Je. Alpert et al., SOCIAL PHOBIA, AVOIDANT PERSONALITY-DISORDER AND ATYPICAL DEPRESSION - COOCCURRENCE AND CLINICAL IMPLICATIONS, Psychological medicine, 27(3), 1997, pp. 627-633
Background. Increasing attention has been directed in recent years to
the detection and treatment of psychiatric co-morbidity among depresse
d individuals. The overlap of social phobia (SP) and avoidant personal
ity disorder (APD) has been well recognized and a relationship between
these disorders and depression has been suggested. Methods. The patte
rn and clinical implications of co-morbidity of SP and APD with major
depressive disorder (MDD), diagnosed by DSM-III-R criteria, were studi
ed 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 s
ocial phobia or avoidant personality disorder met criteria for both (S
P+APD). Depressed adults who met criteria for both SP+APD exhibited a
significantly higher proportion of atypical depression (54.8%) compare
d 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 comorbid Axis I diagnoses, a
nd greater impairment of social adjustment and assertiveness. Conclusi
ons. Results confirm the overlap of SP and APD in a depressed populati
on and the high prevalence of these disorders in MDD. They suggest tha
t depressed individuals with both SP and APD but not SP alone are at p
articularly high risk for atypical depression and for social dysfuncti
on in excess of that caused by a current major depression.