Avoidant personality disorder

Avoidant Personality Disorder (APD). APD is virtually indistinguishable from the generalized subtype of social anxiety disorder. APD is typically diagnosed when the social inhibition pervades almost all social interaction and has been present since childhood. Some have suggested that it is, in fact, the most severe manifestation of generalized social anxiety disorder and does not warrant inclusion as a separate diagnostic entity. 

Avoidant Personality Disorder (APD) and Social Anxiety Disorder. These illnesses share the tendency toward social withdrawal and isolation with the Cluster A disorders. There is, however, a critical difference that can help make the distinction. The patient with social anxiety disorder is greatly troubled by the fact that (s)he may have so few friends or feel uncomfortable around them. (S)he would, in general, much prefer to feel more at ease in a social setting. This differs from the Cluster A personality disorders. The patient with SPD is indifferent to the fact that (s)he has few friends in fact, (s)he prefers to not have any. The patient with STPD is in a somewhat more intermediate position, feeling very anxious around others and perhaps preferring to have more friends, but also finds it easy to withdraw into a life of isolated fantasy. 

The so-called anxious disorders of Cluster C include avoidant personality disorder (APD), dependent personality disorder (DPD), and obsessive-compulsive personality disorder (OCPD). Like the Cluster A disorders, these personality disorders are typically unobtrusive and may escape clinical detection for many years. Over time, patients adapt their life styles to these illnesses by decreasing their social contacts in an effort to minimize anxiety. In so doing, they further decrease the likelihood of encountering mental health professionals. 

Avoidant Personality Disorder (APD). We generally recommend following the same pharmacological treatments for APD that are nsed for the generalized subtype of social anxiety disorder. Because APD is so pervasive, medications should be used on a daily basis as opposed to as-needed dosing. 

Avoidant personality disorder, characterized by marked anxiety and avoidance of most social situations... 

Patients with avoidant personality disorder manifest social inhibition, a sense of inadequacy, and hypersensitivity to negative evaluation. Because most patients with avoidant personality disorder also have social phobias, these conditions overlap to a substantial degree. Indeed, some investigators estimate that as many as 85% of these patients also meet diagnostic criteria for social phobia ( 261, 262). Therefore, social phobias should always be considered when the diagnosis of avoidant personality is made. 

Holt CS, Heimberg RG, Hope DA. Avoidant personality disorder and the generalized subtype of social phobia. J Abnorm Psychol 1992 101 318-325. 

Schneier FR, Spitzer RL, Gibbon M, et al. The relationship of social phobia subtypes and avoidant personality disorder. Compr Psychiatry 1991 32 1-5. 

Avoidant personality disorder a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. 

Cluster C patients may indeed present for psychotherapy and may improve with that treatment modality alone. However, the therapist should carefully consider the differential diagnosis between avoidant personality disorder and panic disorder or social anxiety disorder, for example, which responds well to SSRI therapy. And the therapist should particularly evaluate the Cluster C patient for obsessional signs and symptoms that may respond well to antiobsessional medication. 

More pervasive forms of social anxiety (and avoidant personality disorder) may be treated with MAO inhibitors or SSRIs (see chapter 14), in addition to psychotherapy and social-skills training. 

Mattick, R. P., Newman, C. R. (1991). Social phobia and avoidant personality disorder. International Journal of Psychiatry, 3, 163-173. 

Unfortunately, some patients respond poorly to these first-line interventions. In particular, patients with a long duration of illness, extreme agoraphobic avoidance, and comorbid personality disorders are more likely to exhibit a poor treatment response. For such patients, TCAs such as imipramine or clomipramine and MAOIs such as phenelzine remain viable strategies. 

G. The fear or avoidance is not due to the direct physiological effects of a substance [e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder [e.g., panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoid personality disorder). 

Blairy S, et al. 5-HT2a receptor polymorphism gene in bipolar disorder and harm avoidance personality trait. Am J Med Genet 2000 96(3) 360-364. 

Social phobias are certainly influenced by developmental and other life experiences (such as the quality of early attachments, the development of appropriate social skills, and adequate experience interacting with others). At the same time, there is rather compelling evidence suggesting that social phobics (and their more pervasively impaired cousins—avoidant personalities) may have a biologically based disorder. 

Psychiatric comorbidity is common, as up to 75% of patients have a primary mood disorder. A link between AN and anxiety disorders, especially social phobia (fear of eating in public) and obsessive-compulsive disorder, has been noted. The lifetime prevalence of obsessive-compulsive disorder in patients with AN is reported to be as high as 25%, much higher than the lifetime prevalence in the general population (2.5%). Personality disorders are also more common among people with AN, especially the avoidant and obsessive-compulsive types, than in the general population. ... 

Psychiatric comorbidity includes depression (np to 80%), impulse-control problems, and substance abnse. Approximately 30% to 37% of bulimic patients have a personal history of snbstance abuse. Kleptomania is reported more commonly in patients with BN than in the general pnbhc. Patients commonly steal comfort items snch as laxatives, candies, and clothes. Personality disorders, especially borderline and avoidant types, are more common in these patients than in the general population. ... 

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