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The importance of avoidant personality in social anxiety disorder with and without attention-deficit/hyperactivity disorder

  • Caner Yoldas
  • Bilge Dogan
  • Oktay Kocabas
  • Cagdas Oyku Memis
  • Doga Sevincok
  • Levent SevincokEmail author
Original Article

Abstract

In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson’s correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (β = 0.305, p= 0.007). The severity of current depression (β = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (β = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

Keywords

Social anxiety disorder Avoidant personality disorder Attention-deficit/hyperactivity disorder Depression 

Notes

Funding

The authors received no financial support for the research, authorship, and publication of this article.

Compliance with ethical standards

Conflict interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

References

  1. Alden LE, Laposa JM, Taylor CT, Ryder AG (2002) Avoidant personality disorder: current status and future directions. J Pers Disord 16:1–29CrossRefGoogle Scholar
  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, ArlingtonCrossRefGoogle Scholar
  3. Beck A, Ward C, Mendelson M (1961) Beck depression inventory. Arch Gen Psychiatry 4:561–571CrossRefGoogle Scholar
  4. Biederman J, Petty CR, Clarke A et al (2011a) Predictors of persistent ADHD: an 11-year follow-up study. J Psychiatr Res 45:150–155CrossRefGoogle Scholar
  5. Biederman J, Fried R, Petty CR et al (2011b) Cognitive development in adults with attention deficit/hyperactivity disorder: a controlled study in medication-naive adults across the adult life cycle. J Clin Psychiatry 72:11–16CrossRefGoogle Scholar
  6. Bohlin G, Hagekull B (2009) Socio-emotional development: from infancy to young adulthood. Scand J Psychol 50:592–601CrossRefGoogle Scholar
  7. Boone ML, McNeil DW, Masia CL et al (1999) Multimodal comparisons of social phobia subtypes and avoidant personality disorder. J Anxiety Disord 13:271–292CrossRefGoogle Scholar
  8. Brown EJ, Heimberg RG, Juster HR (1995) Social phobia subtype and avoidant personality disorder: Effect on severity of social phobia, impairment, and outcome of cognitive behavioral treatment. Behav Ther 26:467–486CrossRefGoogle Scholar
  9. Carter SA, Wu KD (2010) Relations among symptoms of social phobia subtypes, avoidant personality disorder, panic, and depression. Behav Ther 41:2–13.  https://doi.org/10.1016/j.beth.2008.10.002 CrossRefGoogle Scholar
  10. Chambless DL, Fydrich T, Rodebaugh TL (2008) Generalized social phobia and avoidant personality disorder: meaningful distinction or useless duplication? Depress Anxiety 25:8–19CrossRefGoogle Scholar
  11. Chavira DA, Stein MB, Bailey K, Stein MT (2004) Comorbidity of generalized social anxiety disorder and depression in a pediatric primary care sample. J Affect Disord 80:163–171CrossRefGoogle Scholar
  12. Corapcigil A, Aydemir O, Yildiz M et al (1999) Adaptation into Turkish and reliability of structured clinical interview for DSM-IV (SCID). J Drug Treat 12:233–236Google Scholar
  13. Cordier R, Bundy A, Hocking C, Einfeld S (2010) Comparison of the play of children with attention deficit hyperactivity disorder by subtypes. Aust Occup Ther J 57:137–145CrossRefGoogle Scholar
  14. Cox BJ, MacPherson PS, Enns MW (2005) Psychiatric correlates of childhood shyness in a nationally representative sample. Behav Res Ther 43:1019–1027CrossRefGoogle Scholar
  15. Cox BJ, Pagura J, Stein MB, Sareen J (2009) The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey. Depress Anxiety 26:354–362CrossRefGoogle Scholar
  16. Cumyn L, French L, Hechtman L (2009) Comorbidity in adults with attention-deficit hyperactivity disorder. Can J Psychiatry 54:673–683CrossRefGoogle Scholar
