Cognitive Behaviour Therapy in Adolescent with Evolving Anxious Avoidant Personality Disorder

Theoretical models propose that Personality Disorders (PD) have definite temperamental precursors in childhood (Millon, 1981; Rutter, 1987). ICD 10 Classification diagnostic guidelines also regard manifestations of PD traits in early childhood and adolescence. There is some research evidence suggesting early manifestations of AAPD in childhood and adolescence (Rettew et al., 2003). Severity and persistence of symptoms through early to late adolescence exceeding sub-syndromal levels warrants discussion of presentation and treatment of this case. The patient is a 16 years old boy from first PUC reported complaints of avoiding school earlier and now college because of significant anxiety in interpersonal interaction, fear of being negatively judged, criticized and rejected in social situations and occasional sad mood. These symptoms precipitated five years ago after a love proposal from a girl in school in which he was falsely implicated. Currently also has doubts and fear related to academics. Psychological assessment supports the diagnosis of AAPD. Highly orthodox family environment, indulgent parenting style absence of father, anxious and shy temperament laid the foundation and reinforced negative self-concept. Relaxation training, cognitive restructuring, graded exposure therapy with components of social skills training were carried out (30sessions). Following treatment he is regular to college and is able to challenge his negative cognitions with minor hitches. This case illustrates the need to consider diagnosing and treating AAPD in adolescence when symptoms are severe.