Social Phobia and Avoidant Personality Disorder: Comorbidity and Clinical-Diagnostic Problems (Analytical Review)



When assessing social phobia and avoidant personality disorder, a number of researchers consider their comorbidity in the continuum of social anxiety and avoidance within a single mental disorder. Based on the analysis and generalization of research data, it is shown that social phobia and avoidant personality disorder have close clinical and pathogenetic links, but very differentiated depending on the contribution of biological, socio-psychological and environmental factors to the formation of pathology. At the present stage of studying the problem, it is premature to talk about the existence of a single mental disorder or its alternative conceptualization. The directions for further study of comorbid relationships associated with the search for markers of differences between avoidant personality disorder and social phobia in the form of biological, personality, cognitive and behavioral (avoidant behavior) parameters are proposed. The study of these markers in dynamics, as well as in the context of the influence of environmental and sociocultural factors, seems promising. The data obtained in the course of further research will be in demand in therapeutic practice.

General Information

Keywords: social phobia, social-anxiety disorder, avoidant personality disorder, comorbidity

Journal rubric: Theoretical Research

Article type: scientific article


For citation: Didenko A.V., Aksenov M.M., Alenina O.K. Social Phobia and Avoidant Personality Disorder: Comorbidity and Clinical-Diagnostic Problems (Analytical Review) [Elektronnyi resurs]. Klinicheskaia i spetsial'naia psikhologiia = Clinical Psychology and Special Education, 2020. Vol. 9, no. 4, pp. 1–20. DOI: 10.17759/cpse.2020090401. (In Russ., аbstr. in Engl.)


