Good clinical practices for avoidant personality disorder

Journal title QUADERNI DI PSICOTERAPIA COGNITIVA
Author/s Ilario Mammone, Giancarlo Dimaggio
Publishing Year 2023 Issue 2023/52
Language Italian Pages 25 P. 72-96 File size 0 KB
DOI 10.3280/qpc52-2023oa16175
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This review focuses on the diagnostic aspects of and the treatments for Avoidant Personality Disorder (AvPD). Current studies underline the close relationship between AvPD and social anxiety disorder and the stability of symptoms as well as the social and economic impact of the disorder. Although little empirical evidence exists, data in favor of psychotherapeutic interventions appear to be promising. Particularly encouraging are findings from cognitive-behavioral orientation therapies, including third wave ones. While studies on patients with severe AvPD are appearing, sufficiently powered randomized controlled trials are still lacking. The available evidence suggests some medium to long term goals to be pursued, that is overcoming patterns of inhibition and social withdrawal, regulating feelings of inadequacy and sensitivity to social criticism, and tackling rejection sensitivity. sustaining reflexive and metacognitive capacities and interrupting repetitive thinking is also suggested. We currently know that AvPD is a disorder with serious symptom comorbidity and social problems, and larger randomized clinical trials are urgently needed to advance our understanding on how to best treat it.

Keywords: ; Avoidant Personality Disorder; social withdrawal; guidelines; psychotherapy

  1. Benjamin, L. (2003). Interpersonal diagnosis and treatment of personality disorders. New York: Guildford.
  2. Alden, L. (1989). Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology, 57(6): 756-764. DOI: 10.1037//0022-006x.57.6.756.
  3. Alden, L.E. & Capreol, M.J. (1993). Avoidant personality disorder: Interpersonal problems as predictors of treatment response. Behavior Therapy, 24(3): 357-376. DOI: 10.1016/S0005-7894(05)80211-4.
  4. Alden, L.E., Laposa, J.M., Taylor, C.T. & Ryder, A.G. (2002). Avoidant personality disorder: current status and future directions. Journal of Personality Disorders, 16(1): 1-29. DOI: 10.1521/pedi.16.1.1.22558.
  5. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (DSM-5). Washington, DC: American Psychiatric Publishing.
  6. Ansell, E.B., Pinto, A., Edelen, M.O., Markowitz, J.C., Sanislow, C.A., Yen, S., Zanarini, M., Skodol, A.E., Shea, M.T., Morey, L.C., Gunderson, J.G., McGlashan, T.H. & Grilo, C.M. (2011). The association of personality disorders with the prospective 7-year course of anxiety disorders. Psychological Medicine, 41(5): 1019-1028. DOI: 10.1017/S0033291710001777.
  7. Arntz, A. (1999). Do personality disorders exist? On the validity of the concept and its cognitive-behavioral formulation and treatment. Behaviour Research and Therapy, 37 Suppl 1: S97-134. DOI: 10.1016/s0005-7967(99)00052-2.
  8. Arntz, A. (2012a). Schema Therapy for Cluster C Personality Disorders (pp. 397-414). In: The Wiley-Blackwell Handbook of Schema Therapy. Hoboken: John Wiley & Sons, Ltd. DOI: 10.1002/9781119962830.ch30.
  9. Arntz, A. (2012b). Imagery Rescripting as a Therapeutic Technique: Review of Clinical Trials, Basic Studies, and Research Agenda. Journal of Experimental Psychopathology, 3(2): 189-208. DOI: 10.5127/jep.024211.
  10. Bamelis, L.L.M., Arntz, A., Wetzelaer, P., Verdoorn, R. & Evers, S.M.A.A. (2015). Economic evaluation of schema therapy and clarification-oriented psychotherapy for personality disorders: a multicenter, randomized controlled trial. The Journal of Clinical Psychiatry, 76(11): e1432-40. DOI: 10.4088/JCP.14m09412.
  11. Bamelis, L.L.M., Evers, S.M.A.A., Spinhoven, P. & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3): 305-322. DOI: 10.1176/appi.ajp.2013.12040518.
  12. Barber, J.P., Morse, J.Q., Krakauer, I.D., Chittams, J. & Crits-Christoph, K. (1997). Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive-expressive therapy. Psychotherapy, 34(2): 133-143. DOI: 10.1037/h0087774.
  13. Bartak, A., Spreeuwenberg, M.D., Andrea, H., Holleman, L., Rijnierse, P., Rossum, B.V., Hamers, E.F.M., Meerman, A.M.M.A., Aerts, J., Busschbach, J.J.V, Verheul, R., Stijnen, T. & Emmelkamp, P.M.G. (2010). Effectiveness of different modalities of psychotherapeutic treatment for patients with cluster C personality disorders: results of a large prospective multicentre study. Psychotherapy and Psychosomatics, 79(1): 20-30. DOI: 10.1159/000254902.
  14. Baumeister, R.F. & Leary, M.R. (1995). The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3): 497-529.
  15. Beck, A.T., Davis, D.D. & Freeman, A. (Eds.). (2015). Cognitive therapy of personality disorders. In: Progress in behavior modification, vol. 28. New York: Guilford Press. DOI: 10.1176/ajp.149.3.402.
