eMedicine Specialties > Psychiatry > Adult

Avoidant Personality Disorder: Differential Diagnoses & Workup

Author: David C Rettew, MD, Director, Pediatric Psychiatry Clinic, Fletcher Allen Health Care; Associate Professor of Psychiatry and Pediatrics, University of Vermont College of Medicine
Coauthor(s): Michael S Jellinek, MD, President, Newton-Wellesley Hospital; Alicia C Doyle, University of Vermont College of Medicine
Contributor Information and Disclosures

Updated: Mar 4, 2008

Differential Diagnoses

Anxiety Disorder: Generalized Anxiety
Hearing Impairment
Anxiety Disorder: Panic Disorder
Mood Disorder: Depression
Anxiety Disorder: Separation Anxiety and School Refusal
Pervasive Developmental Disorder
Anxiety Disorder: Social Phobia and Selective Mutism
Pervasive Developmental Disorder: Autism

Other Problems to Be Considered

  • Panic disorder with agoraphobia
  • Dependent personality disorder
  • Schizoid personality disorder
  • Communication disorders
  • Generalized social anxiety disorder: Whether avoidant personality disorder [APD] and generalized social anxiety disorder are distinct entities or are different points along a common spectrum is still under debate.6  Current evidence suggests that although a high degree of overlap is observed, some qualitative distinctions remain.

Workup

Laboratory Studies

  • No specific laboratory tests are helpful in the diagnostic workup of patients with avoidant personality disorder (APD).

Imaging Studies

  • No specific imaging studies are helpful in the workup of patients with APD. Routine brain CT scanning or MRI without focal neurologic signs are not indicated.

Other Tests

  • Young children should receive an audiology examination to rule out hearing problems.
  • Clinicians may want to consider using rating scales designed for the quantitative assessment of social anxiety in pediatric populations, such as the Liebowitz Social Anxiety Scale for Children and Adolescents.7

More on Avoidant Personality Disorder

Overview: Avoidant Personality Disorder
Differential Diagnoses & Workup: Avoidant Personality Disorder
Treatment & Medication: Avoidant Personality Disorder
Follow-up: Avoidant Personality Disorder
References

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

  2. Grant BF, Hasin DS, Stinson FS, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. Jul 2004;65(7):948-58. [Medline].

  3. Reichborn-Kjennerud T, Czajkowski N, Neale MC, et al. Genetic and environmental influences on dimensional representations of DSM-IV cluster C personality disorders: a population-based multivariate twin study. Psychol Med. May 2007;37(5):645-53. [Medline].

  4. Johnson JG, Cohen P, Chen H, Kasen S, Brook JS. Parenting behaviors associated with risk for offspring personality disorder during adulthood. Arch Gen Psychiatry. May 2006;63(5):579-87. [Medline].

  5. Rettew DC, Zanarini MC, Yen S, et al. Childhood antecedents of avoidant personality disorder: a retrospective study. J Am Acad Child Adolesc Psychiatry. Sep 2003;42(9):1122-30. [Medline].

  6. Rettew DC. Avoidant personality disorder, generalized social phobia, and shyness: putting the personality back into personality disorders. Harv Rev Psychiatry. Dec 2000;8(6):283-97. [Medline].

  7. Masia CL, Klein RG, Liebowitz MR. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). New York, NY: NYU Child Study; Center; 1999.

  8. [Best Evidence] Emmelkamp PM, Benner A, Kuipers A, et al. Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. Br J Psychiatry. Jul 2006;189:60-4. [Medline][Full Text].

  9. Skodol AE, Bender DS, Pagano ME, et al. Positive childhood experiences: resilience and recovery from personality disorder in early adulthood. J Clin Psychiatry. Jul 2007;68(7):1102-8. [Medline].

  10. Beidel DC, Turner SM. Shy Children, Phobic Adults: The Nature and Treatment of Social Phobia. Washington, DC: American Psychological Association; 1998.

  11. Kagan J. Galen's Prophecy: Temperament in Human Nature. New York, NY: Basic Books; 1994.

  12. Millon T. Modern Psychopathology: A Biosocial Approach to Maladaptive Learning and Functioning. Philadelphia, PA: WB Saunders; 1969.

  13. Schwartz CE, Snidman N, Kagan J. Adolescent social anxiety as an outcome of inhibited temperament in childhood. J Am Acad Child Adolesc Psychiatry. Aug 1999;38(8):1008-15. [Medline].

  14. Westen D, Shedler J, Durrett C, et al. Personality diagnoses in adolescence: DSM-IV axis II diagnoses and an empirically derived alternative. Am J Psychiatry. May 2003;160(5):952-66. [Medline].

Further Reading

Keywords

avoidant personality disorder, APD, childhood APD, avoidant disorder, social phobia, social anxiety disorder, personality disorder, SSRIs, limbic system, anxiety disorder, social disorder, shy, shyness, school refusal, oppositional behavior, depression, substance abuse, child neglect, child abuse, obesity, posttraumatic stress disorder, generalized social anxiety disorder

Contributor Information and Disclosures

Author

David C Rettew, MD, Director, Pediatric Psychiatry Clinic, Fletcher Allen Health Care; Associate Professor of Psychiatry and Pediatrics, University of Vermont College of Medicine
David C Rettew, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

Michael S Jellinek, MD, President, Newton-Wellesley Hospital
Michael S Jellinek, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, and American Pediatric Society
Disclosure: Nothing to disclose.

Alicia C Doyle, University of Vermont College of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Carol Diane Berkowitz, MD, Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center
Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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