Comorbidity in Social Anxiety Disorder

Disorders Related to Social Anxiety Disorder

Many disorders can be diagnosed along with social anxiety disorder.
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Comorbidity in social anxiety disorder (SAD) refers to having another disorder in addition to SAD. Having SAD increases the chance that you will be diagnosed with another disorder, and also makes receiving treatment more complex. Many disorders are related to social anxiety disorder (SAD), including other anxiety disorders, depression, and personality disorders.

Avoidant Personality Disorder

If you have avoidant personality disorder (APD), you will experience many of the same symptoms as someone with SAD.

However, your symptoms will be broader and more severe. Because of the overlap between the two disorders, it is possible to be diagnosed with both APD and social anxiety disorder.

One of the key defining features of avoidant personality disorder that tends not to be present to the same degree in SAD is a lack of trust of the motives of others. While those with APD feel others are not to be trusted, those with SAD tend more toward feeling as though others are judging them.

Panic Disorder

Panic disorder differs from SAD in terms of the triggers of panic, the kind of symptoms that are experienced, and beliefs about the underlying causes. It is possible to be diagnosed with both panic disorder and social anxiety disorder, and the treatments may or may not be the same for both disorders.

While individuals with panic disorder and social anxiety disorder may share similar patterns of avoidance and experience some of the same types of symptoms, a key defining difference is that persons with panic disorder often feel better in the presence of a trusted companion, while this may cause those with SAD to feel more anxiety.

Generalized Anxiety Disorder

If you suffer with generalized anxiety disorder (GAD), your worry tends to be broad and general, rather than focused on social or performance situations. You might worry about finances, your job, global warming, family issues, or any number of things. Your worry probably keeps you awake at night and may morph into physical symptoms such as tension headaches or migraines.

People with social anxiety disorder, on the other hand, usually are limited to feeling anxiety about social and performance situations.

Depression

There is an established relationship between depression and social anxiety disorder—if you've been diagnosed with SAD, you are more likely to develop depression later in life.

What's more, people who suffer from both depression and social anxiety disorder often only seek help for depression, even though they may have had severe social anxiety for many more years. Unfortunately, treating depression without also treating underlying social anxiety will not be as effective. This is why it is important to share all of your symptoms with your doctor, and for physicians to be alert to potential signs of social anxiety disorder.

Alcoholism

If you suffer with social anxiety disorder, you are more likely to also suffer with alcoholism. Often people with SAD begin drinking to cope—but eventually drinking becomes a problem in its own right. If you have both social anxiety disorder and alcoholism, treatment must be tailored to your unique situation to address both issues.

Eating Disorders

Social anxiety disorder and eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder may sometimes be diagnosed together.

Fear of eating in public is a common symptom, but the types of behavior and motivation underlying it are quite different. For example, people with anorexia may fear being judged for overeating and may shift food around on their plate, while someone with SAD may fear spilling a drink or having shaking hands while eating.

Schizophrenia

While comorbid SAD and schizophrenia has received less attention, there is some evidence of increased risk for social anxiety disorder among those with schizophrenia. For those with schizophrenia as well as SAD, quality of life can be lowered. 

A Word From Verywell

If you've been diagnosed with social anxiety disorder along with another comorbid disorder, your doctor will determine the best course of treatment to manage the complex interaction between your symptoms.

In order to receive the best possible treatment, be sure to share all of your symptoms during diagnosis, so that a complete picture of your circumstances emerges.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author; 2013.

Cox BJ, Pagura J, Stein MB, Sareen J. The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey. Depress Anxiety. 2009;26:354-362.

Hales RE, Yudofsky SC, eds. The American psychiatry publishing textbook of clinical psychiatry. Washington, DC: American Psychiatric; 2003.

Lowengrub KM, Stryjer R, Birger M, Iancu I. Social Anxiety Disorder Comorbid with Schizophrenia: The Importance of Screening for This Under recognized and Under treated Condition. Isr J Psychiatry Relat Sci. 2015;52(1):40-45.

McMillan KA, Asmundson GJG. PTSD, social anxiety disorder, and trauma: An examination of the influence of trauma type on comorbidity using a nationally representative sample. Psychiatry Res. 2016;246:561-567.

 

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