title: Social phobia, avoidant personality disorder and atypical depression: co-occurrence and clinical implications.
abstract: BACKGROUND
  Increasing attention has been directed in recent years to the detection and treatment of psychiatric co-morbidity among depressed individuals. The overlap of social phobia (SP) and avoidant personality disorder (APD) has been well recognized and a relationship between these disorders and depression has been suggested.
  
  
  METHODS
  The pattern and clinical implications of co-morbidity of SP and APD with major depressive disorder (MDD), diagnosed by DSM-III-R criteria, were studied among 243 out-patients presenting with depression.
  
  
  RESULTS
  Overall, 26.7% of adults in our sample with MDD met criteria for SP and 28.4% for APD. Almost two-thirds of depressed adults meeting criteria for social phobia or avoidant personality disorder met criteria for both (SP+APD). Depressed adults who met criteria for both SP+APD exhibited a significantly higher proportion of atypical depression (54.8%) compared with those with neither SP nor APD (31.1%). Among depressed patients, the co-occurrence of SP with APD was also associated with an earlier age of onset of MDD, a greater number of comorbid Axis I diagnoses, and greater impairment of social adjustment and assertiveness.
  
  
  CONCLUSIONS
  Results confirm the overlap of SP and APD in a depressed population and the high prevalence of these disorders in MDD. They suggest that depressed individuals with both SP and APD but not SP alone are at particularly high risk for atypical depression and for social dysfunction in excess of that caused by a current major depression.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Alpert
authors.forename: L A
authors.initials: LA
authors.lastname: Uebelacker
authors.forename: N E
authors.initials: NE
authors.lastname: McLean
authors.forename: A A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: J A
authors.initials: JA
authors.lastname: Pava
authors.forename: J J
authors.initials: JJ
authors.lastname: Worthington
authors.forename: J R
authors.initials: JR
authors.lastname: Tedlow
authors.forename: J F
authors.initials: JF
authors.lastname: Rosenbaum
authors.forename: M
authors.initials: M
authors.lastname: Fava
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology*; D010698:Phobic Disorders / Q000453:epidemiology*; D015995:Prevalence; D012917:Social Adjustment; D012920:Social Behavior Disorders / Q000453:epidemiology*