Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Avoidant Personality Disorder Follow-up

  • Author: David C Rettew, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Oct 07, 2015
 

Further Outpatient Care

Referral to a psychiatrist or other mental health professional for diagnostic evaluation is indicated.

Referral to a clinician trained in behavioral or cognitive-behavioral therapy can be beneficial. Components of this type of therapy include education, social skills training, relaxation training, rewards for social behavior, slowly graduated exposure to feared situations, and helping the child correct distorted thoughts during feared encounters (real or simulated).

Group therapy may be effective.

Continue monitoring medication dose and adverse effects.

Encourage parents and patients to confront feared situations as tolerated. Supporting additional social interaction in activities in which someone feels competent (eg, sports, art, music) can increase the chance of success.

Watch for the emergence of other psychiatric conditions, particularly major depression and substance abuse.

Next

Inpatient & Outpatient Medications

Although medications are not often used in cases of avoidant personality disorder without other comorbid conditions, improvement has been observed in patients with social phobia using SSRIs, SNRIs, benzodiazepines, MAOIs, and some anticonvulsants.

Avoid caffeine, which may trigger anxiety symptoms.

Previous
Next

Deterrence/Prevention

Current studies are underway to assess the possibility of preventing social anxiety disorders in shy, inhibited children who do not yet meet the criteria for a psychiatric diagnosis.

Reducing parental overprotection and displays of parental anxiety may be beneficial in helping a child to manage his or her anxiety more effectively.

Previous
Next

Complications

Complications may include the following:

  • Social phobia
  • Major depression
  • Substance abuse
  • Long-term difficulties in social and occupational functioning
Previous
Next

Prognosis

Although avoidant personality disorder is often considered to be a chronic condition, significant improvement can occur with many individuals, especially with treatment.

Social anxiety often precedes the onset of adolescent depression and alcohol abuse.

Onset of social phobia in a child younger than 11 years can be associated with continued symptoms into adulthood.

Examinations of adults with avoidant personality disorder indicate that childhood lack of involvement with peers and failure to engage in structured activities may persist through adolescence and adulthood. Conversely, adults who have had positive achievements and interpersonal relationships during childhood and adolescence were more likely to remit from avoidant personality disorder as adults.

Children aged 2 years described as being very fearful and withdrawn in new situations were found to have higher levels of social anxiety in adolescence.

Previous
Next

Patient Education

Encourage caretakers to learn as much as they can about avoidant personality disorder, other social anxiety disorders, and parental styles that may be more helpful to children with avoidant personality disorder.

Instruct families to encourage patient exposure to feared situations in a carefully planned and supportive manner when a good possibility of the patient being able to tolerate the situation exists.

For excellent patient education resources, visit eMedicineHealth's Mental Health Center. Also, see eMedicineHealth's patient education article School Refusal.

Previous
 
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, American Psychiatric Association

Disclosure: Received royalty from Norton Publishers for other.

Coauthor(s)

Michael S Jellinek, MD Chief Clinical Officer, Partners HealthCare System, Inc

Michael S Jellinek, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Pediatric Society

Disclosure: Nothing to disclose.

Alicia C Doyle University of Vermont College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen 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, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Washington, DC: American Psychiatric Association; 2013. 672-675.

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

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

  4. Powell VB, Oliveira OH, Seixas C, Almeida C, Grangeon MC, Caldas M, et al. Changing core beliefs with trial-based cognitive therapy may improve quality of life in social phobia: a randomized study. Rev Bras Psiquiatr. 2013 Jul-Sep. 35(3):243-7. [Medline].

  5. Seefeldt WL, Krämer M, Tuschen-Caffier B, Heinrichs N. Hypervigilance and avoidance in visual attention in children with social phobia. J Behav Ther Exp Psychiatry. 2013 Sep 22. 45(1):105-112. [Medline].

  6. Kendler KS, Aggen SH, Czajkowski N, Roysamb E, Tambs K, Torgersen S, et al. The structure of genetic and environmental risk factors for DSM-IV personality disorders: a multivariate twin study. Arch Gen Psychiatry. 2008 Dec. 65(12):1438-46. [Medline]. [Full Text].

  7. 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. 2007 May. 37(5):645-53. [Medline].

  8. 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. 2004 Jul. 65(7):948-58. [Medline].

  9. Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry. 2005 Oct. 162(10):1911-8. [Medline].

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

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

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

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

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

  15. Cox BJ, Pagura J, Stein MB, Sareen J. The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey. Depress Anxiety. 2009. 26(4):354-62. [Medline].

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

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

  18. 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. 2003 May. 160(5):952-66. [Medline].

  19. Wong Sarver N, Beidel DC, Spitalnick JS. The Feasibility and Acceptability of Virtual Environments in the Treatment of Childhood Social Anxiety Disorder. J Clin Child Adolesc Psychol. 2013 Oct 21. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.