Avoidant personality disorder

It is contended by some that they are merely different conceptualizations of the same disorder, where avoidant personality disorder may represent the more severe form.{{cite journal |last1=Reich |first1=James |year=2009 |title=Avoidant personality disorder and its relationship to social phobia |journal=Current Psychiatry Reports |volume=11 |issue=1 |pages=89–93 |doi=10.1007/s11920-009-0014-0 |pmid=19187715 |s2cid=40728363}}{{cite journal |last1=Huppert |first1=Jonathan D. |last2=Strunk |first2=Daniel R. |last3=Ledley |first3=Deborah Roth |last4=Davidson |first4=Jonathan R. T. |last5=Foa |first5=Edna B. |year=2008 |title=Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome |journal=Depression and Anxiety |volume=25 |issue=5 |pages=441–8 |doi=10.1002/da.20349 |pmid=17618526 |s2cid=9179813 |doi-access=free}} In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalized social phobia alone. But they show no differences in social skills or performance on an impromptu speech.{{cite journal |vauthors=Herbert JD, Hope DA, Bellack AS |year=1992 |title=Validity of the distinction between generalized social phobia and avoidant personality disorder |url=https://digitalcommons.unl.edu/psychfacpub/917 |journal=J Abnorm Psychol |volume=101 |issue=2 |pages=332–9 |doi=10.1037/0021-843x.101.2.332 |pmid=1583228 |url-access=subscription}} Another difference is that social phobia is the ''fear of social circumstances'' whereas AvPD is better described as an ''aversion to intimacy'' in relationships.{{cite book |last=Comer |first=Ronald |url=https://archive.org/details/FundamentalsOfAbnormalPsychologyComerRonaldJ.SRG].pdf |title=Fundamentals of abnormal psychology |publisher=Worth Publishers |year=2014 |isbn=978-1-4292-9563-5 |location=New York, NY |pages=424–427}}

It is contended by some that they are merely different conceptualizations of the same disorder, where avoidant personality disorder may represent the more severe form.{{cite journal |last1=Reich |first1=James |year=2009 |title=Avoidant personality disorder and its relationship to social phobia |journal=Current Psychiatry Reports |volume=11 |issue=1 |pages=89–93 |doi=10.1007/s11920-009-0014-0 |pmid=19187715 |s2cid=40728363}}{{cite journal |last1=Huppert |first1=Jonathan D. |last2=Strunk |first2=Daniel R. |last3=Ledley |first3=Deborah Roth |last4=Davidson |first4=Jonathan R. T. |last5=Foa |first5=Edna B. |year=2008 |title=Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome |journal=Depression and Anxiety |volume=25 |issue=5 |pages=441–8 |doi=10.1002/da.20349 |pmid=17618526 |s2cid=9179813 |doi-access=free}} In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalized social phobia alone. But they show no differences in social skills or performance on an impromptu speech.{{cite journal |vauthors=Herbert JD, Hope DA, Bellack AS |year=1992 |title=Validity of the distinction between generalized social phobia and avoidant personality disorder |url=https://digitalcommons.unl.edu/psychfacpub/917 |journal=J Abnorm Psychol |volume=101 |issue=2 |pages=332–9 |doi=10.1037/0021-843x.101.2.332 |pmid=1583228 |url-access=subscription}} Another difference is that social phobia is the ''fear of social circumstances'' whereas AvPD is better described as an ''aversion to intimacy'' in relationships.{{cite book |last=Comer |first=Ronald |url=https://archive.org/details/FundamentalsOfAbnormalPsychologyComerRonaldJ.SRG].pdf |title=Fundamentals of abnormal psychology |publisher=Worth Publishers |year=2014 |isbn=978-1-4292-9563-5 |location=New York, NY |pages=424–427}}

Another personality disorder diagnosis could be more suitable for a presentation considered for a diagnosis of AvPD; however, these can also be diagnosed alongside AvPD, provided that the requirements for diagnosis are met for all of them (see {{Section link||Comorbidity}}). Specific features may indicate which diagnosis of several is the most suitable. [[Social isolation]] is also a prominent feature of [[Schizoid personality disorder|schizoid]] and [[Schizotypal personality disorder|schizotypal]] PDs; the significant difference between these and AvPD is that people with the former disorders may not experience discomfort stemming from it, whereas people with AvPD are likely to suffer from this isolation. Moreover, there are differences in what gives rise to the "feelings of inadequacy, hypersensitivity to criticism, and [...] need for reassurance" that AvPD shares with [[dependent personality disorder]]; while people with the former disorder are worry excessively about being rejected and humiliated, those with the latter experience a need of nurturance. Lastly, "reluctance to confide in others", which is also a feature of paranoid PD, "is attributable more to a fear of being embarrassed or being found inadequate than to a fear of others' malicious intent", as in the latter disorder.

