Differences Between Social Anxiety and Autism

This article will discuss some similarities and differences between SAD and Autism. It is worth noting that the traits discussed are not exhaustive.

Likewise, not everyone with these disorders will act or present similarly. Autism, especially, is a spectrum disorder, meaning that the traits can differ from person to person, and no two Autistic individuals are the same.

What Is Social Anxiety Disorder?

Social anxiety disorder, also known as social phobia, is an anxiety disorder characterized by intense fear and anxiety in social situations.

People with SAD often experience excessive worry about being judged or scrutinized by others, and may avoid social situations altogether or endure them with extreme discomfort. This disorder can significantly impair daily functioning and negatively impact quality of life.

What is Autism?

Autism is a neurodevelopmental disorder that impacts communication, behavior, and social interaction. It is typically diagnosed during early childhood and can vary in support needs.

Autistic individuals may experience differences in verbal and nonverbal communication, exhibit repetitive behaviors and have limited interests, and struggle with social interactions. However, each individual with Autism is unique and may have a range of strengths and challenges.

How are Autism and Social Anxiety similar?

Some of the overlapping traits between Autism and SAD can include the following:

Social skills

A key trait of Autism is differences in social interaction, such as difficulty maintaining eye contact, different body posture, and speech qualities such as tone, volume, and rate.

Although this is not the case for all autistic individuals, many with this disorder prefer limited social communication and might appear quiet or withdrawn in social situations.

Although the cause of social difficulties in both Autism and SAD differs, many of the same signs are present in both disorders. People with both Autism and SAD may have differences in social competence. 

Due to those with SAD being anxious in social situations, they are also likely not to speak so much, talking quietly, and may present with a less confident posture.

Spending time alone

Autistic individuals and those with SAD may be more likely to want to spend time alone than be in social situations, although the reasons for avoiding these situations are different.

They are likely to avoid situations requiring social interaction and may actively avoid people at times, especially those who are unfamiliar.

They may prefer to be happier when isolating themselves from others, spending more time alone than with anyone else.

Some of the questions or statements on tests for Autism and SAD can be very similar, such as asking whether the individual wants to avoid social situations and whether they prefer spending time alone.

These kinds of overlaps in testing can make it difficult to distinguish whether someone is autistic or has SAD.

Anxiety

An obvious trait of SAD is severe anxiety symptoms, especially in social situations. It is also common for autistic individuals to experience extreme anxiety in social situations, such as feeling nervous or only being comfortable around a few certain people.

Autistic individuals may have difficulty recognizing and regulating their emotions, which could result in co-existing anxiety disorders. 

Likewise, Autistic individuals can become so overwhelmed that they completely withdraw or find they are unable to talk (also known as shutdowns), which others may confuse as being socially anxious.

Autistic individuals may have realistic worries about social failure, social rejection, and negative evaluations from others, which all contribute to anxiety. 

They may engage in masking behaviors, which means they may be hyperaware of how they present themselves and the impression they make on others and adjust their behaviors as a way to fit in. 

Difficulty building friendships

Autistic individuals and those with SAD may also find trouble building and maintaining friendships.

Reasons for this can include all the above difficulties associated with their social skills, wanting to spend time alone, and anxiety they may experience in social settings.

Combined, it can be very challenging for an autistic individual or someone with SAD to form friendships, especially with people they are not as familiar with.

However, it is worth noting this is not always the case, as many people with SAD and autism can form strong relationships with few or many people.

What are the differences?

While Autism and SAD share a lot of similarities, they are distinct in many ways.

The main difference is that Autism is a neurodevelopmental condition while SAD is a mental health condition.

Below are some of the other key differences between these disorders:

Differences in social situations

Although autistic individuals and those with SAD might prefer to avoid social situations, the reasoning behind their avoidance is where the differences lie:

• Autistic individuals may experience sensory overstimulation in social situations and may be less inclined to seek out a social activity. They may simply have a preference for time alone rather than seeking isolation out of fear. 

• Those with SAD do not usually experience sensory issues. They typically choose to withdraw from social situations for fear of being judged.

