Avoidant personality disorder
Background
- A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Clinical Features
- Four (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:[1]
- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
- Is unwilling to get involved with people unless certain of being liked.
- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. **Is preoccupied with being criticized or rejected in social situations.
- Is inhibited in new interpersonal situations because of feelings of inadequacy.
- Views self as socially inept, personally unappealing, or inferior to others.
- Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
Differential Diagnosis
- Anxiety disorders
- Other personality disorders
- Personality change due to another medical condition
- Substance use disorders
Evaluation
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- May need lots of reassurance
- May avoid giving decisive answers
- Try a low-key, casual tone
- Respond with empathy for emotions, but be firm and set boundaries regarding requests for excessive reassurances (e.g. emphasize what is already reassuring about presentation and that additional tests cannot be performed at this time)
- Emphasize follow-up plan and that patient can always return if deteriorates or not getting better
- Referral for outpatient psychiatric treatment. Various techniques can be employed such as psychotherapy, social skills training, group therapy and exposure therapy to increase social contacts.
Disposition
- Discharge
See Also
External Links
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
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