  17. Eggum ND, Eisenberg N, Spinrad TL et al (2009) Predictors of withdrawal: possible precursors of avoidant personality disorder. Dev Psychopathol 21:815–838CrossRefGoogle Scholar
  18. Eikenaes I, Hummelen B, Abrahamsen G et al (2013) Personality functioning in patients with avoidant personality disorder and social phobia. J Pers Disord 26:746–763CrossRefGoogle Scholar
  19. Evren C, Dalbudak E, Ozen S et al (2017) The relationship of social anxiety disorder symptoms with probable attention deficit hyperactivity disorder in Turkish university students; impact of negative affect and personality traits of neuroticism and extraversion. Psychiatry Res 254:158–163CrossRefGoogle Scholar
  20. First M, Spitzer R, Gibbon M, Williams JB (1997) Structured clinical interview for DSM-IV clinical version (SCID-I/CV). American Psychiatric Press, Washington DCGoogle Scholar
  21. Gökler B, Ünal F, Pehlivantürk B et al (2004) Reliability and validity of schedule for affective disorders and schizophrenia for school age children-present and lifetime version-Turkish version (K-SADS-PL T). Turk J Child Adolesc Ment Health 11:109–116Google Scholar
  22. Goldin PR, Manber T, Hakimi S et al (2009) Neural bases of social anxiety disorder: emotional reactivity and cognitive regulation during social and physical threat. Arch Gen Psychiatry 66:170–180CrossRefGoogle Scholar
  23. Gunay S, Savran C, Aksoy UM (2005) The reliability and validity study of adult attention disorder hyperactivity scale (adult ADD/ADHD DSM IV-based diagnostic secreening and rating scale. The J Educ Sci Ataturk Educ Faculty 21:133–150Google Scholar
  24. Herbert JD, Hope DA, Bellack AS (1992) Validity of the distinction between generalized social phobia and avoidant personality disorder. J Abnorm Psychol 101:332-9CrossRefGoogle Scholar
  25. Hodgens JB, Cole J, Boldizar J (2000) Peer-based differences among boys with ADHD. J Clin Child Psychol 29:443–452CrossRefGoogle Scholar
  26. Hummelen B, Wilberg T, Pedersen G, Karterud S (2007) The relationship between avoidant personality disorder and social phobia. Compr Psychiatry 48:348–356CrossRefGoogle Scholar
  27. Hunt C, Issakidis C, Andrews G (2002) DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and well-being. Psychol Med 106:27–34Google Scholar
  28. Huppert JD, Strunk DR, Ledley DR et al (2008) Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome. Depress Anxiety 25:441–448CrossRefGoogle Scholar
  29. Isomura K, Boman M, Rück C et al (2015) Population-based, multi-generational family clustering study of social anxiety disorder and avoidant personality disorder. Psychol Med 45:1581–1589CrossRefGoogle Scholar
  30. Karam RG, Rovaris DL, Breda V (2017) Trajectories of attention-deficit/hyperactivity disorder dimensions in adults. Acta Psychiatr Scand 136:210–219.  https://doi.org/10.1111/acps.12757 CrossRefGoogle Scholar
  31. Kaufman J, Birmaher B, Brent DA et al (1997) Schedule for affective disorders and schizophrenia for school age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988CrossRefGoogle Scholar
  32. Kessler RC, Adler LA, Barkley R et al (2005) Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry 57:1442–1451CrossRefGoogle Scholar
  33. Kessler RC, Adler L, Barkley R et al (2006) The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry 163:716–723CrossRefGoogle Scholar
  34. Klein RG, Mannuzza S, Olazagasti MA et al (2012) Clinical and functional outcome of childhood attention deficit/hyperactivity disorder 33 years later. Arch Gen Psychiatry 69:1295–1303CrossRefGoogle Scholar
  35. Korsgaard HO, Torgersen S, Wentzel-Larsen T, Ulberg R (2016) Personality disorders and Axis I comorbidity in adolescent patients with ADHD. BMC Psychiatry 16:175.  https://doi.org/10.1186/s12888-016-0871-0 CrossRefGoogle Scholar
