Journal of Abnormal Psychology Copyright 1986 by the American Psychological Association, Inc.

1986, Vol. 95, No. 4, 389-394 002l-843X/86/$00.75

Psychopathology of Social Phobia and Comparison to Avoidant

Personality Disorder

Samuel M. Turner, Deborah C. Beidel, Constance V. Dancu, and Dana J. Keys

Department of Psychiatry, Western Psychiatric Institute and Clinic
University of Pittsburgh School of Medicine

The clinical manifestations of social phobia were studied in a carefully diagnosed sample of 21 social
phobics. Social phobia was found to be a chronic and pervasive condition affecting a variety of life
areas and producing significant emotional distress. In a second study, individuals with a diagnosis
of social phobia or avoidant personality disorder were compared using a subsample of socially phobic
subjects and a sample with avoidant personality disorder. Although physiological reactivity and cog-
nitive content were essentially the same for both groups in a number of situational tasks, those
individuals with a diagnosis of avoidant personality disorder were found to be more sensitive inter-
personally, and exhibited significantly poorer social skill than did the social phobic subjects. The
results are discussed in relation to Diagnostic and Statistical Manual of Mental Disorders, third
edition, criteria for social phobia, the significance of social phobia as a clinical syndrome, and the
research and treatment implications of the difference found between individuals with a diagnosis of
social phobia and those with avoidant personality disorders.

Social phobia is a new diagnostic entity introduced in the
third edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-III; American Psychiatric Association, 1980).
The DSM-III defines social phobia as
persistent, irrational fear of and compelling desire to avoid a situa-
tion in which the individual may be exposed to possible scrutiny
by others. There is also fear that the individual may behave in a
manner that will be humiliating and embarrassing, (p. 227)
Presumably, one would qualify for a diagnosis of social phobia if
one's difficulty in any social endeavor embodied these criteria,
provided other exclusionary criteria were not met. Common
examples of social phobia include fear of speaking or perform-
ing in public, eating or writing in public, and using public lava-
tories (DSM-III).
Although the problem of social anxiety is a highly prevalent
and familiar one (e.g., Beidel, Turner, & Dancu, 1985), the rela-
tion of social anxiety to the condition of social phobia as de-
scribed in DSM-III is unclear. In Marks's (1970) original con-
cept of social phobia, individuals with more general social fears
such as fear of initiating conversation or fear of dating were in-
cluded with the specific types of fears noted in the DSM-III. It
is unclear if these broader conditions reflect separate distur-
bances or if they exist in conjunction with the more specific
fears. The DSM-III definition indicates that social phobia is
typically characterized by one specific fear, but recent indica-
tions are that the fear is much more pervasive than the DSM-
This project was supported in part by National Institute of Mental
Health Grant MH-30915.
Correspondence concerning this article should be addressed to Sam-
uel M. Turner, Department of Psychiatry, Western Psychiatric Institute
and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara
Street, Pittsburgh, Pennsylvania 15213.
Ill suggests (Liebowitz, Gorman, Fyer, & Klein, 1985). Under
DSM-III criteria, these broader disturbances might meet cri-
teria for avoidant personality disorder, a condition character-
ized by hypersensitivity to criticism or rejection and social with-
drawal despite a desire for social interaction. The closeness of
this description to that of social phobia is apparent. According
to the hierarchical schema of DSM-III, a diagnosis of social
phobia is not given if the marked anxiety and avoidance of cer-
tain social situations is due to any one of a number of disorders,
including avoidant personality disorder (American Psychiatric
Association, 1980, p. 228). A diagnosis of avoidant personality
disorder supersedes a diagnosis of social phobia. However, clini-
cally this is a difficult diagnostic distinction. Although the
DSM-III attempts to distinguish between these conditions by
defining social phobia as a disorder restricted to circumscribed
and specific situations, whereas avoidant personalities fear per-
sonal relationships in general, to our knowledge there are no
empirical studies examining the relation of these two disorders.
One goal of the present study was to examine the performance
of these two diagnostic groups on a battery of self-report instru-
ments, psychophysiologjcal responding, thought content, and
behavioral skill.
Little data exist on the clinical aspects of social phobia. How-
ever, what data do exist suggest that social phobia is not as cir-
cumscribed as DSM-III indicates, and that there are significant
clinical ramifications for those individuals with the disorder.
For example, Liebowitz et al. (1985) reported the onset of social
phobia to be between the ages of 15 and 20, somewhat later than
the adolescent onset noted in DSM-III. The DSM-III also states
that the disorder is chronic and unremitting, but rarely incapac-
itating. Liebowitz etal. (1985), contrary to DSM-III, found that
socially phobic individuals were impaired in a number of areas
including inability to work, incomplete education, lack of ca-
reer advancement, and severely restricted social functioning. In

