Diagnostic subtype, avoidant personality disorder, and efficacy of cognitive-behavioral group therapy for social phobia

Increasing recognition of the heterogeneity of social phobia has led to the development of various subtyping classification schemes and controversy over the boundary between social phobia and avoidant personality disorder (APD). This study investigated the utility of one subtyping system by comparing efficacy of cognitive-behavioral group therapy for generalized social phobia (fears in all major situational domains) and nongeneralized social phobia (fears in multiple domains but at least one unaffected domain). Overall, most subjects improved in treatment, with generalized and nongeneralized social phobics making similar gains. However, because generalized social phobics were more impaired prior to treatment, they continued to be more impaired after treatment on some measures. A second hypothesis that social phobics with APD would respond more poorly to treatment than social phobics without APD was not supported. This study adds to the growing evidence that social phobia and APD, as defined by DSM-III-R, may not be conceptually distinct. Clinical and conceptual implications and directions for future research are discussed.