  1. Gilenko M.V., Vandysh-Bubko V.V. Komorbidnost' psikhicheskikh rasstroistv: istoriya razvitiya vzglyadov na problemu, opredelenie, klassifikatsii (analiticheskii obzor) [Comorbidity of mental disorders: the history of the development of views on the problem, definition, classification (analytical review)]. Rossiiskii psikhiatricheskii zhurnal=Russian Psychiatric Journal, 2011, no. 4, pp. 73–78 (In Russ., abstr. in Engl.).
  2. Sagalakova O.A., Truevtsev D.V. Sotsial'noe trevozhnoe rasstroistvo v strukture lichnostno-anomal'nogo sindroma: kognitivnye skhemy i narushenie selektivnosti vnimaniya [Social anxiety disorder in the structure of personality-abnormal syndrome: cognitive patterns and impaired attention selectivity]. Izvestiya Altaiskogo gosudarstvennogo universiteta. Seriya: Pedagogika i psikhologiya=News of the Altai State University. Series: Pedagogy and psychology, 2011, no. 2-1. URL: /2-1/psyh/TheNewsOfASU-2011-2-1-psyh-04.pdf (Accessed: 03.06.2020). (In Russ., abstr. in Engl.).
  3. Sagalakova O.A., Truevcev D.V., Stojanova I.Ja. Sindrom social'noj fobii i ego psihologicheskoe soderzhanie [Social phobia syndrome and its psychological content]. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova=Journal of Neurology and Psychiatry.
    S.S. Korsakov
    , 2017, vol. 117, no. 4, pp. 15–22. DOI: 10.17116/jnevro20171174115-22.
    (In Russ., abstr. in Engl.)
  4. Smulevich A.B. Psikhopatologicheskie obrazovaniya i rasstroistva lichnosti
    (k probleme dinamiki psikhopatii) [Psychopathological formations and personality disorders (to the problem of dynamics of psychopathies)]. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova=Journal of Neurology and Psychiatry. S.S. Korsakov, 2000, no. 6, pp. 8–13. (In Russ., abstr. in Engl.).
  5. Smulevich A.B. Psikhopatologiya lichnosti i komorbidnykh rasstroistv: uchebnoe posobie [Psychopathology of personality and comorbid disorders]. Moscow: MEDpress-inform, 2009. 208 p.
  6. Kholmogorova A.B., Garanyan N.G. Mnogofaktornaya model' depressivnykh, trevozhnykh i somatoformnykh rasstroistv=Multifactor model of depressive, anxiety, and somatoform disorders. Sotsial'naya i klinicheskaya psikhiatriya=Social and Clinical Psychiatry, 1998, vol. 8, no. 1, pp. 94–102. (In Russ., abstr. in Engl.).
  7. Chugunov D.A. Kliniko-dinamicheskaya kharakteristika fobii u bol'nykh psikhiatricheskogo statsionara. Diss. kand. med. nauk. [Clinical and dynamic characteristics of phobias in psychiatric hospital patients. PhD. (Medicine) diss.]. Moscow, 2018. 242 p. (In Russ.)
  8. Yastrebov D.V. Sotsial'naya fobiya i sensitivnye idei otnosheniya (klinika i terapiya). Avtoref. diss. kand. med. nauk. [Social phobia and sensitive relationship ideas (clinic and therapy) Ph. D. (Medicine) Thesis]. Moscow, 2000. 17 p. (In Russ.)
  9. American Psychiatric Association. (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: APA, 2013, 991 p.
  10. Caster J.B., Inderbitzen H.M., Hope D. Relationship between youth and parent perceptions of family environment and social anxiety. Journal of Anxiety Disorders, 1999, vol. 13, pp. 237–251. DOI: 10.1016/S0887-6185(99)00002-X
  11. Chambless D.L., Fydrich T., Rodebaugh T.L. Generalized social phobia and avoidant personality disorder: Meaningful distinction or useless duplication? Depression and Anxiety, 2008, vol. 25, pp. 8–19. DOI:10.1002/da.20266
  12. Chartier M.J., Walker J.R., Stein M.B. Social phobia and potential childhood risk factors in a community sample. Psychological Medicine, 2001, vol. 31, pp. 307–315. DOI: 10.1017/S0033291701003348
  13. Cloninger C.R., Przybeck T.R., Svrakic D.M. et al. Configural Analysis of the TCI: Classification and Description of Profile Types. In C.R. Cloninger, T.R. Przybeck, D.M. Svrakic, R.D. Wetzel (eds.), The Temperament and Character Inventory (TCI): A guide to its development and use. St. Louis: Washington University Center for Psychobiology of Personality, 1994, pp. 19–28.
  14. Cloninger C.R., Svrakic D.M., Przybeck T.R. A psychobiological model of temperament and character. Archives of General Psychiatry, 1993, vol. 50, pp. 975–990. DOI: 10.1001/archpsyc.1993.01820240059008
  15. Crome E., Grove R., Baillie A.J. et al. DSM-IV and DSM-5 social anxiety disorder in the Australian community. Australian and New Zealand Journal of Psychiatry, 2015, vol. 49, no. 3, pp. 227–235. DOI: 10.1177/0004867414546699
  16. Eikenaes I., Hummelen B., Abrahamsen G. et al. Personality functioning in patients with avoidant personality disorder and social phobia. Journal Personal Disorders, 2013,
    vol. 27, no. 6, pp. 746–763. DOI:10.1521/pedi_2013_27_109
  17. Feske U., Perry K.J., Chambless D.L. et al. Avoidant personality disorder as a predictor for treatment outcome among generalized social phobics. Journal of Personality Disorders, 1996, vol. 10, pp. 174–184. DOI: 10.1521/pedi.1996.10.2.174
