The relationship between avoidant personality disorder and social phobia

Department for Research and Education, Psychiatric Division, Ullevål University Hospital, 0407 Oslo, Norway.
Comprehensive Psychiatry (Impact Factor: 2.25). 07/2007; 48(4):348-56. DOI: 10.1016/j.comppsych.2007.03.004
Source: PubMed


The main explanatory hypothesis for the distinction between social phobia (SP) and avoidant personality disorder (APD) has been the severity continuum hypothesis, stating that APD only differs from SP in terms of severity of dysfunction and symptomatic distress, that is, social anxiety and depressive symptoms. This study aimed at a comprehensive evaluation of this hypothesis in a large sample (n = 2192) of thoroughly assessed patients, most of whom had a diagnosis of personality disorder. Social phobia was stronger associated with APD than with other personality disorders, and APD was stronger associated with SP than with other symptom disorders. Social phobia-pure patients had a higher level of global functioning and lower levels of general symptom distress and interpersonal problems than APD-pure patients. The 2 groups were similar on domains that pertain to social anxiety and introversion, but APD was associated with a broader array of symptoms and interpersonal problems and was substantially lower on the personality domain of conscientiousness. Avoidant personality disorder was stronger associated with eating disorders, and SP was stronger associated with panic disorder. The APD diagnosis seems to capture a broader constellation of symptoms and personality features pointing toward more severe personality dysfunction. Our findings suggest that the severity continuum hypothesis lacks specificity and exploratory power to account for both similarities and differences between SP and APD.

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    • "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, 1994, 2013; Eikenaes et al., 2013; Hummelen et al., 2007; Marques et al., 2012; Millon, 1981). "
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    ABSTRACT: Avoidant personality disorder (AvPD) and social phobia (SP) are common, closely related conditions. Little is known about the underlying processes related to the social discomfort of subjects with AvPD and SP. Both disorders are associated with interpersonal problems. An attachment perspective may shed light on similarities and differences in close relationships between the disorders. The aim of the study was to compare self-reported attachment styles in patients with AvPD and SP. We expected that patients with AvPD would have more attachment anxiety and avoidance and more often a Fearful attachment style, compared with SP. This is a cross-sectional multisite study of 90 adult patients with AvPD and SP. Patients with AvPD with and without SP (AvPD group) were compared with patients with SP without AvPD (SP group). Patients were assessed using structured diagnostic interviews and self-reporting questionnaires, including Experiences in Close Relationships (ECR). The ECR dimensions, Anxiety and Avoidance, and the new described five factors of the ECR were used. The AvPD group had higher levels of attachment anxiety than the SP group, especially for the sub-factors Anxiety for abandonment and Separation frustration. The diagnostic groups did not differ in levels of avoidance. Anxiety for abandonment was still associated with AvPD after controlling for symptom disorders and the criteria of other personality disorders. A Fearful attachment style was more frequent among patients with AvPD. The results indicate AvPD is associated with more attachment anxiety than SP. Fear of abandonment may play a significant role in the AvPD pathology. This is the first study to compare attachment styles in patients with avoidant personality disorder (AvPD) and social phobia (SP).The AvPD group had higher attachment-related anxiety than the SP group, and anxiety was most pronounced for the fear of abandonment.Fear of abandonment may play an important role in the AvPD pathology.
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    • "The correct interpretation based on this analysis is that these psychiatric diagnostic groups share highly similar interpersonal diagnoses. This fits with the similarity on Five-factor model dimensions reported in the same article (Hummelen et al., 2007). These two studies highlight how researchers can be placed in difficult interpretative positions when circumplex scales are treated as separate linear measures. "
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    ABSTRACT: Using the interpersonal circumplex as an exemplar, this article serves as a methodological primer for integrating techniques of group description and comparison when employing circumplex-based assessment instruments. Circular statistics (Mardia & Jupp, 199927. Mardia , K. V. and Jupp , P. E. 1999. Directional Statistics, New York: Wiley. [CrossRef]View all references) and the structural summary method (Gurtman & Balakrishnan, 199811. Gurtman , M. B. and Balakrishnan , J. D. 1998. Circular measurement redux: The analysis and interpretation of interpersonal circle profiles. Clinical Psychology: Science and Practice, 5: 344–360. [CrossRef], [Web of Science ®]View all references) each offer unique and incrementally useful information when applied to group-level data on circumplex measures. Circular statistics offer a set of parameters that are conceptually similar to their linear equivalents (i.e., mean, variance, and confidence intervals). In interpersonal circumplex models, these parameters each provide specific information regarding substantive theme and group homogeneity and allow for the statistical comparison of groups based on the geometry of the circular model. In a similar fashion, the structural summary method for circumplex data provides a set of parameters that complement circular statistics by offering measures of the interpersonal prototypicality of the group profile, levels of profile differentiation and elevation, and a weighted measure of substantive theme. Used in conjunction, these methods offer more information than is available using either in isolation. We provide 4 examples to demonstrate the complementary information the 2 methods provide for assessments employing interpersonal circumplex measures. These examples will allow investigators to generalize the methods to other personality assessment domains in which circumplex models are utilized, such as emotion and vocational preference.[Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Personality Assessment for the following free supplemental resources: an Excel file that calculates the circular statistics and structural summary information described in this article using manually entered octant scores from up to 500 participants.]
    Full-text · Article · Jul 2009 · Journal of Personality Assessment
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    • "Warner et al. (2004) found that experts also did not report that anger is a prototypic trait of people with AvPD; however, investigators have found positive associations between anger and AvPD or features of AvPD (Meyer, 2002) or SP (Erwin, Heimberg, Schneier, & Liebowitz, 2003; see Hofmann et al., 2004; Moscovitch, McCabe, Antony, Rocca, & Swinson, 2008). In contrast, Hummelen et al. (2007) found that compared to norms for the measure of anger, people with AvPD were not particularly high in self-reported anger. In a review, Hofmann et al. (2004) suggested that some individuals with SP show behaviors that are angry or hostile in social situations, whereas others are submissive. "
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    ABSTRACT: Relations of avoidant personality disorder (AvPD) with shyness and inhibition suggest that a precursor of AvPD is withdrawal. Using a sample of 4.5- to 7-year-olds studied four times, 2 years apart, four and three classes of children differing in trajectories of mother- and teacher-reported withdrawal, respectively, were identified. Mothers and teachers generally did not agree on children's trajectories but the pattern of findings in the two contexts did not differ markedly. The mother-identified high and declining withdrawal class, in comparison with less withdrawn classes, and the teacher-identified high and declining class compared with low withdrawal classes, were associated with relatively high levels of anger and low levels of attentional control and resiliency. The mother-identified moderate and increasing withdrawal class was distinguished from less problematic withdrawal classes by higher anger, lower resiliency, and sometimes, lower attentional control. The teacher-identified low and increasing withdrawal class was distinguished from less problematic withdrawal classes by lower resiliency and lower attentional control. Findings are discussed in terms of the developmental precursors to social withdrawal and avoidant behavior.
    Full-text · Article · Feb 2009 · Development and Psychopathology
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