Understanding the Differences Between Social Anxiety and Autism

By NeuroSpark Health

Social anxiety and autism are two experiences that can significantly impact a person's life in a variety of ways. While they share some similarities in terms of social difficulties and anxiety, they are fundamentally different in their nature, origins, and manifestations. This article aims to explore the differences between social anxiety vs autism, including distinctions in the DSM-5 criteria, experiences and realities of individuals, and appropriate support strategies.
 

DSM-5 Criteria: Social Anxiety vs. Autism

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides clear criteria for diagnosing both social anxiety and autism, highlighting their differences. While many neuroaffirming providers do not support the deficit-focused approach of the DSM-5’s criteria for autism, it can be helpful in comparing the two criteria for a better understanding of what makes them diagnostically different. In this section, the criteria for autism have been modified to be more neuroaffirming and less deficit-focused. 
 

Social Anxiety Disorder (SAD)

Social anxiety disorder, also known as social phobia, is characterized by an intense fear of social situations where one might be scrutinized by others. The DSM-5 criteria for SAD include:

1. Marked fear or anxiety about one or more social situations: These situations involve possible scrutiny by others, such as social interactions, being observed, or performing in front of others.
    

2. Fear of negative evaluation: The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated (e.g., humiliating or embarrassing).
    

3. Social situations almost always provoke fear or anxiety: These situations are either avoided or endured with intense fear or anxiety.
    

4. Fear or anxiety is out of proportion: The fear or anxiety is out of proportion to the actual threat posed by the social situation.
    

5. Duration: The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.
    

6. Significant distress or impairment: The fear, anxiety, or avoidance causes significant distress or impairment in social, occupational, or other important areas of functioning.
    

Autism

Autism is a neurotype characterized by differences in social communication and interaction, as well as restricted and repetitive behaviors, interests, or activities. It is important to note that the DSM-5 uses a deficit-focused criteria, which is not a holistic view of autism. The DSM-5 criteria for autism, with modifications to be more neuroaffirming, include:
 

1. Differences in social communication and social interaction: This includes difficulties in social-emotional reciprocity, nonverbal communicative behaviors, and developing, maintaining, and understanding relationships in a neurotypical manner. Autistic communication is often more comfortable among other autistic individuals. 
    

2. Repetitive patterns of behavior, interests, or activities: This includes repetitive motor movements (which are called stims), preference for routine, specific interests (which are called special interests), and hyper- or hypo-reactivity to sensory input. 
    

3. Traits must be present in the early developmental period: Although they may not become fully apparent until social demands exceed capacity. Additionally, many autistic individuals mask their autistic traits, making it hard to determine whether they were present in childhood or not. 
    

4. Traits can cause challenges, especially when not accommodated: These traits cause difficulties for the autistic individual in social, occupational, or other important areas where they are not accommodated. 
    

Differences in Experiences and Realities

While both can involve social challenges, the experiences and realities of the individuals differ significantly in social anxiety vs. autism. 
 

Social Anxiety: Experiences and Realities

1. Fear of Social Judgment: Individuals with social anxiety primarily struggle with an intense fear of being judged, embarrassed, or humiliated in social situations. This fear can lead to avoidance behaviors, such as skipping social events or staying quiet in group settings.
    

2. Awareness of Anxiety: People with social anxiety are often acutely aware of their anxiety and fear responses. They understand that their fear is irrational but feel powerless to control it.
    

3. Situational Anxiety: The anxiety experienced by individuals with social anxiety is often specific to certain situations. For example, public speaking, eating in front of others, or meeting new people might trigger anxiety, while other situations might not.
    

4. Desire for Social Interaction: Despite their anxiety, individuals with social anxiety often have a desire to form social connections. They may want to participate in social activities but feel paralyzed by their fear.
    

Autism: Experiences and Realities

1. Social Communication Differences: Autistic individuals experience differences in social communication and interaction. This can include difficulties understanding social cues, making eye contact, or engaging in reciprocal conversation. Additionally, autistic individuals may be acutely aware of patterns in social behavior and work extra hard to mimic social behaviors through masking.
    

2. Sensory Sensitivities: Many autistic individuals have sensory sensitivities, such as being overwhelmed by loud noises, bright lights, or certain textures. These sensitivities can impact their ability to engage in social situations, especially since many social environments in our society are not sensory-friendly. Bars, restaurants, and other social places can be overstimulating and uncomfortable for autistic individuals, making socializing even more difficult. 
    

3. Routine and Predictability: Autistic individuals often prefer routine and predictability. Changes in routine or unexpected events can cause significant distress and anxiety. This can make it hard to adapt to changing plans. 
    

4. Intense Interests: Autistic individuals may have intense interests in specific topics or activities, known as special interests. These interests can provide comfort and stability but might also be misunderstood by others. Allistic people may judge autistic individuals for having such strong feelings towards specific topics or preferences. 
    

5. Differences in Empathy: While it is a misconception and incorrect stereotype that autistic individuals lack empathy, their way of expressing and experiencing empathy can be different. They may struggle with recognizing and interpreting others' emotions, leading to social misunderstandings. Or they may experience alexithymia and can struggle to identify and express their own emotions. They may not know how an individual wants them to respond when they are expressing emotions, which can cause rifts in relationships. 
    