  36. Kose S, Solmaz M, Celikel FC et al (2009) Comorbidity of Avoidant personality disorder in generalized social phobia and its impact on psychopathology. Bull Clinical Psychopharmacol 19:1340–1346Google Scholar
  37. Koyuncu A, Ertekin E, Yüksel Ç et al (2015a) Predominantly inattentive type of ADHD is associated with social anxiety disorder. J Atten Disord 19:856–864CrossRefGoogle Scholar
  38. Koyuncu A, Çelebi F, Ertekin E et al (2015b) Clinical effects of ADHD subtypes in patients with social anxiety disorder. J Atten Disord 2015:4Google Scholar
  39. Koyuncu A, Çelebi F, Ertekin E et al (2016) Attention deficit and hyperactivity in social anxiety disorder: relationship with trauma history and impulsivity. Atten Defic Hyperact Disord 8:95–100CrossRefGoogle Scholar
  40. Lampe L, Sunderland M (2013) Social phobia and avoidant personality disorder: similar but different? J Pers Disord 27:1–16.  https://doi.org/10.1521/pedi.2013.27.1.1 CrossRefGoogle Scholar
  41. Lara C, Fayyad J, de Graaf R et al (2009) Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey initiative. Biol Psychiatry 65:46–54CrossRefGoogle Scholar
  42. Liebowitz MR (1987) Social phobia. Mod Probl Pharmacopsychiatry 22:141–173CrossRefGoogle Scholar
  43. Mancini C, Van Ameringen M, Oakman JM et al (1999) Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders. Psychol Med 29:515–525CrossRefGoogle Scholar
  44. Marques L, Porter E, Keshaviah A et al (2012) Avoidant personality disorder in individuals with generalized social anxiety disorder: what does it add? J Anxiety Disord 26:665–672.  https://doi.org/10.1016/j.janxdis.2012.05.004 CrossRefGoogle Scholar
  45. McGough JJ, Smalley SL, McKracken JT et al (2005) Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. Am J Psychiatry 162:1621–1627CrossRefGoogle Scholar
  46. Meyer B, Ajchenbrenner M, Bowles DP (2005) Sensory sensitivity, attachment experiences, and rejection responses among adults with borderline and avoidant features. J Pers Disord 19:641–658CrossRefGoogle Scholar
  47. Mörtberg E, Tilfors K, Bejerot S (2012) Screening for ADHD in an adult social phobia sample. J Atten Disord 16:645–659CrossRefGoogle Scholar
  48. Oncu B, Olmez S, Sentürk V (2005) Validity and reliability of the Turkish version of the Wender Utah rating scale for attention-deficit/hyperactivity disorder in adults. Turk Psikiyatri Derg 16:252–259Google Scholar
  49. Park S, Cho MJ, Chang SM et al (2011) Prevalence, correlates, and comorbidities of adult ADHD symptoms in Korea: results of the Korean epidemiologic catchment area study. Psychiatry Res 186:378–383.  https://doi.org/10.1016/j.psychres.2010.07.047 CrossRefGoogle Scholar
  50. Perroud N, Hasler R, Golay N et al (2016) Personality profiles in adults with attention deficit hyperactivity disorder (ADHD). BMC Psychiatry 16:199.  https://doi.org/10.1186/s12888-016-0906-6 CrossRefGoogle Scholar
  51. Pliszka SR (1998) Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorders: an overview. J Clin Psychiatry 59(suppl 7):50–58Google Scholar
  52. Ralevski E, Sanislow CA, Grilo CM et al (2005) Avoidant personality disorder and social phobia: distinct enough to be separate disorders? Acta Psychiatr Scand 112:208–214CrossRefGoogle Scholar
  53. Rappe RM, Heimberg R (1997) A cognitive-behavioral model of anxiety in social phobia. Behav Res Therapy 35:72–75Google Scholar
  54. Reich J (2000) The relationship of social phobia to avoidant personality disorder: a proposal to reclassify avoidant personality disorder based on clinical empirical findings. Eur Psychiatry 15:151–159CrossRefGoogle Scholar
  55. Reich J (2009) Avoidant personality disorder and its relationship to social phobia. Curr Psychiatry Rep 11:89–93CrossRefGoogle Scholar
