der may become increasingly shy and avoidant  during adolescence and early adulthood,
when social relationships with new people become especially important. There is some
evidence that in adults, avoi dant personality disorder tend s to become less evident or to
remit with age. This diagnosi s should be used with great caution in children and adoles-
cents, for whom shy and avoidant behavi or may be developmentally appropriate.
Culture-Related Diagnostic Issues
There may be variation in the degree to whic h different cultural and ethnic groups regard
diffidence and avoidance as appropriate. Mo reover, avoidant behavior may be the result
of problems in acculturat ion following immigration. 
Gender-Related Diagnostic Issues
Avoidant personality disorder appears to be equally frequent in males and females.
Differential Diagnosis
Anxiety disorders. There appears to be a great deal of  overlap between avoidant person-
ality disorder and social anxiety disorder (s ocial phobia), so much so that they may be
alternative conceptualizations of the same or similar conditions. Avoidance also character-
izes both avoidant personality disorder and agoraphobia, and they often co-occur. 
Other personality disorders and personality traits. Other personality disorders may
be confused with avoidant pers onality disorder because they have certain fe atures in com-
mon. It is, therefore, important to distingu ish among these disorder s based on differences
in their characteristic features. However, if  an individual has personality features that
meet criteria for one or more personality diso rders in addition to avoidant personality dis-