Social phobia, avoidant personality disorder and atypical depression: Co-occurrence and clinical implications

Jonathan E. Alpert, L. A. Uebelacker, N. E. McLean, A. A. Nierenberg, J. A. Pava, J. J. Worthington, J. R. Tedlow, J. F. Rosenbaum, M. Fava

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Background. Increasing attention has been directed in recent years to the detection and treatment of psychiatric co-morbidity among depressed individuals. The overlap of social phobia (SP) and avoidant personality disorder (APD) has been well recognized and a relationship between these disorders and depression has been suggested. Methods. The pattern and clinical implications of co-morbidity of SP and APD with major depressive disorder (MDD), diagnosed by DSM-III-R criteria, were studied among 243 out-patients presenting with depression. Results. Overall, 26.7% of adults in our sample with MDD met criteria for SP and 28.4% for APD. Almost two-thirds of depressed adults meeting criteria for social phobia or avoidant personality disorder met criteria for both (SP + APD). Depressed adults who met criteria for both SP + APD exhibited a significantly higher proportion of atypical depression (54.8%) compared with those with neither SP nor APD (31.1%). Among depressed patients, the co-occurrence of SP with APD was also associated with an earlier age of onset of MDD, a greater number of co-morbid Axis I diagnoses, and greater impairment of social adjustment and assertiveness. Conclusions. Results confirm the overlap of SP and APD in a depressed population and the high prevalence of these disorders in MDD. They suggest that depressed individuals with both SP and APD but not SP alone are at particularly high risk for atypical depression and for social dysfunction in excess of that caused by a current major depression.

Original languageEnglish (US)
Pages (from-to)627-633
Number of pages7
JournalPsychological Medicine
Volume27
Issue number3
DOIs
StatePublished - May 1997
Externally publishedYes

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Personality Disorders
Depression
Major Depressive Disorder
Social Phobia
Assertiveness
Morbidity
Social Adjustment
Age of Onset
Diagnostic and Statistical Manual of Mental Disorders
Psychiatry
Outpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Psychology(all)
  • Clinical Psychology

Cite this

Alpert, J. E., Uebelacker, L. A., McLean, N. E., Nierenberg, A. A., Pava, J. A., Worthington, J. J., ... Fava, M. (1997). Social phobia, avoidant personality disorder and atypical depression: Co-occurrence and clinical implications. Psychological Medicine, 27(3), 627-633. https://doi.org/10.1017/S0033291797004765

Social phobia, avoidant personality disorder and atypical depression : Co-occurrence and clinical implications. / Alpert, Jonathan E.; Uebelacker, L. A.; McLean, N. E.; Nierenberg, A. A.; Pava, J. A.; Worthington, J. J.; Tedlow, J. R.; Rosenbaum, J. F.; Fava, M.

In: Psychological Medicine, Vol. 27, No. 3, 05.1997, p. 627-633.

Research output: Contribution to journalArticle

Alpert, JE, Uebelacker, LA, McLean, NE, Nierenberg, AA, Pava, JA, Worthington, JJ, Tedlow, JR, Rosenbaum, JF & Fava, M 1997, 'Social phobia, avoidant personality disorder and atypical depression: Co-occurrence and clinical implications', Psychological Medicine, vol. 27, no. 3, pp. 627-633. https://doi.org/10.1017/S0033291797004765
Alpert, Jonathan E. ; Uebelacker, L. A. ; McLean, N. E. ; Nierenberg, A. A. ; Pava, J. A. ; Worthington, J. J. ; Tedlow, J. R. ; Rosenbaum, J. F. ; Fava, M. / Social phobia, avoidant personality disorder and atypical depression : Co-occurrence and clinical implications. In: Psychological Medicine. 1997 ; Vol. 27, No. 3. pp. 627-633.
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