  18. Frandsen F.W., Simonsen S., Poulsen S. et al. Social anxiety disorder and avoidant personality disorder from an interpersonal perspective. Psychology and Psychotherapy, 2020, vol. 93, no. 1, pp. 88–104. DOI: 10.1111/papt.12214
  19. Gilboa-Schechtman E.A Dual-System Model of social anxiety disorder: The interplay of the social-rank and affiliation biopsychosocial systems. Clinical Psychology and Special Education, 2020, vol. 9, no. 3. pp. 15–33. DOI: 10.17759/cpse.2020090302
  20. Goldberg L.R. An alternative “description of personality”: The Big-Five factor structure. Journal of Personality and Social Psychology, 1990, vol. 59, no. 6, pp. 1216–1229. DOI: 10.1037/0022-3514.59.6.1216
  21. Heimberg R., Horner K.J., Juster H.R. et al. Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine, 1999, vol. 29, pp. 199–212. DOI: 10.1017/ s0033291798007879
  22. Heimberg R.G., Hofmann S.G., Liebowitz M.R. et al. Social anxiety disorder in DSM-5. Depression and Anxiety, 2014, vol. 31, no. 6, pp. 472–479. DOI: 10.1002/da.22231
  23. Henderson L.E., Zimbardo P.G. Shyness, social anxiety, and social phobia. In S. Hofmann, P. di Bartolo (eds.), Social Anxiety: Clinical, Developmental, and Social Perspectives: Second Edition. New York: Elsevier, 2010, pp. 65–76. DOI: 10.1016/B978-0-12-375096-9.00003-1
  24. Hopwood C.J., Schade N., Krueger R.F. et al. Connecting DSM-5 Personality Traits and Pathological Beliefs: Toward a Unifying Model. Journal of Psychopathology and Behavioral Assessment, 2013. Vol. 35, pp. 162–172. DOI: 10.1007/s10862-012-9332-3
  25. Hummelen B., Wilberg T., Pedersen G. et al. The relationship between avoidant personality disorder and social phobia. Comprehensive Psychiatry, 2007, vol. 48, pp. 348–356. DOI: 10.1016/j.comppsych.2007.03.004
  26. Huppert J.D, Strunk D.R., Ledley D.R. et al. Generalized social anxiety disorder and avoidant personality disorder: structural analysis and treatment outcome. Depression and Anxiety, 2008, vol. 25, no. 5, pp. 441–448. DOI: 10.1002/da.20349
  27. Isomura K., Boman M., Rück C. et al. Population-based, multi-generational family clustering study of social anxiety disorder and avoidant personality disorder. Psychological Medicine, 2015, vol. 45, no. 8, pp. 1581–1589. DOI: 10.1017/S0033291714002116
  28. Keller M., Lavori P.W., Friedman B. et al. The Longitudinal Interval Follow-up Evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 1987, vol. 44, pp. 540–548. DOI: 10.1001/archpsyc. 1987.01800180050009
  29. Kotov R., Gamez W., Schmidt F. et al. Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 2010, vol. 136, pp. 768–821. DOI: 10.1037/a0020327
  30. Koyuncu A., İnce E., Ertekin E. et al. Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs Context, 2019, vol. 8, no. 212573. DOI: 10.7573/dic.212573
  31. Lampe L., Malhi G.S. Avoidant personality disorder: current insights. Psychology Research and Behavior Management, 2018, vol. 8, no. 11, pp. 55–66. DOI: 10.2147/ PRBM.S121073
  32. Liebowitz M.R., Heimberg R.G., Fresco D.M. et al. Social phobia or social anxiety disorder: what's in a name? Archives of General Psychiatry, 2000, vol. 57, pp. 191–192. DOI: 10.1001/archpsyc.57.2.191-a
  33. Magee W.J. Effects of negative life experiences on phobia onset. Social Psychiatry and Psychiatric Epidemiology, 1999, vol. 34, pp. 343–351. DOI: 10.1007/s001270050154
  34. Marteinsdottir I., Furmark T., Tillfors M. et al. Personality traits in social phobia. European Psychiatry, 2001, vol. 16, pp. 143–150. DOI: 10.1016/S0924-9338(01)00555-7
  35. Marteinsdottir I., Tillfors M., Furmark T. et al. Personality dimensions measured by the Temperament and Character Inventory (TCI) in subjects with social phobia. Nordic Journal of Psychiatry, 2003, vol. 57, pp. 29–35. DOI: 10.1080/08039480310000239
  36. Millon T. Disorders of Personality: Introducing a DSM/ICD Spectrum from normal to abnormal, 3rd ed. New Jersey: John Wiley and Sons, 2011. 1105 p.
  37. O'Day E.B., Morrison A.S., Goldin P.R. et al. Social anxiety, loneliness, and the moderating role of emotion regulation. Journal of Social and Clinical Psychology, 2019, vol. 38, no. 9, pp. 751–773. DOI: 10.1521/jscp.2019.38.9.751.
  38. Pelissolo A. Anxiety: personality, life style or illness? L Encéphale, 1998, vol. 24, no. 3, pp. 247–251.
  39. Rahm-Knigge R.L., Prince M.A., Conner B.T. Social interaction anxiety and personality traits predicting engagement in health risk sexual behaviors. Journal of Anxiety Disorders, 2018, vol. 57, pp. 57–65. DOI: 10.1016/j.janxdis.2018.05.002.
  40. Ralevski E., Sanislow C.A., Grilo C.M. et al. Avoidant personality disorder and social phobia: distinct enough to be separate disorders? Acta Psychiatrica Scandinavica, 2005, vol. 112, pp. 208–214. DOI: 10.1111/j.1600-0447.2005.00580.x
  41. Reichborn-Kjennerud T., Czajkowski N., Torgersen S. et al. The relationship between avoidant personality disorder and social phobia: a population based twin study. American Journal of Psychiatry, 2007, vol. 164, pp. 1722–1728. DOI: 10.1176/appi.ajp. 2007.06101764