  56. Safren SA, Lanka GD, Otto MW, Pollack MH (2001) Prevalence of childhood ADHD among patients with generalized anxiety disorder and a comparison condition, social phobia. Depress Anxiety 13:190–191CrossRefGoogle Scholar
  57. Schmitz M, Ludwig H, Rohde LA (2010) Do hyperactive symptoms matter in ADHD-I restricted phenotype? J Clin Child Adolesc Psychol 39:741–748CrossRefGoogle Scholar
  58. Schneier FR, Spitzer RL, Gibbon M et al (1991) The relationship of social phobia subtypes and avoidant personality disorder. Compr Psychiatry 32:496–502CrossRefGoogle Scholar
  59. Sobanski E, Bruggemann D, Alm B et al (2005) Subtype differences in adults with attention deficit hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment. Eur Psychiatry 23:142–149CrossRefGoogle Scholar
  60. Soykan C, Ozgüven HD (2003) Liebowitz social anxiety scale: the Turkish version. Psychol Rep 93:1059–1069CrossRefGoogle Scholar
  61. Stein MB, Stein DJ (2008) Social anxiety disorder. Lancet 371:1115–1125CrossRefGoogle Scholar
  62. Storch EA, Masia-Warner C, Brassard MR (2003) The relationship of peer victimization to social anxiety and loneliness in adolescence. Child Study J 33:1–18Google Scholar
  63. Storch EA, Roth DA, Coles ME et al (2004) The measurement and impact of childhood teasing in a sample of young adults. J Anxiety Disord 18:681–694CrossRefGoogle Scholar
  64. Tillfors M, Furmark T, Ekselius L, Fredrikson M (2004) Social phobia and avoidant personality disorder: one spectrum disorder? Nord J Psychiatry 58:147–152CrossRefGoogle Scholar
  65. Turgay A (1995) Adult hyperactivity assessment scale based on DSM IV (unpublished scale). Integrative Therapy Institute Toronto, CanadaGoogle Scholar
  66. Turgay A, Ansari R (2006) Major depression with ADHD in children adolescents. Psychiatry (Edgmont) 3:20–32Google Scholar
  67. Turner SM, Beidel DC, Borden JW et al (1991) Social phobia: axis I and II correlates. J Abnorm Psychol 100:102–106CrossRefGoogle Scholar
  68. Turner SM, Beidel DC, Townsley RM (1992) Social phobia: a comparison of specific and generalized subtypes and avoidant personality disorder. J Abnorm Psychol 101:326–331CrossRefGoogle Scholar
  69. van Velzen CJM, Emmelkamp PMG, Scholing A (2000) Generalized social phobia versus avoidant personality disorder: differences in psychopathology, personality traits, and social and occupational functioning. J Anxiety Disord 14:395–411CrossRefGoogle Scholar
  70. Ward MF, Wender PH, Reimherr FW (1993) The Wender Utah rating scale: an aid in the retrospective diagnosis of childhood Attention Deficit Hyperactivity Disorder. Am J Psychiatry 150:885–890CrossRefGoogle Scholar
  71. Weiss M, Gibbins C, Hunter JD (2011) Attention- deficit hyperactivity disorder and anxiety disorder in adults. In: Buitelaar JK, Kan CC, Asherson P (eds) ADHD in adults, chapter 11. Cambridge University Press, Cambridge, UK, pp 130–137CrossRefGoogle Scholar
  72. Young SJ (2005) Coping strategies used by ADHD adults. Pers Individ Dif 38:809–816CrossRefGoogle Scholar
  73. Yuce M, Zoroglu SS, Ceylan MF et al (2013) Psychiatric comorbidity distribution and diversities in children and adolescents with attention deficit/hyperactivity disorder: a study from Turkey. J Neuropsychiat Dis Treat 9:1791–1799CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Caner Yoldas
    • 1
  • Bilge Dogan
    • 1
  • Oktay Kocabas
    • 2
  • Cagdas Oyku Memis
    • 1
  • Doga Sevincok
    • 3
  • Levent Sevincok
    • 1
    Email author
  1. 1.Department of PsychiatryAdnan Menderes UniversityAydinTurkey
  2. 2.Psychiatry ServiceTurhal State HospitalTokatTurkey
  3. 3.Department of Child and Adolescent PsychiatryAdnan Menderes UniversityAydinTurkey

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