Wichstrøm Lars, Wilberg Theresa, Hartveit Kvarstein Elfrida, Steinsbekk Silje
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Child and Adolescent Psychiatry, St Olavs Hospital, Trondheim, Norway.
J Child Psychol Psychiatry. 2025 Mar;66(3):366-377. doi: 10.1111/jcpp.14064. Epub 2024 Nov 4.
Although it is widely assumed that avoidant personality disorder (AvPD) originates in childhood, there is little prospective research to substantiate this claim. We therefore aimed to determine whether presumed childhood risk factors predict AvPD traits at 16 years.
A population-based sample (n = 1,077; 50.9% female) from the 2003 and 2004 birth cohorts in Trondheim, Norway was examined biennially from 4 to 16 years. The number of AvPD traits at the age of 16 was assessed with the structured clinical interview for DSM-5 personality disorders and regressed on the intercept and growth in child risk and protective factors until the age of 14.
The prevalence of AvPD at the age of 16 was 3.2% (95% CI: 2.2-4.1). Higher levels and an increased number of social anxiety symptoms over time, as well as increased negative affectivity/neuroticism, predicted a higher number of AvPD traits. When the levels and changes in these factors were adjusted for, less and decreasing extraversion forecasted more AvPD traits, as did declining self-worth, higher levels of parental AvPD traits, and increased onlooking behavior.
Neuroticism, low extraversion, social anxiety symptoms, passive onlooking behavior, and low self-worth predicted a higher number of AvPD traits in adolescence, as did more AvPD traits in parents. Efforts to enhance self-worth, reduce social anxiety, and promote peer interaction among onlooking children may reduce the development of AvPD traits in adolescence.
尽管人们普遍认为回避型人格障碍（AvPD）起源于童年，但几乎没有前瞻性研究来证实这一说法。因此，我们旨在确定假定的童年风险因素是否能预测16岁时的AvPD特质。
对挪威特隆赫姆2003年和2004年出生队列中的一个基于人群的样本（n = 1077；50.9%为女性）从4岁到16岁每两年进行一次检查。使用针对《精神疾病诊断与统计手册》第5版人格障碍的结构化临床访谈评估16岁时的AvPD特质数量，并将其作为因变量，以14岁之前儿童风险和保护因素的截距及增长情况作为自变量进行回归分析。
16岁时AvPD的患病率为3.2%（95%置信区间：[2.2, 4.1]）。随着时间推移，社交焦虑症状水平更高、数量增加，以及消极情感性/神经质增加，预测出更多的AvPD特质。当对这些因素的水平和变化进行调整后，外向性减少且呈下降趋势、自我价值降低、父母的AvPD特质水平较高以及旁观行为增加，都预测出更多的AvPD特质。
神经质、低外向性、社交焦虑症状、被动旁观行为和低自我价值预测了青少年期更多的AvPD特质，父母更多的AvPD特质也有同样的预测作用。提高自我价值、减少社交焦虑以及促进旁观儿童之间的同伴互动的努力，可能会减少青少年期AvPD特质的发展。
