersonal functioning is a hallmark feature of PDs, and such difficulties may distinguish AvPD from SAD (Eikenaes, Hummelen, Abrahamsen, Andrea, & Wilberg, 2013; Hummelen et al, 2007). Thus, akin to a pathoplastic model, it may be that one common disorder is expressed and recognized as SAD, AvPD, or both, depending on the patient’s personality traits (c.f.…”