A patient describes long-standing social isolation. Before revealing the answer, decide what distinguishes anxious (avoidant) personality disorder from schizoid personality disorder.

Ask directly about the person's underlying wish for closeness, not just their current level of social contact. Anxious personality disorder is defined by the presence of an intense, keenly felt desire to make friends, frustrated by shyness, tension, and lack of confidence, so the isolation is unwanted and distressing. Schizoid personality disorder involves little underlying wish for closeness in the first place — the detachment is not something the person is straining against, and typically does not carry the same distress. Two people can look outwardly similar, both isolated and withdrawn, while one desperately wants connection and the other simply does not feel the need for it — establishing which of these is true is the actual discriminating question.