389
390 TURNER, BEIDEL, DANCU, AND KEYS

addition, these investigators noted considerable abuse of alco- Table 2

hol and other drugs among this population. Finally, 45% of their Number of Social Situations Producing Avoidance and Distress
sample had depressive symptoms or a history of depression.
The presence of significant depressive symptoms also was found Distress and/ or Avoidance Distress
avoidance limited to (%)• (%)
in a sample studied by Amies, Gelder, and Shaw (1983).
It would appear that the clinical manifestations of social pho- One social situation 14.3 9.5
bia are more pervasive and significant than is generally recog- Two social situations 47.6 42.9
nized. Furthermore, the best epidemiologic data available sug- Three social situations 19.0 38.9
Four social situations 4.8 9.5
gest that the disorder has an approximate 2% prevalence rate in
the general population (Myers et al., 1984). Therefore, in addi- M 1.9 2.5
tion to comparing social phobia and avoidant personality disor-
• Percentages do not add up to 100% because 3 individuals (14.3%) de-
der, a second major aim was to study the clinical syndrome of
nied any type of avoidance although they felt significant distress in so-
social phobia. cial interactions.

Method
Procedure
Subjects
The aim of the first study was to examine the clinical picture of social
Subjects were 21(15 women and 6 men) patients consecutively admit- phobia. The primary data collection instrument used to generate infor-
ted to the Anxiety Disorders Clinic at Western Psychiatric Institute and mation on the clinical syndrome of social phobia was the Social Anxiety
Clinic with a DSM-II1 diagnosis of social phobia, as well as 7 men and History Questionnaire (SAHQ), an interview-administered question-
I woman with a DSM-III diagnosis of avoidant personality disorder. naire designed to elicit information specifically related to social phobia.
Subjects were diagnosed in the following fashion. They were first inter- The questionnaire, developed specifically for this study, covers a range
viewed by an experienced clinician using a semistructured interview of topics including the earliest recall of feelings of social anxiety, epide-
schedule, the Initial Evaluation Form (1EF; Mezzich, Dow, Rich, Cos- miology, alcohol and drug usage, and the range of life areas that might
tello, & Himmelhoch, 1981). This was followed by an interview with a be affected. Additional information was obtained from the IEF. Only
stan" psychiatrist, after which a consensus diagnosis was reached. The the social phobia sample participated in Study 1.
IEF is designed for use with all psychiatric disorders and is keyed to
DSM-III criteria. In an ongoing study, Mezzich (personal communica-
tion, July 1, 1986) reported kappa coefficients for interrater reliability
Results
of .61 for Axis I diagnoses (collapsed across all categories) and .61 for
Types and Frequency of Fears
Axis II diagnoses (collapsed across all categories). The patient was then
referred to the Anxiety Disorders Clinic, where a second interview was A major aim of this study was to assess the range of fears
conducted by a staff member using the Anxiety Disorders Interview experienced by social phobics and to determine the pattern of
Schedule (ADIS; DiNardo, O'Brien, Barlow, Waddell, & Blanchard, these fears in individual patients. Table 1 lists some common
1983). The DSM-III decision rules were followed in that if a patient met
social situations and the percentage of the socially phobic sam-
criteria for avoidant personality disorder, a diagnosis of social phobia
ple who avoid or experience significant distress in each of the
was not assigned. The final diagnosis of social phobia or avoidant per-
situations.
sonality disorder was made as the result of a consensus procedure. Pa-
tients did not meet criteria for any other DSM-III diagnosis. The aver- As is evident from Table 1, formal (public) speaking is the
age age of the socially phobic sample was 37.6 years, ranging from 21 most commonly avoided social situation. It is also the situation
to 53 years. The average age of the avoidant personality sample was 48 most often reported as creating significant distress, whether
years, ranging from 30 to 60 years. strict avoidance is present or not. Informal speaking situations
(cocktail parties, speaking to co-workers) are also avoided by
more than 50% of the sample, and are described as stressful by
more than 75%. Other situations including eating in public
Table 1 (33%) and writing in public (19%) were singled out as problem-
Percentage of Avoidance and Distress in atic by significant percentages of the sample.
Common Social Situations One of the major tenets in the DSM-III diagnostic criteria for
social phobia is that "generally, individuals have only one Social
Avoidance Distress
Situation Phobia" (American Psychiatric Association, 1980, p. 227).
Therefore, in addition to surveying the range of social situations
Formal speaking 71.4 81.0 in which social phobics may experience significant distress,
Informal speaking 57.1 76.2
each social phobic was also interviewed with respect to the fre-
Eating in public 28.6 33.3
Drinking in public 4.8 4.8 quency of situations avoided or producing significant distress.
Writing in public 19.0 19.0 Table 2 lists the number of social situations that lead to avoid-
Taking tests 0.0 9.5 ance or produce significant distress for each social phobic.
Other types of observation In contrast to DSM-III, it is evident from the data presented
(playing golf, bowling,
here that the majority of socially phobic individuals experience
using office equipment) 4.8 23.8
distress in more than one type of social situation. Fully 90% of
Note, n ~ 21. the sample could identify at least two common social situations