• Autistic individuals can struggle to guess what others are thinking and read subtle social cues, which can be stressful and could result in social misunderstandings and bullying. They may also display nervousness because they have had bad social experiences in the past.

• Those with SAD may not have difficulty reading facial expressions and body language but may experience cognitive distortions (e.g., using mental filters or catastrophizing) in social situations.

• Social anxiety can cause physical symptoms in social situations, such as blushing, sweating, and a rapid heart rate due to being in a fearful situation, whereas autistic people may not experience these symptoms in the same situations. 

Differences in social skills

Autistic individuals and those with SAD also have differences in their social skills:

• Autistic individuals may struggle in social situations since they may not have some of the same social skills as neurotypicals. However, many Autistic people are skilled at ‘masking’ their traits (e.g., through observing or mirroring others) to present themselves as more neurotypical.

• Those with SAD may have ‘socially accepted’ social skills but are too scared to use them – their fear of socializing makes it difficult to use these skills.

• SAD often causes people to stutter, blush, or make their minds go ‘blank’ in social situations, making it difficult to execute a conversation. Consequently, they appear to have poor social skills when anxious. When the person with SAD is in a comfortable situation, these symptoms will likely cease.

• Autistic individuals may fidget or use repetitive movements (e.g., ‘stimming’) in social situations; however, this is often a way to help them self-regulate, and they will continue to do it outside of social situations. Someone with SAD may also fidget or use repetitive movements in social situations, but this may just be because they are nervous and will stop when out of the social situation.

• Many autistic individuals are not withdrawn and quiet – they can speak loudly, stand too close to another person, and can talk at length about their special interests. 

• In comparison, those with SAD may speak quietly or too softly, prefer to stand far away from others, and avoid eye contact out of fear.

• Autistic individuals do not necessarily avoid eye contact out of fear; they may find it uncomfortable or overstimulating to do so. Overall, those with SAD tend to be quicker at orienting away from eye contact while Autistic people are slower at making eye contact.

• Autism is a spectrum, and people may communicate differently – some may be nonverbal, while others may engage in one-sided conversations or miss social cues. In comparison, those with SAD may intentionally avoid conversations because of fear of embarrassment or negative judgment.

Differences in diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes a set of criteria that an individual must meet before being diagnosed as autistic or with SAD.

The diagnostic criteria for both disorders are very different. For Autism, the DSM includes:

• Persistent difficulties in social communication, including but not limited to lack of back-and-forth conversations and differences in eye contact.

• Repetitive patterns of behavior.

• Symptoms were present in early development, even if they went unnoticed.

• The symptoms interfere with daily functioning.

For SAD, the DSM includes the following:

• Fear of judgment in social situations.

• Consistent anxiety in social situations that do not fit the context.

• Avoidance of social interaction.

• A fear of social interaction that impedes day-to-day life.

• The fear must be present for at least six months and not attributed to another mental health condition.

Differences in the onset

It is important to note the age of onset for these conditions. SAD can develop at any age, in childhood, or with adults who have never experienced social anxiety before.

It can be influenced in some way by genetics, but SAD can also be triggered by trauma or stressful life events such as bullying.

Autism, on the other hand, is not triggered by environmental factors and is present from birth. Autism is also a lifelong condition that cannot be ‘cured,’ whereas SAD can be effectively treated with therapy and medication. 

Social anxiety vs Autism

Social Anxiety Disorder	Autism
An anxiety disorder characterized by excessive fear of social situations and fear of being judged or evaluated by others	A neurodevelopmental disorder characterized by difficulty in social communication and interaction, and restrictive and repetitive patterns of behavior
Typically develops in adolescence or early adulthood	Usually diagnosed in early childhood
Fear and avoidance of social situations, but desire to connect with others	Difficulty with social communication, understanding social cues, and maintaining relationships
May have typical emotional expression, but may experience heightened anxiety in social situations	May have difficulty with emotional expression, including difficulty identifying and understanding emotions in others
May have a variety of interests and hobbies	May have intense, narrow interests
May be hypersensitive to criticism or negative evaluation from others	May have sensory processing issues, including hypersensitivity or hyposensitivity to sensory stimuli

Can Autism and Social Anxiety co-exist?

