In the DSM system social phobia and avoidant personality have been conceptualized as independent entities. Each had separate, if overlapping diagnostic criteria. The specific inclusion and exclusion criteria provided by DSM allowed empirical research to guide future revisions. This review evaluates the empirical literature and evolution of the concepts of these diagnoses from DSM-III to DSM-IIR to DSM-IV. The empirical evidence leads us to the conclusion that there is no dividing line between social phobia and avoidant personality disorder. In addition to their being no dividing line diagnostically between the disorders, there appears to be no separation of the two by treatment techniques. This raises interesting questions about how we differentiate Axis I from Axis II disorders. Suggestions for revisions of the social phobia and avoidant personality disorder categories are given.

The purpose was to assess personality traits in subjects with a DSM-IV diagnosis of social phobia. Thirty-two subjects were administered the Structured Clinical Interview for DSM-IV for Axes I and II disorders (SCID I and II). Personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Current and lifetime axis I co-morbidity was diagnosed in 28% and 53% of the subjects, respectively. In total, 59% had at least one personality disorder and 47% were diagnosed with an avoidant personality disorder.

The social phobics scored significantly higher than a Swedish normative sample on the KSP measuring anxiety proneness, irritability, detachment, and indirect aggression but lower on the scales for socialisation and social desirability. The presence as compared to absence of avoidant personality disorder in the social phobics was associated with significantly higher psychic anxiety and inhibition of aggression. In addition, symptom severity was higher in social phobics with an avoidant personality disorder. Generally, the results support the view that social phobia and avoidant personality disorder reflect different aspects of a social anxiety spectrum.

A 25-year-old man with DSM-IV-TR Axis I social phobia and Axis II avoidant personality disorder and erectile dysfunction, presenting with depression, anxiety and insomnia, responded partially to extended release oral venlafaxine (75 mg/die for 6 weeks), but developed side effects and worsening symptoms when dose was increased to 150 mg/die; he responded to a combination of 75 mg/die venlafaxine and 4 mg/die reboxetine and improved on most of his symptoms.

The study investigated if the degree of personality pathology among people with clinical levels of social anxiety disorder was similar to those with personality disorders more generally, if the degree of avoidant personality pathology was correlated positively with Neuroticism and negatively with Extraversion and facets of Agreeableness (particularly Trust), and finally if scores on the relevant personality dimensions improve from pre- to post-treatment. Changes in Neuroticism, Extraversion, and Agreeableness were examined following group treatment for social anxiety disorder. The current study employed a within-subjects repeated-measures design (N = 25) to investigate whether these traits can be changed by group treatment for social anxiety disorder. A measure of personality disorder pathology was found to correlate positively with Neuroticism and negatively with Agreeableness in the absence of significant relationships with other Five-Factor Model traits. Treatment was associated with significant reductions in Neuroticism and there was significant improvement of the Trust facet of Agreeableness. These results are discussed in terms of the way that group treatment for Social Anxiety Disorder may be enhanced.