In this paper, we discuss avoidant personality disorder and its complexities by presenting a case in which the differential diagnosis was extremely difficult. The presented case concerns a patient, who initially received the diagnosis of Taijin kyofusho, a diagnosis commonly made in the traditional psychiatry in Japan, and later, his diagnosis was changed to avoidant personality disorder as the DSM-III gained popularity. His chief complaint was his concern over his odour from his genitourinary organs, which led him to avoid interpersonal relationships. During the course of illness, his concern over his body odour and appearance grew to the extent that he sought surgical treatment, but he managed to succeed in his business. Currently, he is being treated with the medium dose of selective serotonin reuptake inhibitors in addition to psychotherapy, but his symptoms concerning interpersonal relationships still remain. Many symptoms other than typical ones of avoidant personality disorder were observed, and other psychiatric diagnoses, including delusional disorder, somatization disorder, and body dysmorphic disorder, were considered for differential diagnosis. Although they were ruled out in light of the criteria in the current diagnostic classification, this case illustrates the complex nature of the diagnosis of avoidant personality disorder, and furthermore, of psychiatric diagnoses. Copyright (c) 2012 John Wiley Sons, Ltd.
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