Autism and social anxiety can definitely co-exist. As someone who is autistic and also struggled with social anxiety since childhood, this is something I have experience with.

In autism, social communication challenges and restricted interests are primary features. When combined with SAD, these traits can be exacerbated, leading to more severe social difficulties and anxiety than either condition alone.

As well as not always understanding subtle social cues, I also experience physical signs of anxiety in most social situations, which would further distract me from trying to understand others.

I will often avoid eye contact, both because I find it too intense (an autistic sign) and because I feel too anxious (social anxiety sign.)

I often overthink social situations and ruminate on my ‘mistakes.’ These can be both mistakes that may have occurred from appearing ‘too autistic,’ such as oversharing a special interest or appearing obviously anxious, such as blushing or stuttering.

It is very common for me to over-prepare for social situations, such as having a script or pre-prepared questions ready. This unhelpful coping strategy is meant to help me feel less fearful but is also a masking behavior to appear more neurotypical and protect me from potential negative judgment.

After social situations, I might need a lot of time alone and frequently go mute. I also find that my stimming behaviors increase as a way for me to regulate my nervous system.

This overlap between autism and SAD can make diagnosis challenging and necessitates tailored support strategies.

Do All Autistic People Have Anxiety?

While not all autistic individuals experience anxiety, there is a significant overlap between the two conditions.

Research indicates that anxiety disorders are more prevalent in autistic individuals compared to the general population.

SAD is particularly common, with studies suggesting up to 50% of autistic individuals may qualify for this diagnosis.

This higher prevalence may be due to challenges in social communication and interaction, which are core characteristics of autism.

Other anxiety disorders, such as Generalized Anxiety Disorder, Specific Phobias, and Obsessive-Compulsive Disorder, are also more common in autistic individuals.

These can manifest in unique ways, often intertwining with autistic traits and sensory sensitivities.

Factors contributing to heightened anxiety in autism include:

• Sensory differences and overload
• Communication challenges
• Difficulties with changes in routine and uncertainty
• Executive function demands
• The stress of masking or camouflaging autistic traits

While anxiety is common in autism, it’s important to note that not all autistic individuals experience clinical levels of anxiety. Each person’s experience is unique, and many develop effective coping strategies.

Can Autism be Misdiagnosed as SAD?

Due to similarities in social traits, autistic individuals may be misdiagnosed with social anxiety disorder (SAD), particularly females.

I was accessing support for social anxiety when I was around 20 years old and understood that this is something I struggled with since early childhood. However, I did not get a diagnosis of Autism until I was 30 and did not consider I was autistic at all until a couple of years prior.

I took medication and had psychotherapy to overcome my social anxiety, which did indeed help me navigate social situations with less fear.

However, I kept returning back to therapy over the years because I was still feeling ‘different’ in social situations compared to others and thinking this was still due to social anxiety when it might have been better attributed to autism.

Social anxiety may be misdiagnosed or diagnosed first in those who are autistic for the following reasons:

1. Historical male bias in autism research and diagnosis.
2. Some individuals with autism, especially females, may learn to “mask” or camouflage their autistic traits to fit in socially.
3. Effective masking can make autism harder to recognize, potentially leading to an SAD diagnosis instead.
4. The anxiety experienced in social situations by individuals with autism may be mistaken for SAD.

It’s important for clinicians to consider both Autism and SAD when evaluating social difficulties, as accurate diagnosis is crucial for appropriate support and interventions.

Carly Jones MBE, an Autistic woman who is a British Autism Advocate, describes her experience of misdiagnosis:

‘They thought I had a social anxiety disorder. I was medicated, which made me feel like a zombie. I don’t have a social anxiety disorder. I’m just socially anxious because I’m Autistic… the root cause of my social anxiety, previous eating disorders… was Autism.’

Source: Autism: In conversation with auticon Podcast

References

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