  16. Beckwith, H., Moran, P.F. & Reilly, J. (2014). Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personality and Mental Health, 8(2): 91-101. DOI: 10.1002/pmh.1252.
  17. Cambridge Handbook of Personality Disorders (2020). In The Cambridge Handbook of Personality Disorders. Cambridge: Cambridge University Press.
  18. Carcione, A., Nicolò, G. & Semerari, A. (2016). Curare i Casi Complessi: la terapia metacognitiva interpersonale dei disturbi di personalità. Roma-Bari: Laterza.
  19. Chan, C.C., Bach, P.A. & Bedwell, J.S. (2015). An Integrative Approach Using Third-Generation Cognitive-Behavioral Therapies for Avoidant Personality Disorder. Clinical Case Studies, 14(6): 466-481. DOI: 10.1177/1534650115575788.
  20. Clark, D.M. & Wells, A. (1995). A cognitive model of social phobia (pp. 69-93). In: Heimberg, R.G., Liebowitz, M.R., Hope, D.A. & Schneier, F.R. (eds.), Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press. psycnet.apa.org/record/1995-98887-004.
  21. Coid, J., Yang, M., Tyrer, P., Roberts, A. & Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. The British Journal of Psychiatry : The Journal of Mental Science, 188: 423-431. DOI: 10.1192/bjp.188.5.423.
  22. Colle, L., Pellecchia, G., Moroni, F., Carcione, A., Nicolò, G., Semerari, A. & Procacci, M. (2017). Levels of social sharing and clinical implications for severe social withdrawal in patients with personality disorders. Frontiers in Psychiatry, 8(DEC): 263. DOI: 10.3389/fpsyt.2017.00263.
  23. Cox, B.J., Pagura, J., Stein, M.B. & Sareen, J. (2009). The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey. Depression and Anxiety, 26(4): 354-362. DOI: 10.1002/da.20475.
  24. Cramer, V., Torgersen, S. & Kringlen, E. (2006). Personality disorders and quality of life. A population study. Comprehensive Psychiatry, 47(3): 178-184. DOI: 10.1016/j.comppsych.2005.06.002.
  25. Cramer, V., Torgersen, S. & Kringlen, E. (2007). Socio-demographic conditions, subjective somatic health, Axis I disorders and personality disorders in the common population: the relationship to quality of life. Journal of Personality Disorders, 21(5): 552-567. DOI: 10.1521/pedi.2007.21.5.552.
  26. Crino, R.D. & Andrews, G. (1996). Personality disorder in obsessive compulsive disorder: a controlled study. Journal of Psychiatric Research, 30(1): 29-38. DOI: 10.1016/0022-3956(95)00043-7.
  27. Dalrymple, K.L. (2012). Issues and controversies surrounding the diagnosis and treatment of social anxiety disorder. Expert Review of Neurotherapeutics, 12(8): 993-1008, quiz 1009. DOI: 10.1586/ern.12.81.
  28. Denys, D., Tenney, N., van Megen, H.J.G.M., de Geus, F. & Westenberg, H.G.M. (2004). Axis I and II comorbidity in a large sample of patients with obsessive-compulsive disorder. Journal of Affective Disorders, 80(2-3): 155-162. DOI: 10.1016/S0165-0327(03)00056-9.
  29. Dimaggio, G., D’Urzo, M., Pasinetti, M., Salvatore, G., Lysaker, P.H., Catania, D. & Popolo, R. (2015). Metacognitive interpersonal therapy for co-occurrent avoidant personality disorder and substance abuse. Journal of Clinical Psychology, 71(2): 157-166. DOI: 10.1002/jclp.22151.
  30. Dimaggio, G., MacBeth, A., Popolo, R., Salvatore, G., Perrini, F., Raouna, A., Osam, C.S., Buonocore, L., Bandiera, A. & Montano, A. (2018). The problem of overcontrol: Perfectionism, emotional inhibition, and personality disorders. Comprehensive Psychiatry, 83: 71-78. DOI: 10.1016/j.comppsych.2018.03.005.
  31. Dimaggio, G., Montano, A., Popolo, R. & Salvatore, G. (2013). Terapia Metacognitiva Interpersonale dei Disturbi di Personalità. Milano: Raffaello Cortina.
  32. Dimaggio, G., Ottavi, P., Popolo, R. & Salvatore, G. (2019). Corpo, Immaginazione e Cambiamento. Terapia Metacognitiva Interpersonale. Milano: Raffaello Cortina.
  33. Dimaggio, G., Popolo, R. & Salvatore, G. (2019). Formulation of functioning for avoidant personality disorder in metacognitive interpersonal therapy (pp. 137-160). In: Case Formulation for Personality Disorders: Tailoring Psychotherapy to the Individual Client. Amsterdam: Elsevier. DOI: 10.1016/B978-0-12-813521-1.00008-4.
  34. Dimaggio, G., Procacci, M., Nicolò, G., Popolo, R., Semerari, A., Carcione, A. & Lysaker, P.H. (2007). Poor metacognition in Narcissistic and Avoidant Personality Disorders: four psychotherapy patients analysed using the Metacognition Assessment Scale. Clinical Psychology & Psychotherapy, 14(5): 386-401. DOI: 10.1002/cpp.541.
