A 34-year-old woman experiences marked fear and avoidance of social situations in which she might be scrutinised or embarrassed. She avoids parties, public speaking, and eating in restaurants. Symptoms have been present since adolescence and cause significant occupational limitations. Which of the following distinguishes social anxiety disorder from avoidant personality disorder?

• A Avoidant personality disorder always includes paranoid ideation, while social anxiety disorder does not
• B Social anxiety disorder cannot co-exist with avoidant personality disorder
• C Social anxiety disorder is focused on fear of evaluation in performance or social situations, while avoidant personality disorder represents a pervasive pattern of inhibition and feelings of inadequacy across all areas ✓
• D Avoidant personality disorder responds well to SSRIs while social anxiety disorder does not

Explanation

Social anxiety disorder and avoidant personality disorder share substantial phenomenological overlap and can co-occur; the generalised specifier of social anxiety disorder (fear in most social situations) has the highest comorbidity with avoidant personality disorder. The conceptual distinction is that social anxiety disorder centres on situational fears of negative evaluation, whereas avoidant personality disorder is a deeply ingrained, pervasive pattern of social inhibition, inferiority feelings, and hypersensitivity that pervades all areas of life. Both respond to SSRIs and CBT, though personality disorder features may require longer-term treatment.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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