Avoidant Personality Disorder Follow-up
- Author: David C Rettew, MD; Chief Editor: Caroly Pataki, MD more...
Further Inpatient Care
Inpatient care is rarely required.
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.[10] 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.
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.
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.
Complications
- Social phobia
- Major depression
- Substance abuse
- Long-term difficulties in social and occupational functioning
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.[11]
- 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.
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 eMedicine's Mental Health and Behavior. Also, see eMedicine's patient education article School Refusal.
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