  35. Dimaggio, G., Salvatore, G., Fiore, D., Carcione, A., Nicolò, G. & Semerari, A. (2012). General principles for treating personality disorder with a prominent inhibitedness trait: towards an operationalizing integrated technique. Journal of Personality Disorders, 26(1): 63-83. DOI: 10.1521/pedi.2012.26.1.63.
  36. Dimaggio, G., Salvatore, G., MacBeth, A., Ottavi, P., Buonocore, L. & Popolo, R. (2017). Metacognitive Interpersonal Therapy for Personality Disorders: A Case Study Series. Journal of Contemporary Psychotherapy, 47(1): 11-21. DOI: 10.1007/s10879-016-9342-7.
  37. Dimaggio, G. & Semerari, A. (2003). I Disturbi di Personalità. Modelli e trattamento Stati mentali, metarappresentazione, cicli interpersonali. Roma-Bari: Laterza.
  38. Drago, A., Marogna, C. & Søgaard, H. (2016). A Review of Characteristics and Treatments of the Avoidant Personality Disorder. Could the DBT be an Option? International Journal of Psychology and Psychoanalysis, 2. DOI: 10.23937/2572-4037.1510013.
  39. Eikenaes, I., Egeland, J., Hummelen, B. & Wilberg, T. (2015). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLoS ONE, 10(3). DOI: 10.1371/journal.pone.0122846.
  40. Eikenaes, I., Hummelen, B., Abrahamsen, G., Andrea, H. & Wilberg, T. (2013). Personality functioning in patients with avoidant personality disorder and social phobia. Journal of Personality Disorders, 27(6): 746-763. DOI: 10.1521/pedi_2013_27_109.
  41. Eikenæs, I., Pedersen, G. & Wilberg, T. (2016). Attachment styles in patients with avoidant personality disorder compared with social phobia. Psychology and Psychotherapy: Theory, Research and Practice, 89(3): 245-260. DOI: 10.1111/papt.12075.
  42. Emmelkamp, P.M.G., Benner, A., Kuipers, A., Feiertag, G.A., Koster, H.C. & van Apeldoorn, F.J. (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. The British Journal of Psychiatry : The Journal of Mental Science, 189: 60-64. DOI: 10.1192/bjp.bp.105.012153.
  43. Eskedal, G.A. & Demetri, J.M. (2006). Etiology and Treatment of Cluster C Personality Disorders. Journal of Mental Health Counseling, 28(1): 1-17. DOI: 10.17744/mehc.28.1.7yjq6tabcexb1a6j.
  44. Eskildsen, A., Hougaard, E. & Rosenberg, N.K. (2010). Pre-treatment patient variables as predictors of drop-out and treatment outcome in cognitive behavioural therapy for social phobia: A systematic review. Nordic Journal of Psychiatry, 64(2): 94-105. DOI: 10.3109/08039480903426929.
  45. Farstad, S., McGeown, L. & von Ranson, K. (2016). Eating Disorders and Personality, 2004-2016: A Systematic Review and Meta-analysis. Clinical Psychology Review, 46: 91-105. DOI: 10.1016/j.cpr.2016.04.005.
  46. Feske, U., Perry, K.J., Chambless, D.L., Renneberg, B. & Goldstein, A.J. (1996). Avoidant personality disorder as a predictor for treatment outcome among generalized social phobics. Journal of Personality Disorders, 10(2): 174-184. DOI: 10.1521/pedi.1996.10.2.174.
  47. Gabbard, G.O. (2014). APA – Psychodynamic Psychiatry in Clinical Practice Fifth Edition. Washington, DC: American Psychiatric Press.
  48. Garyfallos, G., Adamopoulou, A., Karastergiou, A., Voikli, M., Milis, V., Donias, S., Giouzepas, J. & Parashos, A. (1999). Psychiatric comorbidity in Greek patients with generalized anxiety disorder. Psychopathology, 32(6): 308-318. DOI: 10.1159/000029104.
  49. Gilbert, P. (1989). Human Nature And Suffering. New York: Routledge.
  50. Gjerde, L.C., Czajkowski, N., Røysamb, E., Ystrom, E., Tambs, K., Aggen, S.H., Ørstavik, R.E., Kendler, K.S., Reichborn-Kjennerud, T. & Knudsen, G.P. (2015). A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood. Psychological Medicine, 45(16): 3539-3548. DOI: 10.1017/S0033291715001440.
  51. Gordon-King, K., Schweitzer, R.D. & Dimaggio, G. (2018). Metacognitive Interpersonal Therapy for Personality Disorders Featuring Emotional Inhibition: A Multiple Baseline Case Series. Journal of Nervous and Mental Disease, 206(4): 263-269. DOI: 10.1097/NMD.0000000000000789.
  52. Gordon-King, K., Schweitzer, R.D. & Dimaggio, G. (2019). Metacognitive Interpersonal Therapy for Personality Disorders: The Case of a Man with Obsessive–Compulsive Personality Disorder and Avoidant Personality Disorder. Journal of Contemporary Psychotherapy, 49(1): 39-47. DOI: 10.1007/s10879-018-9404-0.