Another personality disorder diagnosis could be more suitable for a presentation considered for a diagnosis of AvPD; however, these can also be diagnosed alongside AvPD, provided that the requirements for diagnosis are met for all of them (see {{Section link||Comorbidity}}). Specific features may indicate which diagnosis of several is the most suitable. [[Social isolation]] is also a prominent feature of [[Schizoid personality disorder|schizoid]] and [[Schizotypal personality disorder|schizotypal]] PDs; the significant difference between these and AvPD is that people with the former disorders may not experience discomfort stemming from it, whereas people with AvPD are likely to suffer from this isolation. Moreover, there are differences in what gives rise to the "feelings of inadequacy, hypersensitivity to criticism, and [...] need for reassurance" that AvPD shares with [[dependent personality disorder]]; while people with the former disorder worry excessively about being rejected and humiliated, those with the latter disorder experience a need of nurturance. Lastly, "reluctance to confide in others", which is also a feature of paranoid PD, "is attributable more to a fear of being embarrassed or being found inadequate than to a fear of others' malicious intent", as in the latter disorder.

There is also an overlap between avoidant and schizoid personality traits and AvPD may have a relationship to the [[schizophrenia spectrum]].{{cite journal |author1=David L. Fogelson |author2=Keith Nuechterlein |year=2007 |title=Avoidant personality disorder is a separable schizophrenia-spectrum personality disorder even when controlling for the presence of paranoid and schizotypal personality disorders |journal=Schizophrenia Research |volume=91 |issue=1–3 |pages=192–199 |citeseerx=10.1.1.1019.5817 |doi=10.1016/j.schres.2006.12.023 |pmc=1904485 |pmid=17306508}} Avoidant personality disorder must also be differentiated from [[autism spectrum|autism spectrum disorder]].{{cite journal |last1=Lehnhardt |first1=Fritz-Georg |last2=Gawronski |first2=Astrid |last3=Pfeiffer |first3=Kathleen |last4=Kockler |first4=Hanna |last5=Schilbach |first5=Leonhard |last6=Vogeley |first6=Kai |date=November 2013 |title=The Investigation and Differential Diagnosis of Asperger Syndrome in Adults |journal=Deutsches Ärzteblatt International |volume=110 |issue=45 |pages=755–763 |doi=10.3238/arztebl.2013.0755 |pmc=3849991 |pmid=24290364}}

There is also an overlap between avoidant and schizoid personality traits and AvPD may have a relationship to the [[schizophrenia spectrum]].{{cite journal |author1=David L. Fogelson |author2=Keith Nuechterlein |year=2007 |title=Avoidant personality disorder is a separable schizophrenia-spectrum personality disorder even when controlling for the presence of paranoid and schizotypal personality disorders |journal=Schizophrenia Research |volume=91 |issue=1–3 |pages=192–199 |citeseerx=10.1.1.1019.5817 |doi=10.1016/j.schres.2006.12.023 |pmc=1904485 |pmid=17306508}} Avoidant personality disorder must also be differentiated from [[autism spectrum|autism spectrum disorder]].{{cite journal |last1=Lehnhardt |first1=Fritz-Georg |last2=Gawronski |first2=Astrid |last3=Pfeiffer |first3=Kathleen |last4=Kockler |first4=Hanna |last5=Schilbach |first5=Leonhard |last6=Vogeley |first6=Kai |date=November 2013 |title=The Investigation and Differential Diagnosis of Asperger Syndrome in Adults |journal=Deutsches Ärzteblatt International |volume=110 |issue=45 |pages=755–763 |doi=10.3238/arztebl.2013.0755 |pmc=3849991 |pmid=24290364}}