Table 3
Alcohol and Anxiolytic Drug Usage
Drug usage sample
1. Have at least 1 alcoholic beverage per week
2. Use alcohol to feel more sociable at a party
3. Intentional use of alcohol prior to attending a social
event
4. Use anxiolytic drugs to relieve anxiety
5. Intentional use of anxiolytic drugs prior to attending a
social event
Note, n = 21 for 1 and 4; n = 15 for 2, 3, and 5 (only those who reported
any alcohol or anxiolytic drug use).
that were associated with significant distress, and 47.5% identi-
fied more than two types of social interactions producing dis-
tress. The mean number of situations producing significant dis-
tress was 2.5. Similar to the percentages for distress, avoidance
of social situations was not limited to a single type of interac-
tion. The mean number of situations avoided was 1.9, with
71.4% of the sample reporting avoidance in two or more social
interactions. Thus, it would appear that socially phobic individ-
uals experience distress in a wide variety of social encounters,
and that for the majority of individuals, avoidance and distress
are not limited to a single type of social performance.
Concomitant Simple Phobias
Socially phobic subjects were asked to identify any situations
other than those involving social contact that also produced in-
creases in anxiety. Thirty-three percent of the sample reported
at least one nonsocial fear. Fear of heights and of small animals
were the most commonly identified simple phobias.
Alcohol and Anxiolytic Drug Usage
The DSM-III acknowledges that socially phobic individuals
may use alcohol to alleviate anxiety when in social situations,
but the extent and severity of this usage is still in question. In
our sample, individuals were interviewed regarding alcohol and
anxiolytic drug usage, whether the use of these agents alleviated
their distress when in social situations, and whether they ever
intentionally used these agents prior to attending social events
in an attempt to reduce or alleviate distress when in those situa-
tions. Use of other substances, including cannabis derivatives,
amphetamines, cocaine, hallucinogens, and narcotics was also
assessed. Only one subject reported using any of these other
drugs (marijuana) on a regular basis. Table 3 presents the data
on alcohol and anxiolytic drug usage for this sample.
These data indicate that a significant percentage of this so-
cially phobic sample use alcohol and anxiolytic drugs in an at-
tempt to control their social distress. Of the sample, 46% re-
ported consuming alcohol when at social engagements in an at-
tempt to cope with their distress, and 50% reported that they
deliberately drank prior to attending social engagements or
public speaking events in an effort to reduce their anticipatory
anxiety. Similar percentages were reported for anxiolytic drug
SOCIAL PHOBIA 391
usage (52%), with a smaller percentage (13.3%) intentionally us-
ing these medications prior to encountering their feared situa-
tion. Six subjects denied any alcohol consumption or anxiolytic
%of
drug use, and 2 subjects reported using both substances (at vari-
ous times) to alleviate social distress. Finally, 3 patients were
52 taking anxiolytics on a daily basis (one each on Valium, Ativan,
46 and Xanax).
50
52 Impairment in Social and Occupational Functioning
13.3 According to the DSM-III, social phobia is rarely considered
incapacitating. The findings reported here reveal that social
phobics suffer considerable impairment in their academic, oc-
cupational, and social functioning. Table 4 lists the percentages
of the sample who believed their social anxiety significantly im-
pacted on each of several life areas.
As can be seen, social phobics indicated a significant degree
of impairment. Eighty-three percent felt that their fear inhib-
ited academic or school functioning by preventing them from
speaking in class, joining clubs or athletic teams, being elected
to leadership positions in clubs or student organizations, or pre-
venting them from getting better grades due to nonparticipation