  53. Grant, B.F., Hasin, D.S., Stinson, F.S., Dawson, D.A., Chou, S.P., Ruan, W.J. & Pickering, R.P. (2004). Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. The Journal of Clinical Psychiatry, 65(7): 948-958. DOI: 10.4088/jcp.v65n0711.
  54. Grilo, C.M., Levy, K.N., Becker, D.F., Edell, W.S. & McGlashan, T.H. (1996). Comorbidity of DSM-III-R axis I and II disorders among female inpatients with eating disorders. Psychiatric Services, 47(4): 426-429. DOI: 10.1176/ps.47.4.426.
  55. Gude, T. & Vaglum, P. (2001). One-year follow-up of patients with cluster C personality disorders: a prospective study comparing patients with “pure” and comorbid conditions within cluster C, and “pure” C with “pure” cluster A or B conditions. Journal of Personality Disorders, 15(3): 216-228. DOI: 10.1521/pedi.15.3.216.19210.
  56. Gunderson, J.G., Shea, M.T., Skodol, A.E., McGlashan, T.H., Morey, L.C., Stout, R.L., Zanarini, M.C., Grilo, C.M., Oldham, J.M. & Keller, M.B. (2000). The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics. Journal of Personality Disorders, 14(4): 300-315. DOI: 10.1521/pedi.2000.14.4.300.
  57. Hayes, S.C. & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland: New Harbinger Publications.
  58. Hayes, S.C., Strosahl, K. & Wilson, K.G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.
  59. Heimberg, R. (1996). Social phobia, avoidant personality disorder and the multiaxial conceptualization of interpersonal anxiety. New York: John Wiley & Sons.
  60. Herbert, J.D., Hope, D.A. & Bellack, A.S. (1992). Validity of the distinction between generalized social phobia and avoidant personality disorder. Journal of Abnormal Psychology, 101(2): 332-339. DOI: 10.1037//0021-843x.101.2.332.
  61. Holt, C.S., Heimberg, R.G. & Hope, D.A. (1992). Avoidant personality disorder and the generalized subtype of social phobia. Journal of Abnormal Psychology, 101(2): 318-325. DOI: 10.1037//0021-843x.101.2.318.
  62. Hope, D.A., Herbert, J.D. & White, C. (1995). Diagnostic subtype, avoidant personality disorder, and efficacy of cognitive-behavioral group therapy for social phobia. Cognitive Therapy and Research, 19(4): 399-417. DOI: 10.1007/BF02230408.
  63. Hopwood, C.J., Morey, L.C., Donnellan, M.B., Samuel, D.B., Grilo, C.M., McGlashan, T.H., Shea, M.T., Zanarini, M.C., Gunderson, J.G. & Skodol, A.E. (2013). Ten-year rank-order stability of personality traits and disorders in a clinical sample. Journal of Personality, 81(3): 335-344. DOI: 10.1111/j.1467-6494.2012.00801.x.
  64. Hummelen, B., Wilberg, T., Pedersen, G. & Karterud, S. (2007). The relationship between avoidant personality disorder and social phobia. Comprehensive Psychiatry, 48(4): 348-356. DOI: 10.1016/j.comppsych.2007.03.004.
  65. Inchausti, F., Moreno-Campos, L., Prado-Abril, J., Sánchez-Reales, S., Fonseca-Pedrero, E., MacBeth, A., Popolo, R. & Dimaggio, G. (2020). Metacognitive Interpersonal Therapy in Group for Personality Disorders: Preliminary Results from a Pilot Study in a Public Mental Health Setting. Journal of Contemporary Psychotherapy, 50(3): 197-203. DOI: 10.1007/s10879-020-09453-9.
  66. Johnson, S.M. (2021). La teoria dell’attaccamento in pratica. La terapia focalizzata sulle emozioni EFT nel setting individuale, di coppia e familiare. Miano: FrancoAngeli.
  67. Karterud, S., Pedersen, G., Bjordal, E., Brabrand, J., Friis, S., Haaseth, O., Haavaldsen, G., Irion, T., Leirvåg, H., Tørum, E. & Urnes, O. (2003). Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network. Journal of Personality Disorders, 17(3): 243-262. DOI: 10.1521/pedi.17.3.243.22151.
  68. Kato, T.A., Kanba, S. & Teo, A.R. (2020). Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori. World Psychiatry, 19(1): 116-117. DOI: 10.1002/wps.20705.
  69. Kvarstein, E.H., Arnevik, E., Halsteinli, V., Rø, F.G., Karterud, S. & Wilberg, T. (2013). Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice. BMC Psychiatry, 13: 315. DOI: 10.1186/1471-244X-13-315.
  70. Kvarstein, E.H. & Karterud, S. (2012). Large variations of global functioning over five years in treated patients with personality traits and disorders. Journal of Personality Disorders, 26(2): 141-161. DOI: 10.1521/pedi.2012.26.2.141.
  71. Lampe, L. & Malhi, G.S. (2018). Avoidant personality disorder: current insights. Psychology Research and Behavior Management, 11: 55-66. DOI: 10.2147/PRBM.S121073.
