hardsocial anxiety disorderavoidant personality disorderdifferential diagnosispersonality disordersanxiety disorders
A 26-year-old man presents with longstanding difficulty in social situations. He reports intense fear of being judged negatively by others, avoidance of social gatherings, and reluctance to speak in groups. He has never had a close friend outside of his immediate family and has turned down two job promotions because they would require public presentations. He describes feeling fundamentally inferior to others and states he has felt this way "as far back as I can remember." He avoids all new activities due to fear of embarrassment and describes himself as "socially inept and unlikeable." He does experience physical anxiety symptoms including sweating and trembling in social situations. Which clinical feature is most helpful in distinguishing avoidant personality disorder from social anxiety disorder in this presentation?