SOCIAL PHOBIA, AVOIDANT PERSONALITY-DISORDER AND ATYPICAL DEPRESSION - COOCCURRENCE AND CLINICAL IMPLICATIONS

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.