Vol.:(0123456789) 1 3 ADHD Attention Defcit and Hyperactivity Disorders https://doi.org/10.1007/s12402-019-00291-x ORIGINAL ARTICLE The importance of avoidant personality in social anxiety disorder with and without attention‑defcit/hyperactivity disorder Caner Yoldas 1  · Bilge Dogan 1  · Oktay Kocabas 2  · Cagdas Oyku Memis 1  · Doga Sevincok 3  · Levent Sevincok 1 Received: 19 November 2018 / Accepted: 6 February 2019 © Springer-Verlag GmbH Austria, part of Springer Nature 2019 Abstract In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-defcit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical vari- ables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had signifcantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson’s correlation coefcient in total sample (n = 76) showed that the mean number of AVPD criteria was signifcantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS signifcantly predicted the mean number of AVPD criteria (β = 0.305, p= 0.007). The severity of current depression (β = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (β = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might dem- onstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood. Keywords Social anxiety disorder · Avoidant personality disorder · Attention-defcit/hyperactivity disorder · Depression Social anxiety disorder (SAD) is characterized by a per- sistent fear of at least one social or performance condition with exposure to unfamiliar people or to possible scrutiny by others (American Psychiatric Association 2013). A person with SAD fears that he or she will be in conditions that will be humiliating or embarrassing, and being exposed to the feared situations almost invariably provokes anxiety (Stein and Stein 2008). Avoidant personality disorder (AVPD) is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation and criticism that begins in early adulthood (American Psychiatric Associa- tion 2013). Several studies found a signifcant association between AVPD and SAD with varying rates of comorbid- ity between 22 and 89% (Cox et al. 2009; Hummelen et al. 2007; Alden et al. 2002; Schneier et al. 1991; Reich 2000). SAD and AVPD comorbidity was considered as a continuum of social anxiety, ranging from normal social anxiety and shyness to AVPD (Isomura et al. 2015; Ralevski et al. 2005; Reich 2009). Previous studies reported that comorbid SAD and AVPD was associated with more severe anxiety symp- toms (Cox et al. 2009; Chambless et al. 2008; van Velzen et al. 2000), increased psychiatric comorbidity (Cox et al. 2009; Reich 2000; Boone et al. 1999), and greater disability (Reich 2000) compared to those with SAD and no comorbid AVPD. Attention-defcit/hyperactivity disorder (ADHD) is a childhood-onset disorder that persists into adolescence and adulthood in more than half of the cases (Biederman et al. 2011a, b; Klein et al. 2012; Kessler et al. 2005; Lara et al. 2009). While hyperactivity and impulsivity decline with * Levent Sevincok lsevincok@adu.edu.tr 1 Department of Psychiatry, Adnan Menderes University, Aydin, Turkey 2 Psychiatry Service, Turhal State Hospital, Tokat, Turkey 3 Department of Child and Adolescent Psychiatry, Adnan Menderes University, Aydin, Turkey