Differences in Support Strategies

Effective support strategies for social anxiety and autism must be tailored to the unique needs and challenges of each individual.
 

Supporting Individuals with Social Anxiety

1. Cognitive Behavioral Therapy (CBT): CBT is a highly effective treatment for social anxiety. It helps individuals identify and challenge negative thought patterns and develop coping strategies for managing anxiety.
    

2. Exposure Therapy: Gradual exposure to feared social situations can help individuals build confidence and reduce anxiety over time. This therapy involves facing fears in a controlled and systematic way.
    

3. Mindfulness and Relaxation Techniques: Techniques such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help individuals manage anxiety symptoms.
    

4. Medication: In some cases, medication such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines may be prescribed to help manage anxiety symptoms.
    

5. Social Skills Training: Learning and practicing social skills can help individuals with social anxiety feel more confident in social interactions.
    

Supporting Autistic Individuals

1. Neuroaffirming Therapy: Like individuals with social anxiety, autistic individuals can benefit from therapy. Neuroaffirming therapy is catered to an individual's unique neurodivergent needs and provides a more holistic approach to emotional regulation, trauma processing, and more.
    

2. Sensory Accommodations: Providing sensory-friendly environments and accommodations can help autistic individuals manage sensory sensitivities. This might include noise-canceling headphones, dim lighting, or sensory breaks.
    

3. Routine and Predictability: Creating structured and predictable environments can help reduce anxiety for autistic individuals. Visual schedules, clear routines, and advance notice of changes can be beneficial.
    

4. Special Interests: Encouraging and supporting special interests can provide a sense of stability and comfort. These interests can also be used as a bridge for social interaction and learning.
    

5. Communication Support: Providing alternative communication methods, such as augmentative and alternative communication (AAC) devices, can help nonverbal or minimally verbal autistic individuals communicate effectively.
    

Overlapping Challenges and Misdiagnosis

Despite their differences, social anxiety and autism can present overlapping challenges, leading to potential misdiagnosis. Additionally, some autistic individuals may suffer from social anxiety, further muddying the waters. 
 

Overlapping Challenges

1. Social Difficulties: Both social anxiety and autism can involve difficulties with social interactions. This can make it challenging to distinguish between the two based solely on social behavior.
    

2. Avoidance Behavior: Individuals with social anxiety may avoid social situations due to fear, while autistic individuals might avoid them due to sensory overload or social confusion. In both cases, avoidance behavior is a common response.
    

3. Anxiety: Anxiety is a prevalent experience in both social anxiety and autism. Autistic individuals often experience anxiety related to sensory sensitivities, changes in routine, and social interactions, which can be mistaken for social anxiety. Additionally, autistic individuals may have social anxiety due to traumatic past experiences related to social environments. Many autistic individuals have experienced bullying or ridicule due to being perceived as different by their peers. 
    

Misdiagnosis

1. Misinterpreting Social Behavior: Autistic individuals who mask their traits might be misdiagnosed with social anxiety because their social difficulties are attributed to anxiety rather than neurodivergence. Conversely, individuals with social anxiety might be misdiagnosed as autistic if their avoidance behaviors and social difficulties are seen as stemming from autism-related social communication differences.
    

2. Overlapping Experiences: The overlap in traits, such as social withdrawal, difficulty in social situations, and anxiety, can lead to confusion in diagnosis. Clinicians must carefully evaluate the underlying causes of these behaviors to make an accurate diagnosis.
    

Personal Narratives and Lived Experiences

Understanding the lived experiences of those who are autistic and socially anxious provides valuable insight into their distinct realities.
 

Personal Narratives of Individuals with Social Anxiety

1. Navigating Social Events: Many individuals with social anxiety describe the intense fear and dread they feel before attending social events. They may worry about being judged, saying something wrong, or embarrassing themselves. This fear often leads to avoidance behaviors, such as making excuses to skip events or staying in the background.
    

2. Physical Symptoms: Social anxiety can manifest in physical symptoms such as sweating, trembling, rapid heartbeat, and nausea. These symptoms can be overwhelming and make it challenging to engage in social interactions.
    

3. Impact on Daily Life: Social anxiety can impact various aspects of daily life, including work, school, and relationships. Individuals may struggle with public speaking, participating in meetings, or forming close friendships.
    

Personal Narratives of Autistic Individuals

1. Sensory Experiences: Autistic individuals often describe their sensory experiences as intense and overwhelming. They might find certain sounds, lights, or textures unbearable, leading to sensory overload and anxiety.
    

2. Social Communication Differences: Many autistic individuals describe their challenges with social communication. They might struggle to understand social cues, maintain eye contact, or interpret body language. These differences can lead to social misunderstandings and feelings of isolation.
    

3. Special Interests: Autistic individuals often have passionate interests that provide comfort and stability. These interests can be a source of joy and a way to connect with others who share similar passions.
    

Conclusion

While social anxiety and autism share some similarities in terms of social challenges and anxiety, they are fundamentally different in their nature, origins, and manifestations. Understanding these differences is crucial for providing effective support and accommodations for individuals with either condition. At NeuroSpark, we recognize the unique experiences and realities of individuals with social anxiety and autistic individuals and are happy to offer affirming adult autism assessments which can help you make sense of your neurotype.