in class discussions. Ninety-two percent felt that their occupa-
tional performance was significantly impaired, citing inabilities
to make informal suggestions in staff meetings and to make pre-
sentations before small or large groups; all resulting in lack of
career advancement or being passed over for promotion. In
evaluating their general social functioning, 69% reported im-
pairment, stating that their fear prohibited them from attending
social events connected to their work, joining philanthropic or
civic organizations, or being elected to leadership positions in
these same organizations. Finally, 50% of the unmarried so-
cially phobic individuals believed their heterosocial functioning
was limited, either by their hesitancy to engage in social activi-
ties or the inability to establish a level of intimacy conducive
to long-term relationships. Thus, social phobia appears to be a
disorder resulting in significant impact on life functioning in a
majority of those seen in our clinic, and although there was no
report of complete incapacitation, significant impairment was
highly prevalent.
Age of Onset
The mean age of onset in the present sample is 16.5 with a
median of 14 years (range = 4-39). This is consistent with
DSM-III, which indicates social phobia is a disorder appearing
in early adolescence, and reasonably close to the reported age
Table 4
Impairment in Occupational or Social Functioning
% of sample
Life area impaired
Academic 84.6
Occupational 92.3
General social relationships 69.2
Heterosocial relationships* 50.0
a
This question was asked only of the unmarried patients (n = 8).
392 TURNER, BEIDEL, DANCU, AND KEYS
onset of between 15 and 20 noted by Liebowitz et al. (1985) on
a smaller sample. However, the wide range of onset ages suggests
this disorder can develop at any age, although it is more likely
to appear during adolescence.
Chronicity
With respect to actual avoidance, the mean number of years
reported by our sample was 15.3 (range = 0-46 years). The
mean number of years of reported social distress was 20.9
(range = 5-46). These data are consistent with the notion that
social phobia is a chronic and unremitting disorder.
An Exploratory Analysis Comparing Social Phobia
and Avoidant Personality Disorder
The second major aim of our study was to compare the per-
formance of social phobics and avoidant personality disorders
on behavioral, psychophysiological, and cognitive parameters.
The subject sample in this study—10 social phobic (SP) and 8
avoidant personality disorder (APD) subjects—is small. Thus,
the results should be considered preliminary and interpreted
accordingly. However, as far as we know, this is the first attempt
to determine if these two similar conditions can be empirically
differentiated.
The battery of self-report instruments included the Social
Avoidance and Distress scale (SAD; Watson & Friend, 1969),
the Fear of Negative Evaluation scale (FNE; Watson & Friend,
1969), the Symptom Checklist-90-Revised (SCL-90-R; Dero-
gatis, 1983), and the State-Trait Anxiety Inventory (STAI;
Spielberger, Gorsuch, & Lushene, 1970). A series of structured
social interactions were presented to the subject, including an
opposite-sex role play, a same-sex role play, and an impromptu
speech. The opposite-sex interaction required the subject to
imagine a dinner party at the home of a friend. The same-sex
interaction required the subject to imagine meeting a new
neighbor. Each interaction was 3 min in length. Each subject
also was requested to make an impromptu speech on a self-
selected topic. The experimenter and confederates served as the
audience. Prior to beginning the speech, the subject was given
a 3-min preparation period. The assessment began with a 10-
min baseline period. Following this, the three tasks were pre-
sented, with order of presentation counterbalanced within each
group. Presentation of subsequent tasks were withheld until any
increase in physiological levels subsided. During the role-play
