Social anxiety in the context of the alternative DSM-5 model of personality disorder

Section-III of DSM-5 introduced an alternative model of personality disorder (AMPD) including both personality dysfunction and maladaptive-range traits. This study clarified relations of social anxiety symptoms, social anxiety disorder (SAD), and Section-II avoidant personality disorder (APD) with AMPD personality pathology.

Adults (N = 600; including mental-health outpatients and non-patients at risk for personality pathology) completed self-report and interviewer-rated measures of social anxiety and AMPD constructs, including self and interpersonal functioning and trait negative affectivity, detachment, disinhibition, antagonism, and psychoticism. Most participants (n = 497) completed reassessment, on average 8 months later. We examined convergence of social anxiety with personality pathology, as well as prediction of longitudinal changes in social anxiety from baseline personality and vice versa. We focused on results replicating across self-reported social anxiety symptoms, interviewer-rated SAD and APD criterion counts, and self- and interviewer-rated personality.

Concurrently, social anxiety related to higher negative affectivity, detachment, self dysfunction, and interpersonal dysfunction. Of these, the latter three dimensions predicted increases in social anxiety longitudinally. Social anxiety did not predict longitudinal changes in personality pathology as consistently.

Generalization of findings to other populations, settings, and methods, such as adolescents, primary care, or direct observation, is uncertain. Longitudinal analyses suggested causality but could not establish it.

The AMPD enriches description of current social anxiety and prediction of changes in social anxiety. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, may identify targets for prevention or treatment of social anxiety, to be tested in future research.