Avoidant personality disorder in individuals with generalized social anxiety disorder: What does it add?

Avoidant personality disorder (AvPD) has a high level of symptom overlap and comorbidity with generalized social anxiety disorder (GSAD). We examined whether the presence of comorbid AvPD adds significant clinically relevant information for individuals seeking treatment for GSAD. Results suggested that AvPD was significantly associated with poorer quality of life and greater disability in univariate, but not multivariate analyses. Endorsement of more AvPD symptoms was associated with increased disability, increased risk of intimacy, and lower social support, even after covariate adjustment. Specifically, AvPD item 3, hard to be “open” even with people you are close to, was most strongly correlated with quality of life and disability. A binary diagnosis of AvPD alone adds little beyond a marker of greater GSAD severity and depression among patients with GSAD, while a specific feature of AvPD not captured by the GSAD diagnosis, namely emotional guardedness, may be associated with greater impairment.

► AvPD diagnosis was significantly associated with each outcome measure examined after adjustment for gender and age.
► After additionally controlling for GSAD symptom severity, AvPD diagnosis was no longer significant in any of the models.
► However, in univariate analyses, number of AvPD symptoms remained a significant predictor of most of the measured psychosocial outcomes.
► After adjustment for comorbid MDD, number of AvPD symptoms remained a significant predictor of interpersonal difficulties and poor quality of life.
► Although AvPD and GSAD share much variance, AvPD symptomatology has some unique identifiers that are not currently captured by a GSAD diagnosis.