  72. Lampe, L. & Sunderland, M. (2015). Social phobia and avoidant personality disorder: similar but different? Journal of Personality Disorders, 29(1): 115-130. DOI: 10.1521/pedi_2013_27_079.
  73. Leichsenring, F. & Leibing, E. (2007). Psychodynamic psychotherapy: a systematic review of techniques, indications and empirical evidence. Psychology and Psychotherapy, 80(2): 217-228. DOI: 10.1348/147608306X117394.
  74. Lenzenweger, M.F. (1999). Stability and change in personality disorder features: the Longitudinal Study of Personality Disorders. Archives of General Psychiatry, 56(11): 1009-1015. DOI: 10.1001/archpsyc.56.11.1009.
  75. Lenzenweger, M.F., Lane, M.C., Loranger, A.W. & Kessler, R.C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6): 553-564. DOI: 10.1016/j.biopsych.2006.09.019.
  76. Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.
  77. Liotti, G., Fassone, G. & Monticelli, F. (2017). L’evoluzione dei sistemi motivazionali. Teoria, ricerca e clinica. Milano: Raffaello Cortina.
  78. Liotti, G. & Gilbert, P. (2011). Mentalizing, motivation, and social mentalities: Theoretical considerations and implications for psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 84(1): 9-25. DOI: 10.1348/147608310X520094.
  79. Luborsky, L. (1984). Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive Treatment. New York: Basic Books.
  80. Lynch, T.R. (2018). Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Context Press.
  81. Lynch, T.R. & Cheavens, J.S. (2008). Dialectical behavior therapy for comorbid personality disorders. Journal of Clinical Psychology, 64(2): 154-167. DOI: 10.1002/jclp.20449.
  82. Lynch, T.R., Cheavens, J.S., Cukrowicz, K.C., Thorp, S.R., Bronner, L. & Beyer, J. (2007). Treatment of older adults with co-morbid personality disorder and depression: A dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22(2): 131-143. DOI: 10.1002/gps.1703.
  83. Magnavita, J. (2010). Evidence-based treatment of personality dysfunction: Principles, methods, and processes. In: Magnavita, J. (ed.), Evidence-based treatment of personality dysfunction: Principles, methods, and processes. American Psychological Association. DOI: 10.1037/12130-000.
  84. Malan, D.H. (1976). The frontier of brief psychotherapy: An example of the convergence of research and clinical practice. New York-London: Plenum Medical Book.
  85. Massion, A.O., Dyck, I.R., Shea, M.T., Phillips, K.A., Warshaw, M.G. & Keller, M.B. (2002). Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Archives of General Psychiatry, 59(5): 434-440. DOI: 10.1001/archpsyc.59.5.434.
  86. McCullough, L., Kuhn, N., Andrews, S., Kaplan, A., Wolf, J. & Lanza Hurley, C. (2003). Treating Affect Phobia: A Manual for Short-Term Dynamic Psychotherapy. New York: Guilford Press.
  87. McCullough, V.L. (1997). Changing Character: Short-term Anxiety-regulating Psychotherapy For Restructuring Defenses, Affects, And Attachment. New York: Basic Books.
  88. McGlashan, T.H., Grilo, C.M., Sanislow, C.A., Ralevski, E., Morey, L.C., Gunderson, J.G., Skodol, A.E., Shea, M.T., Zanarini, M.C., Bender, D., Stout, R.L., Yen, S. & Pagano, M. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. The American Journal of Psychiatry, 162(5): 883-889. DOI: 10.1176/appi.ajp.162.5.883.
  89. Millon, T. (1981). Disorders of Personality DSM-III: Axis II. Hoboken: John Wiley & Sons.
  90. Millon, T. & Everly, Gsj. (1985). Personality and its disorders: A biosocial learning approach. Hoboken: John Wiley & Sons.
  91. Moran, P., Jenkins, R., Tylee, A., Blizard, R. & Mann, A. (2000). The prevalence of personality disorder among UK primary care attenders. Acta psychiatrica scandinavica, 102(1): 52-57. DOI: 10.1034/j.1600-0447.2000.102001052.x.
  92. Moroni, F., Procacci, M., Pellecchia, G., Semerari, A., Nicolò, G., Carcione, A., Pedone, R. & Colle, L. (2016). Mindreading dysfunction in avoidant personality disorder compared with other personality disorders. Journal of Nervous and Mental Disease, 204(10): 752-757. DOI: 10.1097/NMD.0000000000000536.
  93. Nestadt, G., Di, C., Samuels, J.F., Bienvenu, O.J., Reti, I.M., Costa, P., Eaton, W.W. & Bandeen-Roche, K. (2010). The stability of DSM personality disorders over twelve to eighteen years. Journal of Psychiatric Research, 44(1): 1-7. DOI: 10.1016/j.jpsychires.2009.06.009.
  94. Nicolò, G., Semerari, A., Lysaker, P.H., Dimaggio, G., Conti, L., D’Angerio, S., Procacci, M., Popolo, R. & Carcione, A. (2011). Alexithymia in personality disorders: Correlations with symptoms and interpersonal functioning. Psychiatry Research, 190(1): 37-42. DOI: 10.1016/j.psychres.2010.07.046.