interactions, the subject was instructed to respond as if the situ-
ation were actually occurring. Confederates were trained to re-
spond in a neutral fashion, leaving responsibility for conversa-
tion maintenance to the subject. Confederates were approxi-
mately 30 years of age, had no specific prompts, were instructed
not to ask questions, and were monitored by the second author
to assure adherence. During the assessment procedure, physio-
logical reactivity, type of cognitions, and behavioral manifesta-
tions of skill and anxiety were monitored.
Systolic and diastolic blood pressure and heart rate were as-
sessed while the individual participated in each task. On com-
pletion of each of the three tasks, the patient filled out the Social
Interaction Self-Statement Test (SISST; Glass, Merluzzi, Biever,
& Larsen, 1982), a 30-item listing of thoughts an individual may
experience during a social interaction.
The behavioral assessment consisted of skill ratings for the
following behaviors: intonation, gaze, voice volume, overall
skill, and overall anxiety. Independent raters blind to group as-
signment used 5-point Likert scales (Trower, Bryant, & Argyle,
1978) to rate these behaviors. Each scale was anchored with a
rating of 1 indicating extremely inadequate skill level for that
particular behavior and 5 representing a high skill level. Anxi-
ety was rated using a 9-point Likert scale with 1 indicating a
feeling of relaxation, 5 indicating a moderate level of anxiety,
and 9 suggestive of extreme anxiety. These scales have been used
extensively in previous assessments of social skill and anxiety
(e.g., Beidel et al., 1985; Turner, Beidel, Hersen, & Bellack,
1984).
In view of the small sample and lack of significant differences
on psychophysiological and cognitive parameters, it was de-
cided not to report those data. Although the lack of significant
differences might indicate that the two disorders do not differ
on these variables, it might also be due to the lack of sufficient
power (Type II error). A separate report will be made when a
sufficiently large sample of subjects is available.
Results
Scores on the self-report battery (SAD, FNE, STAI A-state
and A-trait, and the SCL-90-R) were analyzed using a series of
(tests. The results of the analysis indicated that the APD group
had significantly higher social avoidance and distress as evi-
denced by their scores on the SAD (M = 22.0 vs. M = 12.8,
p < .05). The APD group also scored significantly higher on the
SCL-90-R Interpersonal Sensitivity scale (M = 78.4 vs. M =
67 A, p < .005); the Anxiety scale (M = 76.0 vs. M = 65.7, p <
.025); the Obsessive-Compulsive scale (M = 70.8 vs. M = 60.6,
p < .05); the Depression scale (M = 70.4 vs. M = 59.3, p < .05);
and the General Symptom Index (M = 72.3 vs. M = 63.1, p <
.05). Scores on the other self-report measures did not reach sig-
nificance (p > .05). Therefore, it would appear that those indi-
viduals diagnosed as avoidant personality disorders reported
distress in a greater range of social situations, reported a greater
number of somatic anxiety symptoms (as measured by the Anx-
iety subscale of the SCL-90-R), appeared to be more hypersen-
sitive in their interactions with others, were more depressed,
and were more ruminative than were the social phobics. The
scores for both groups on each of the self-report measures are
presented in Table 5.
Behavior
The four social skill ratings and the anxiety rating were ana-
lyzed separately using a 2 X 3 (Group X Task) repeated mea-
sures analysis of variance. The results indicate a main effect for
group on two of the variables and a Task X Group interaction
on a third variable. The SP group was rated as having signifi-
cantly more appropriate gaze (M = 4.5) when compared to the
APD group (M = 2.9, p < .005). The SP group also had signifi-
cantly higher ratings for voice tone (M = 4.2) than did the APD
group (A/ = 2.9, p < .01). The Task X Group interaction for the
variable of overall skill indicated that the APD group displayed
 SOCIAL PHOBIA 393

