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Attachment styles in patients with avoidant personality disorder compared with social phobia

Ingeborg Eikenaes¹, Geir Pedersen², Theresa Wilberg³

¹Division of Mental Health and Addiction, Department of Group Psychotherapy, Vestfold Hospital Trust, Tønsberg, Norway.

Psychology and Psychotherapy

|September 3, 2015

Abstract

Objectives:

Avoidant personality disorder (AvPD) and social phobia (SP) are common, closely related conditions. Little is known about the underlying processes related to the social discomfort of subjects with AvPD and SP. Both disorders are associated with interpersonal problems. An attachment perspective may shed light on similarities and differences in close relationships between the disorders. The aim of the study was to compare self-reported attachment styles in patients with AvPD and SP. We expected that patients with AvPD would have more attachment anxiety and avoidance and more often a Fearful attachment style, compared with SP.

Design:

This is a cross-sectional multisite study of 90 adult patients with AvPD and SP. Patients with AvPD with and without SP (AvPD group) were compared with patients with SP without AvPD (SP group).

Methods:

Patients were assessed using structured diagnostic interviews and self-reporting questionnaires, including Experiences in Close Relationships (ECR). The ECR dimensions, Anxiety and Avoidance, and the new described five factors of the ECR were used.

Results:

The AvPD group had higher levels of attachment anxiety than the SP group, especially for the sub-factors Anxiety for abandonment and Separation frustration. The diagnostic groups did not differ in levels of avoidance. Anxiety for abandonment was still associated with AvPD after controlling for symptom disorders and the criteria of other personality disorders. A Fearful attachment style was more frequent among patients with AvPD.

Conclusions:

The results indicate AvPD is associated with more attachment anxiety than SP. Fear of abandonment may play a significant role in the AvPD pathology.

Practitioner Points:

This is the first study to compare attachment styles in patients with avoidant personality disorder (AvPD) and social phobia (SP). The AvPD group had higher attachment-related anxiety than the SP group, and anxiety was most pronounced for the fear of abandonment. Fear of abandonment may play an important role in the AvPD pathology.

Keywords:

Experience in Close Relationships attachment attachment anxiety avoidant personality disorder fear of abandonment social phobia

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