  95. Oddo-Sommerfeld, S., Hain, S., Louwen, F. & Schermelleh-Engel, K. (2016). Longitudinal effects of dysfunctional perfectionism and avoidant personality style on postpartum mental disorders: Pathways through antepartum depression and anxiety. Journal of Affective Disorders, 191: 280-288. DOI: 10.1016/j.jad.2015.11.040.
  96. Oleski, J., Cox, B.J., Robinson, J. & Grant, B. (2012). The predictive validity of Cluster C personality disorders on the persistence of major depression in the national epidemiologic survey on alcohol and related conditions. Journal of Personality Disorders, 26(3): 322-333. DOI: 10.1521/pedi.2012.26.3.322.
  97. Olssøn, I. & Dahl, A.A. (2012). Avoidant personality problems--their association with somatic and mental health, lifestyle, and social network. A community-based study. Comprehensive Psychiatry, 53(6): 813-821. DOI: 10.1016/j.comppsych.2011.10.007.
  98. Oosterbaan, D.B., van Balkom, A.J.L.M., Spinhoven, P., de Meij, T.G.J. & van Dyck, R. (2002). The influence on treatment gain of comorbid avoidant personality disorder in patients with social phobia. The Journal of Nervous and Mental Disease, 190(1): 41-43. DOI: 10.1097/00005053-200201000-00010.
  99. Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emotions. Oxford: Oxford University Press. psycnet.apa.org/record/1999-02235-000.
  100. Parker, G., Roussos, J., Austin, M.P., Hadzi-Pavlovic, D., Wilhelm, K. & Mitchell, P. (1998). Disordered personality style: higher rates in non-melancholic compared to melancholic depression. Journal of Affective Disorders, 47(1-3): 131-140. DOI: 10.1016/s0165-0327(97)00133-x.
  101. Pellecchia, G., Moroni, F., Colle, L., Semerari, A., Carcione, A., Fera, T., Fiore, D., Nicolò, G., Pedone, R. & Procacci, M. (2018). Avoidant personality disorder and social phobia: Does mindreading make the difference? Comprehensive Psychiatry, 80: 163-169. DOI: 10.1016/j.comppsych.2017.09.011.
  102. Pinto, A., Mancebo, M.C., Eisen, J.L., Pagano, M.E. & Rasmussen, S.A. (2006). The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. The Journal of Clinical Psychiatry, 67(5): 703-711. DOI: 10.4088/jcp.v67n0503.
  103. Popolo, R., Lysaker, P.H., Salvatore, G., Montano, A., Buonocore, L., Sirri, L., Imbimbo, A. & Dimaggio, G. (2014). Emotional inhibition in personality disorders. In Psychotherapy and Psychosomatics, 83(6): 377-378. DOI: 10.1159/000365110.
  104. Popolo, R., MacBeth, A., Brunello, S., Canfora, F., Ozdemir, E., Rebecchi, D., Toselli, C., Venturelli, G., Salvatore, G. & Dimaggio, G. (2018). Metacognitive interpersonal therapy in group: a feasibility study. Research in Psychotherapy: Psychopathology, Process and Outcome, 21(3): 155-163. DOI: 10.4081/ripppo.2018.338.
  105. Popolo, R., MacBeth, A., Canfora, F., Rebecchi, D., Toselli, C., Salvatore, G. & Dimaggio, G. (2019). Metacognitive Interpersonal Therapy in group (MIT-G) for young adults with personality disorders: A pilot randomized controlled trial. Psychology and Psychotherapy: Theory, Research and Practice, 92(3): 342-358. DOI: 10.1111/papt.12182.
  106. Prabhu, L., Cherian, A.V., Viswanath, B., Kandavel, T., Bada Math, S. & Janardhan Reddy, Y.C. (2013). Symptom dimensions in OCD and their association with clinical characteristics and comorbid disorders. Journal of Obsessive-Compulsive and Related Disorders, 2(1): 14-21. DOI: 10.1016/j.jocrd.2012.10.002.
  107. Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. (2001). The American Journal of Psychiatry, 158(10): 1-52. psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bpd.pdf.
  108. Quirk, S.E., Berk, M., Pasco, J.A., Brennan-Olsen, S.L., Chanen, A.M., Koivumaa-Honkanen, H., Burke, L.M., Jackson, H.J., Hulbert, C.A., Olsson, C., Moran, P., Stuart, A.L. & Williams, L.J. (2017). The prevalence, age distribution and comorbidity of personality disorders in Australian women. The Australian and New Zealand Journal of Psychiatry, 51(2): 141-150. 10.1177/0004867416649032.
  109. Rafaeli, E. & Bernstein, D.P. (2010). Schema Therapy: Distinctive Features. New York: Routledge.
  110. Rees, C.S. & Pritchard, R. (2015). Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52(1): 45-55. DOI: 10.1037/a0035158.
  111. Reich, J. (2000). The relationship of social phobia to avoidant personality disorder: a proposal to reclassify avoidant personality disorder based on clinical empirical findings. European psychiatry: the journal of the Association of European Psychiatrists, 15(3): 151-159. DOI: 10.1016/s0924-9338(00)00240-6.