Table 5 bly more general anxiety and depression than do those individu-
Comparison of Social Phobia andAvoidant Personality als with simple phobia, but somewhat less than the anxiety
Disorder on Self-Report Inventories states. Similar findings were reported by Cerny et al. (1984).
A number of findings from this study bear on the DSM-III
Social Avoidant
description of this disorder. The DSM-III asserts that social
Measure phobia personality (
phobia is characterized by one specific fear. The results re-
FNE 23.3 22.4 0.11 ported here suggest that this is not the case in many instances.
SAD 12.7 22.0 2.29* Also, in a number of cases, although pervasive avoidance of so-
STAI-Trait 47.2 49.4 1.16 cial situations is not evident, significant distress is experienced,
STAI-Slate 40.0 44.9 0.58
supporting the DSM-III rule of allowing for a diagnosis of social
SCL-90-R
Somatization 55.8 61.6 1.30 phobia even when there is not clear avoidance. This will be
Obsessive-Compulsive 60.6 70.8 2.32* made more explicit in the soon-to-be-published DSM-III-R
Interpersonal sensitivity 67.4 78.4 3.22*** (Spitzer, 1985).
Depression 59.3 70.4 2.45*
The implication of the DSM-III statement that the disorder is
Anxiety 65.7 76.0 2.60**
Hostility 53.4 61.6 1.86 rarely incapacitating is that one does not experience significant
Phobia 62.1 67.6 1.33 consequences as a result of this condition. However, the results
Paranoia 62.0 67.1 1.33 from this sample, as well as from others, indicate that in addi-
Psychoticism 62.1 67.8 1.44 tion to the drug and alcohol usage already noted, there is sig-
General symptom index 62.1 72.3 2.42*
nificant impairment in a number of life areas, including school
Note. FNE = Fear of Negative Evaluation; SAD = Social Avoidance and performance, occupational choice and adjustment, and general
Distress; STAI = State-Trait Anxiety Inventory; SCL-90-R = Symptom social functioning. Thus, it appears that the effects of the disor-
Checklist-90-Revised. der are more pervasive than was previously believed.
* p < .05. **p < .025. ***p < .005.
With respect to age of onset, the majority of cases appear to
develop during the adolescent years. However, in this sample,
the disorder developed as early as the age of 4 and as late as 39.
lower levels of social competence during the opposite sex (M = This suggests that although many people develop this disorder
2.1) and same-sex role play (M = 2.1) than during the im- during adolescence, it can occur at any age. Consistent with
promptu speech (M = 3.1, p < .01). In addition, the perfor- DSM-III, our data support the idea that social phobia is a
mance of the APD group during these two interactions was sig- chronic and unremitting condition.
nificantly less skilled than the SP group for either the opposite- In summary, the results of the first study show that social
sex interaction (M = 4.1) or the same-sex interaction (M = 4.2), phobia is a much more pervasive condition than the DSM-III
or the impromptu speech (M = 4.0). There were no main or implies. It is also interesting to note that 33% of our sample
interaction effects for the variables of voice volume or overall
anxiety. Table 6 lists the ratings for the two groups for each so-
cial interaction.
Table 6
Comparison of Social Phobia andAvoidant Personality
Discussion Disorder on Behavioral Ratings of Skill and Anxiety
Although we have witnessed an explosion in the quantity and
Social Avoidant
type of research in the anxiety disorders over the past few years, Measure phobia personality F
one anxiety disorder, social phobia, remains relatively unstud-
ied. Socially phobic behavior can be seen in a number of clinical Gaze
Opposite sex 4.5 2.8 10.27**
syndromes (Cerny, Himadi, & Barlow, 1984), but socially pho-
Same sex 4.5 2.9
bic individuals meeting DSM-III criteria are specifically char- Speech 4.2 3.1
acterized by fear of negative evaluation and scrutiny by others. Volume
Little empirical data exist on the clinical syndrome of social Opposite sex 4.5 4.0 1.83
phobia, but newly emerging data suggest that the clinical mani- Same sex 4.6 4.0
Speech 4.6 4.3
festations are much more severe than previously thought (e.g.,
Tone
Amies et al., 1983; Pilkonis, Feldman, & Himmelhoch, 1981; Opposite sex 4.2 2.7 9.38*
Smail, Stockwell, Canter, & Hodgson, 1984). The present study Same sex 4.2 2.9
