Background. Increasing attention has been directed in
years to the detection and treatment of psychiatric co-morbidity among
individuals. The overlap of social phobia
(SP) and avoidant personality disorder (APD) has been well recognized and
relationship between these disorders and depression has been suggested.
Methods. The pattern and clinical implications of co-morbidity
and APD with major depressive disorder (MDD), diagnosed by DSM-III-R criteria,
studied among 243 out-patients presenting with depression.
Results. Overall, 26·7% of adults in our sample with MDD met
for SP and 28·4% for
APD. Almost two-thirds of depressed adults meeting criteria for social
avoidant personality disorder met criteria for both (SP+APD). Depressed
met criteria for both
SP+APD exhibited a significantly higher proportion of atypical depression
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
number of co-morbid Axis I diagnoses, and greater impairment of social
Conclusions. Results confirm the overlap of SP and APD in a
population and the
high prevalence of these disorders in MDD. They suggest that depressed
with both SP and APD but not SP alone are at particularly high risk for
atypical depression and for social dysfunction in excess of that caused
current major depression.