  112. Reichborn-Kjennerud, T., Czajkowski, N., Torgersen, S., Neale, M.C., Ørstavik, R.E., Tambs, K. & Kendler, K.S. (2007). The relationship between avoidant personality disorder and social phobia: a population-based twin study. The American Journal of Psychiatry, 164(11): 1722-1728. DOI: 10.1176/appi.ajp.2007.06101764.
  113. Renneberg, B., Goldstein, A.J., Phillips, D. & Chambless, D.L. (1990). Intensive behavioral group treatment of avoidant personality disorder. Behavior Therapy, 21(3): 363-377. DOI: 10.1016/S0005-7894(05)80337-5.
  114. Sanislow, C.A. & Hector, A.D. (2020). Cluster C Anxious-Fearful Personality Pathology and Avoidance (pp. 302-316). In: The Cambridge Handbook of Personality Disorders. Cambridge University Press. DOI: 10.1017/9781108333931.053.
  115. Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolò, G., Procacci, M. & Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology & Psychotherapy, 10(4): 238-261. DOI: 10.1002/cpp.362.
  116. Semerari, A., Colle, L., Pellecchia, G., Buccione, I., Carcione, A., Dimaggio, G., Nicolo, G., Procacci, M. & Pedone, R. (2014). Metacognitive dysfunctions in personality disorders: Correlations with disorder severity and personality styles. Journal of Personality Disorders, 28(6): 751-766. DOI: 10.1521/pedi_2014_28_137.
  117. Sexton, M.C., Sunday, S.R., Hurt, S. & Halmi, K.A. (1998). The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients. The International Journal of Eating Disorders, 23(3): 277-286. DOI: 10.1002/(sici)1098-108x(199804)23:3<277::aid-eat5>3.0.co;2-g.
  118. Simon, W. (2009). Follow-up psychotherapy outcome of patients with dependent, avoidant and obsessive-compulsive personality disorders: A meta-analytic review. International Journal of Psychiatry in Clinical Practice, 13(2): 153-165. DOI: 10.1080/13651500802570972.
  119. Simonsen, S., Eikenæs, I.U.M., Nørgaard, N.L., Normann-Eide, E., Juul, S. & Wilberg, T. (2019). Specialized Treatment for Patients with Severe Avoidant Personality Disorder: Experiences from Scandinavia. Journal of Contemporary Psychotherapy, 49(1): 27-38. DOI: 10.1007/s10879-018-9395-x.
  120. Simonsen, S., Popolo, R., Juul, S., Frandsen, F.W., Sørensen, P. & Dimaggio, G. (2022). Treating Avoidant Personality Disorder with Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study. Journal of Nervous and Mental Disease, 210(3): 163-171. DOI: 10.1097/NMD.0000000000001432.
  121. Skewes, S.A., Samson, R.A., Simpson, S.G. & van Vreeswijk, M. (2015). Short-term group schema therapy for mixed personality disorders: a pilot study. Frontiers in Psychology, 5. DOI: 10.3389/fpsyg.2014.01592.
  122. Skodol, A.E., Bender, D.S., Morey, L.C., Clark, L.A., Oldham, J.M., Alarcon, R.D., Krueger, R.F., Verheul, R., Bell, C.C. & Siever, L.J. (2011). Personality disorder types proposed for DSM-5. Journal of Personality Disorders, 25(2): 136-169. DOI: 10.1521/pedi.2011.25.2.136.
  123. Skodol, A.E., Gunderson, J.G., Shea, M.T., McGlashan, T.H., Morey, L.C., Sanislow, C.A., Bender, D.S., Grilo, C.M., Zanarini, M.C., Yen, S., Pagano, M.E. & Stout, R.L. (2005). The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. Journal of Personality Disorders, 19(5): 487-504. DOI: 10.1521/pedi.2005.19.5.487.
  124. Skodol, A.E., Pagano, M.E., Bender, D.S., Shea, M.T., Gunderson, J.G., Yen, S., Stout, R.L., Morey, L.C., Sanislow, C.A., Grilo, C.M., Zanarini, M.C. & McGlashan, T.H. (2005). Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychological Medicine, 35(3): 443-451. DOI: 10.1017/s003329170400354x.
  125. Soeteman, D.I., Hakkaart-van Roijen, L., Verheul, R. & Busschbach, J.J.V. (2008). The economic burden of personality disorders in mental health care. The Journal of Clinical Psychiatry, 69(2): 259-265. DOI: 10.4088/jcp.v69n0212.
  126. Sørensen, K.D., Wilberg, T., Berthelsen, E. & Råbu, M. (2019). Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be. Frontiers in Psychology, 10: 2879. DOI: 10.3389/fpsyg.2019.02879.
  127. Sperry, L. (2016). Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders. In: Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders. New York: Routledge.
  128. Strauss, J.L., Hayes, A.M., Johnson, S.L., Newman, C.F., Brown, G.K., Barber, J.P., Laurenceau, J.-P. & Beck, A.T. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2): 337-345. DOI: 10.1037/0022-006X.74.2.337.
