The Relationship Between PTSD and Social Anxiety Disorder

Guilt and shame in PTSD patients may lead to SAD

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PTSD and social anxiety disorder (SAD) commonly co-occur, and there are a number of possible reasons why people with PTSD, as compared to those without the diagnosis, may be more likely to develop fears of social situations.

What is Social Anxiety Disorder?

SAD (sometimes also called "social phobia") is considered an anxiety disorder. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, to be diagnosed with SAD, you need to have a frequent and unending fear of social situations or situations where you are expected to perform in some way.

In these situations, you come into contact with unfamiliar people or experience the possibility of scrutiny by others.

You may also experience fear about appearing anxious or acting in a way that will bring about embarrassment or humiliation. Moreover, your upcoming contact with a feared situation almost always causes anxiety, maybe even in the form of a panic attack.

You recognize that the fear you experience in response to social situations is unreasonable or greater than it should be, and you avoid situations you fear. If you have to be in those situations, you do so with high levels of anxiety and distress.

These symptoms interfere considerably with many aspects of your life (work, relationships, etc.) and are not due to medication, a substance (i.e., alcohol), a medical condition or other disorder.

Rates of SAD Among People with PTSD

The percentage of people with PTSD who also have SAD differs depending on the group of people that you look at.

For example, in a large study of people from the general population, approximately 28 percent with a current or past diagnosis of PTSD also were found to have or have had a diagnosis of SAD. People who had PTSD at some point in their lives were three times as likely as someone without PTSD to have also had SAD.

Another study of patients seeking treatment for PTSD found that, of those patients with a diagnosis of PTSD, 43 percent also had SAD. But in another study of a group of people who survived a disaster, only 8 percent of those with PTSD also had SAD. Finally, a couple of studies found that anywhere between 12 and 15 percent of combat veterans with PTSD have SAD, and this rate is higher than what is found among combat veterans without PTSD.

Why Are PTSD and SAD Related?

A number of theories have been proposed to explain why PTSD and SAD are related. First, the symptoms of PTSD may make a person feel different, as though they can't relate or connect with others. A person with PTSD may have difficulties communicating or interacting with others for fear of coming into contact with trauma-related reminders. All of this may feed the development of SAD.

In addition, many people with PTSD feel high levels of shame, guilt and self-blame, and these feelings may lead to SAD. Finally, there is evidence that SAD among people with PTSD stems from depression.

People with PTSD often experience depression, which may lead to social withdrawal, isolation and a lack of motivation that could contribute to the development of SAD.

Getting Help

If you have PTSD and SAD, it is important to seek help. Fortunately, there are many effective treatments for SAD. In addition, there are treatments for PTSD that have been shown to be successful in reducing symptoms. By getting treatment for PTSD, you may also notice that your symptoms of SAD lower as well. 

Sources:

Green, B.L., Lindy, J.D., Grace, M.C., & Leonard, A.C. (1992). Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample. Journal of Nervous and Mental Disease, 180, 760-766.

Hofmann, S.G., Litz, B.T., & Weathers, F.W. (2003). Social anxiety, depression, and PTSD in Vietnam veterans. Social anxiety, depression, and PTSD in Vietnam veterans. Journal of Anxiety Disorders, 17, 573-582.

Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.

Orsillo, S.M., Heimberg, R.G., Juster, H.R., & Garrett, J. (1996). Social phobia and PTSD in Vietnam veterans. Journal of Traumatic Stress, 9, 235-252.

Orsillo, S.M., Weathers, F.W., Litz, B.T., Steinberg, H.R., Huska, J.A., & Keane, T.M. (1996). Current and lifetime psychiatric disorders among Veternas with war zone-related posttraumatic stress disorder. Journal of Nervous and Mental Disease, 184, 307-313.

Roszell, D.K., McFall, M.E., & Malas, K.L. (1991). Frequency of symptoms and concurrent psychiatric disorder in Vietnam veterans with chronic PTSD. Hospital Community Psychiatry, 42, 293-296.

Zayfert, C., DeViva, J., & Hofmann, S.G. (2005). Comorbid PTSD and social phobia in a treatment seeking population: An exploratory study. Journal of Nervous and Mental Disease, 193, 93-101.

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