Comorbid Avoidant Personality Disorder Research Articles

Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial

BackgroundPatients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. MethodsWe conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). ResultsIntention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. ConclusionGST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.

The importance of avoidant personality in social anxiety disorder with and without attention-deficit/hyperactivity disorder

In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (β = 0.305, p= 0.007). The severity of current depression (β = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (β = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

Metacognitive Interpersonal Therapy for Personality Disorders: The Case of a Man with Obsessive–Compulsive Personality Disorder and Avoidant Personality Disorder

Personality disorders have a deleterious impact on individual quality of life, and are associated with a significant social burden. Despite a broad range of presentations across the various personality disorders, clinical research has shown a strong bias toward borderline personality disorder. In contrast to the emotional dysregulation of borderline personality disorder, a number of personality disorders are characterised by emotional inhibition and alexithymia. Research increasingly suggests that these deficits in emotional regulation may be symptomatic of problems with metacognition—the ability to identify, understand, and influence mental states. Research and specific treatment approaches are needed which target personality dysfunction characterised by emotional inhibition, rather than dysregulation. Emerging evidence suggests that metacognitive interpersonal therapy may be an effective treatment approach for personality disorders characterised by emotional inhibition. The current case study provides an in-depth examination of the application of metacognitive interpersonal therapy for a man diagnosed with comorbid avoidant personality disorder, and obsessive compulsive personality disorder. The patient described a history of bullying and unmet needs throughout his childhood, resulting in maladaptive interpersonal schemas and metacognitive deficits. Treatment focused on building the patient’s ability to identify and understand his mental states, and targeted schema-driven behaviour. The patient reported experiencing the therapy as helpful, and stated that it contributed to a marked improvement in his quality of life. Results indicate that a 1 year intervention was successful in achieving diagnostic recovery and symptom reduction, supporting metacognitive interpersonal therapy as an effective intervention.

Social phobia and avoidant personality disorder: One spectrum disorder?

General population data was used to examine if empirically derived subtypes of social phobia with and without avoidant personality disorder (APD) could be differentiated on self-report measures of anxiety severity, level of global functioning and the number of fulfilled diagnostic criteria for other personality disorders. DSM-IV diagnoses of social phobia, APD and indices of other personality disorders were determined by means of a postal survey. The presence of APD was associated with compromised functional status and a higher frequency of fulfilled diagnostic criteria for additional personality disorders. However, APD did not modify the effect of social phobia subtypes on anxiety severity, level of global functioning or number of personality disorder indices. The presence of comorbid APD in social phobics seems to predict a global functioning decrement independent of anxiety severity. The results imply that social phobia and APD may represent different points on a severity continuum rather than easily defined discreet categories suggesting that social phobia and APD may represent a spectrum of anxiety symptoms related to social anxiety.

Avoidant Personality Disorder as a Predictor for Treatment Outcome among Generalized Social Phobics

The effect of comorbid avoidant personality disorder (APD) on response to exposure-based treatment for social phobia was examined in a sample of 48 outpatients with generalized social phobia. Diagnoses were based on the Structured Clinical Interview for DSM-III-R. At pretest, clients with APD were more severely impaired on all self-report measures and had a higher frequency of comorbid diagnoses than those without the disorder. Although clients with APD improved significantly with treatment, they continued to report more severe impairment on all outcome measures at posttest and 3-month follow-up as compared to those without APD. Depression may in part explain the poorer rate of improvement during treatment of those with APD.

Psychopathology of social phobia: Effects of subtype and of avoidant personality disorder

The effects of social phobia subtypes and of comorbid avoidant personality disorder (APD) on the symptoms of 45 outpatients with a primary diagnosis of social phobia were examined. Generalized social phobic subjects with (GSP-APD, n = 16) and without APD (GSP-NAPD, n = 13) reported greater social anxiety and fear of negative evaluation than specific social phobic subjects without APD (SSP-NAPD, n = 16). Compared to SSP-NAPD clients, GSP-APD clients tended to exhibit poorer social skills during behavioral testing and were more likely to be unmarried and to use medication. GSP-APD subjects were more depressed than both SSP-NAPD and GSP-NAPD subjects, while non-APD groups did not differ. The results showed that both social phobia subtype and APD comorbidity contributed to the differences found among the three subgroups of social phobic clients.

Sleep impairment in patients with social phobia

Patient reports of sleep difficulty and sleep quality were systematically assessed in 30 nondepressed, untreated patients with the generalized subtype of social phobia and 30 sex-matched and age-comparable healthy control subjects. Sleep characteristics of the preceding month were assessed using a standardized, validated instrument: the Pittsburgh Sleep Quality Index (PSQI). Patients with generalized social phobia reported significantly poorer sleep quality, longer sleep latency, more frequent sleep disturbance, and more severe daytime dysfunction. Global PSQI scores did not differ significantly among social phobia with or without a lifetime history of major depression (48%), comorbid dysthymia (15%), or comorbid avoidant personality disorder (64%). These findings, which are reminiscent of those in other anxiety syndromes such as panic disorder, suggest that disturbed sleep may be a feature of the generalized subtype of social phobia that deserves further clinical and research attention.