Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome

There has been considerable controversy about whether generalized social phobia (GSP) and avoidant personality disorder (APD) are redundant diagnostic categories. In light of the ongoing controversy, more data are needed to help determine whether GSP and APD are independent constructs. Data were obtained from 335 people seeking treatment for GSP at a two site clinical trial. Indicators of GSP and APD were obtained along with assessments of demographic factors, level of functioning, and indicators of related psychopathology. Confirmatory factor analyses of indicators of GSP and APD suggested a somewhat better fit for a two-factor solution. Comparisons of GSP patients with and without APD suggested that in addition to having more severe social phobia symptoms, patients with APD were more depressed on a self-report measure and had more functional impairment, thereby suggesting potential utility of the diagnostic category of APD. Furthermore, the presence of APD predicted treatment response, in that patients with APD had more change early in treatment than those without APD. APD and GSP remain highly related constructs, and different aspects of these data support and dispute the utility of the diagnosis of APD in GSP. Possible new directions in conceptualizing APD are discussed.