Avoidant personality disorder, generalized social phobia, and shyness: putting the personality back into personality disorders.
With increasing recognition of social phobia as a common and often debilitating disorder, interest is developing in its boundaries with other disorders such as avoidant personality disorder and temperamental constructs such as shyness. Such interest reflects the more general debate concerning Axis I disorders, personality disorders, and what is considered normal personality variance. This review summarizes the available literature comparing avoidant personality disorder (APD), generalized social phobia (GSP), and shyness. In studies comparing APD and GSP, comorbidity rates have varied from approximately 25% to numbers high enough that the ability to diagnose one disorder without the other was questioned. Comparisons of the characteristics of APD and GSP have yielded few qualitative differences, although some studies have shown evidence that APD may represent a more severe form of GSP with respect to levels of symptoms, fear of negative evaluation, anxiety, avoidance, and depression. Personality dimensions including, but not limited to, shyness have been found to be strongly associated with GSP and APD, and there is some evidence that persons who suffer from social anxiety also suffer from fears and avoidance across nonsocial domains. In conclusion, although there is evidence that shyness, GSP, and APD exist along a continuum, the factors that constitute this continuum may need to be revised.
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Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
D015897:Comorbidity; D003937:Diagnosis, Differential; D005239:Fear / Q000523:psychology*; D006801:Humans; D007266:Inhibition, Psychological; D008960:Models, Psychological; D010551:Personality; D010554:Personality Disorders / Q000175:diagnosis* / Q000523:psychology; D010698:Phobic Disorders / Q000175:diagnosis* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012792:Shyness