used a carefully diagnosed sample of socially phobic subjects, Speech 4.1 3.3
Overall skill
and the results indeed indicate a significant clinical disturbance
Opposite sex 4.1 2.1 5.59*
with wide-ranging ramifications. Previous reports of pervasive Same sex 4.2 2.1
alcohol and drug use were confirmed in this sample. Similarly, Speech 4.0 3.1
individuals with this disorder experience significant emotional Anxiety
distress and reported that their ability to function academically, Opposite sex 4.1 5.0 3.88
Same sex 3.6 5.0
occupationally, and socially was greatly hampered. It was also
Speech 4.3 4.7
reported in an earlier study by Turner, McCann, Beidel, & Mez-
zich (1986) that socially phobic subjects experience considera- *p<.01.»*p<.005.
394 TURNER, BEIDEL, DANCU, AND KEYS
reported at least one simple phobia. This is very close to the
31.6% figure reported by Cerny et al. (1984). It remains to be
seen whether or not this is an indication of a tendency for social
phobics to be more generally anxious and phobic, although both
the Cerny et al. study and an earlier one of our own (Turner et
al., 1986} suggested that this is the case.
The second major objective of this study was to conduct an
exploratory analysis comparing social phobics with avoidant
personality disorders to determine if they could be differenti-
ated on an empirical basis. There are even fewer studies on
avoidant personalities than on social phobia, and Liebowitz et
al. (1985) have pointed out that there are no data indicating
these are in fact different conditions. In examining psychophysi-
ological and cognitive variables, there were no differences be-
tween the two disorders. This could be a true lack of differences
or could be attributed to the limited sample size. However, there
were considerable differences on behavioral skill factors as
judged from the ratings of blind judges viewing the role-played
interactions. Specific differences were found in molecular be-
haviors such as eye contact and also on the important dimen-
sion of overall skill. The avoidant personalities were consistently
judged to be less socially skilled than were the social phobics.
The self-report inventories also revealed an interesting pat-
tern of differences between the two groups. The avoidant per-
sonality group reported more social avoidance and subjective
distress, consistent with the DSM-III contention that this disor-
der is characterized by generalized social inhibition. This is fur-
ther supported by the significantly higher score on the SCL-90-
R Interpersonal Sensitivity scale for the avoidant group, another
indication of extreme social sensitivity. The avoidant group also
scored significantly higher than the social phobics on the SCL-
90-R Anxiety, Depression and Obsessive-Compulsive sub-
scales. Finally, the general symptom index of the SCL-90-R was
significant, suggesting that the avoidant group exhibited a wider
variety of concerns.
The results of the comparison of social phobia and avoidant
personality disorder support the DSM-III position of separating
these two conditions. Furthermore, these findings could have
significant implications for treatment and research if they were
confirmed on a larger sample. The disorders can be differenti-
ated on certain self-report indices as well as on measures of in-
terpersonal skill. From a treatment standpoint, this might sug-
gest that different treatment strategies are in order. Although
exposure-based treatments would likely be useful for social
phobia, a social skills training program designed to remediate
basic social inadequacies might well prove more efficacious for
avoidant personalities. Although the interpretation of results
from both studies reported here is limited by the relatively small
sample, the findings reported in Study 1 are buttressed by sim-
ilar findings from other recent studies (e.g., Cerny et al., 1984;
Liebowitz et al., 1985). In the case of Study 2, this is the only
comparison of social phobics and avoidant personalities of
which we are aware, and these findings suggest important dis-
tinctions between these disorders that could have significant
treatment implications.
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Received March 14,1986
Revision received July 11, 1986 •