  42. Rettew D. Avoidant personality disorder, generalized social phobia, and shyness: putting the personality back into personality disorders. Harvard Review of Psychiatry, 2000, vol. 8, pp. 283–297. DOI: 10.1093/hrp/8.6.283
  43. Romano M., Moscovitch D.A., Huppert J.D. et al. The effects of imagery rescripting on memory outcomes in social anxiety disorder. Journal of Anxiety Disorders, 2020, vol. 69, no. 102169. DOI: 10.1016/j.janxdis.2019.102169.
  44. Romano M., Moscovitch D.A., Ma R. et al. Social problem solving in social anxiety disorder. Journal of Anxiety Disorders, 2020, vol. 68, pp. 1–9. DOI: 10.1016/j.janxdis. 2019.102152.
  45. Santoft F., Salomonsson S., Hesser H. et al. Processes in cognitive behavior therapy for social anxiety disorder: Predicting subsequent symptom change. Journal of Anxiety Disorders, 2019, vol. 67, no. 102118. DOI: 10.1016/j.janxdis.2019.102118.
  46. Savoia M.G., de Barros Neto T.P., Vianna A.M. et al. Evaluation of personality traits in social phobia patients. Revista de Psiquiatria Clínica, 2009, vol. 37, no. 2, pp. 57–59.
  47. Schneier F., Goldmark J. Social anxiety disorder. In D.J. Stein, B. Vythilingum (eds.), Anxiety Disorders and Gender. Cham: Springer International Publishing Switzerland, 2015, pp. 49–57. DOI: 10.1007/978-3-319-13060-6_3
  48. Shin K.E., Newman M.G. Self- and other-perceptions of interpersonal problems: Effects of generalized anxiety, social anxiety, and depression. Journal of Anxiety Disorders, 2019, vol. 65, pp. 1–10. DOI: 10.1016/j.janxdis.2019.04.005
  49. Simon N.M., Otto M.W., Korbly N.B. et al. Quality of life in social anxiety disorder compared with panic disorder and the general population. Psychiatric Services, 2002,
    vol. 53, no. 6, pp. 714–718. DOI: 10.1176/
  50. Solomonov N., Kuprian N., Zilcha-Mano S., et al. Comparing the interpersonal profiles of obsessive-compulsive personality disorder and avoidant personality disorder: Are there homogeneous profiles or interpersonal subtypes? Personality Disorders, 2020, vol. 11, no. 5, pp. 348–356. DOI: 10.1037/per0000391
  51. Sørensen K.D., Råbu M., Wilberg T. et al. Struggling to be a person: Lived experience of avoidant personality disorder. Journal of Clinical Psychology, 2019, vol. 75, no. 4, pp. 664–680. DOI: 10.1002/jclp.22740
  52. Sørensen K.D., Wilberg T., Berthelsen E. et al. Subjective experience of the origin and development of avoidant personality disorder. Journal of Clinical Psychology, 2020, vol. 76, no. 12, pp. 2232–2248. DOI: 10.1002/jclp.23013
  53. Stein M.B., Chartier M.J., Hazen A.L. et al. A direct-interview family study of generalized social phobia. American Journal of Psychiatry, 1998, vol. 155, no. 1, pp. 90–97. DOI: 10.1176/ajp.155.1.90
  54. Storch E., Roth D., Coles M.E. et al. The measurement and impact of childhood teasing in a sample of young adults. Journal of Anxiety Disorders, 2004, vol. 18, pp. 681–694. DOI: 10.1016/j.janxdis.2003.09.003
  55. Torvik F.A., Welander-Vatn A., Ystrom E. et al. Longitudinal associations between social anxiety disorder and avoidant personality disorder: a twin study. Journal of Abnormal Psychology, 2016, vol. 125, no. 1, pp. 114–124. DOI: 10.1037/abn0000124
  56. Weeks J.W., Howell A.N., Srivastav A. et al. “Fear guides the eyes of the beholder”: Assessing gaze avoidance in social anxiety disorder via covert eye tracking of dynamic social stimuli. Journal of Anxiety Disorders, 2019, vol. 65, pp. 56–63. DOI: 10.1016/ j.janxdis.2019.05.005
  57. Weiller E., Bisserbe J.C., Boyer P. et al. Social phobia in general health care: An unrecognised undertreated disabling disorder. The British Journal of Psychiatry, 1996,
    vol. 168, no. 2, pp. 169–174. DOI: 10.1192/bjp.168.2.169
  58. Welander-Vatn A., Torvik F.A., Czajkowski N. et al. Relationships among avoidant personality disorder, social anxiety disorder, and normative personality traits: A twin study. Journal of Personality Disorders, 2018, vol. 32, pp. 1–21. DOI: 10.1521/pedi_2018 _32_341
  59. Wong Q.J.J., McEvoy P.M., Rapee R.M. The structure of social-evaluative threat detection in social anxiety disorder. Journal of Anxiety Disorders, 2020, vol. 74, no. 102273. DOI: 10.1016/j.janxdis.2020.102273.

Information About the Authors

Alexander V. Didenko, Doctor of Medicine, Associate Professor, Leading Researcher, Department of the Borderline States of the Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Professor of the Department of Psychiatry, Narcology and Psychotherapy of the Siberian State Medical University, Tomsk, Russia, ORCID:, e-mail:

Mikhail M. Aksenov, Doctor of Medicine, Professor, scientific leader of the Department of Borderline States of the Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia, ORCID:, e-mail:

Olesya K. Alenina, psychiatrist of the Department of Borderline States of the Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia, ORCID:, e-mail:



Total: 1865
Previous month: 54
Current month: 59


Total: 752
Previous month: 12
Current month: 16