  129. Stravynski, A., Belisle, M., Marcouiller, M., Lavallée, Y.J. & Elie, R. (1994). The treatment of avoidant personality disorder by social skills training in the clinic or in real-life settings. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 39(8): 377-383. DOI: 10.1177/070674379403900805.
  130. Stuart, S., Pfohl, B., Battaglia, M., Bellodi, L., Grove, W. & Cadoret, R. (1998). The cooccurrence of DSM-III-R personality disorders. Journal of Personality Disorders, 12(4): 302-315. DOI: 10.1521/pedi.1998.12.4.30.
  131. Svartberg, M., Stiles, T.C. & Seltzer, M.H. (2004). Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. The American Journal of Psychiatry, 161(5): 810-817. DOI: 10.1176/appi.ajp.161.5.810.
  132. Tillfors, M., Furmark, T., Ekselius, L. & Fredrikson, M. (2004). Social phobia and avoidant personality disorder: one spectrum disorder? Nordic Journal of Psychiatry, 58(2): 147-152. DOI: 10.1080/08039480410005530.
  133. Tomasello, M., Carpenter, M., Call, J., Behne, T. & Moll, H. (2005). Understanding and sharing intentions: The origins of cultural cognition. Behavioral and Brain Sciences, 28(5): 675-691. DOI: 10.1017/S0140525X05000129.
  134. Torgersen, S. (2009). The nature (and nurture) of personality disorders. Scandinavian Journal of Psychology, 50(6): 624-632. DOI: 10.1111/j.1467-9450.2009.00788.x.
  135. Torgersen, S. (2012). Epidemiology. In The Oxford Handbook of Personality Disorders. Oxford University Press. DOI: 10.1093/oxfordhb/9780199735013.001.0001.
  136. Torgersen, S., Kringlen, E. & Cramer, V. (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry, 58(6): 590-596. DOI: 10.1001/archpsyc.58.6.590.
  137. Torvik, F.A., Welander-Vatn, A., Ystrom, E., Knudsen, G.P., Czajkowski, N., Kendler, K.S. & Reichborn-Kjennerud, T. (2016). Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study. Journal of Abnormal Psychology, 125(1): 114-124. DOI: 10.1037/abn0000124.
  138. Trull, T.J., Jahng, S., Tomko, R.L., Wood, P.K. & Sher, K.J. (2010). Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24(4): 412-426. DOI: 10.1521/pedi.2010.24.4.412.
  139. Turkat, I. (1990). Personality Disorders: A Psychological Approach to Clinical Management. New York: Pergamon.
  140. Ullrich, S., Farrington, D.P. & Coid, J.W. (2007). Dimensions of DSM-IV personality disorders and life-success. Journal of Personality Disorders, 21(6): 657-663. DOI: 10.1521/pedi.2007.21.6.657.
  141. Videler, A.C., van Alphen, S.P.J., van Royen, R.J.J., van der Feltz-Cornelis, C.M., Rossi, G. & Arntz, A. (2018). Schema therapy for personality disorders in older adults: a multiple-baseline study. Aging and Mental Health, 22(6): 738-747. DOI: 10.1080/13607863.2017.1318260.
  142. Weinbrecht, A., Schulze, L., Boettcher, J. & Renneberg, B. (2016). Avoidant Personality Disorder: a Current Review. Current Psychiatry Reports, 18(3): 29. DOI: 10.1007/s11920-016-0665-6.
  143. Widiger, T.A. (1992). Generalized social phobia versus avoidant personality disorder: a commentary on three studies. Journal of Abnormal Psychology, 101(2): 340-343. DOI: 10.1037//0021-843x.101.2.340.
  144. Wilberg, T., Karterud, S., Pedersen, G. & Urnes, Ø. (2009). The impact of avoidant personality disorder on psychosocial impairment is substantial. Nordic Journal of Psychiatry, 63(5): 390-396. DOI: 10.1080/08039480902831322.
  145. Wilberg, T., Pedersen, G., Bremer, K., Johansen, M. & Kvarstein, E. (2023). Combined group and individual therapy for patients with avoidant personality disorder. A pilot study. Frontiers in Psychiatry, 14: 1181686 DOI: 10.3389/fpsyt.2023.1181686.
  146. Winston, A., Laikin, M., Pollack, J., Samstag, L.W., McCullough, L. & Muran, J.C. (1994). Short-term psychotherapy of personality disorders. American Journal of Psychiatry, 151(2): 190-194. DOI: 10.1176/ajp.151.2.190.
  147. Wurmser, L. (1981). The mask of shame. Baltimora: Johns Hopkins University Press.
  148. Young, J.E. & Klosko, J.S. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford Press.
  149. Young, J.E., Klosko, J.S. & Weishaar, M.E. (2018). Schema therapy. La terapia cognitivo-comportamentale integrata per i disturbi della personalità. Trento: Erickson.
  150. Zeigler-Hill, V. & Shackelford, T. (2020). Encyclopedia of Personality and Individual Differences. Cham: Springer. DOI: 10.1007/978-3-319-24612-3.
  151. Zimmerman, M., Rothschild, L. & Chelminski, I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients. The American Journal of Psychiatry, 162(10): 1911-1918. DOI: 10.1176/appi.ajp.162.10.1911.

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