Differential Diagnoses of Social Anxiety Disorder
Since social anxiety often comes along with different personality disorders, it is important to determine whether social anxiety disorder is the only potential diagnosis or if there is another psychological disorder involved (Stangier, Heidenreich, & Peitz, 2009). This knowledge is likely to have an influence on the planning of therapy and gives insight to possible additional interventions.
Social retreat and fears related to social situations often accompany depression (Stangier, Heidenreich, & Peitz, 2009). It has been pointed out that in these cases social anxiety disorder should only be diagnosed if its symptoms had been present before the beginning of the depressive episode or persist after it it has ended.
Panic Disorder & Agoraphobia
In order to differentiate between social anxiety disorder and panic disorder, the main concern of the individual during a panic attack is observed. People with social phobia are mainly concerned with rejection, being negatively evaluated, and being humiliated by others, while people suffering from panic disorder usually fear physical harm, such as a heart attack, or losing control over themselves in general (Stangier, Heidenreich, & Peitz, 2009).
While both socially anxious people and individuals suffering from agoraphobia tend to avoid places with many people (Schneider & Margraf, 1998, p. 11), their main reason for it differs as well. Agoraphobia is related to fears of helplessness, social anxiety to humiliation and embarassment (Stangier, Heidenreich, & Peitz, 2009).
Generalized Anxiety Disorder
As might be suspected, the fears of generalized anxiety disorder relate not only to the social realm, but also to other areas, such as one’s finances and health (Stangier, Heidenreich, & Peitz, 2009). When the fears of the individual mainly circulate around social situations, physical symptoms can help to determine the diagnosis. While headaches, insomnia and mortal agony are more typical for generalized anxiety disorder, excessive sweating, blushing and difficulties breathing rather correspond to social anxiety (Reich, Noyes, & Yates, 1988).
Obsessive Compulsive Disorder
Rituals of people suffering from obsessive compulsive disorder can sometimes be confused with social anxiety symptoms (Stangier, Heidenreich, & Peitz, 2009). However, the motivation for engaging in these behaviors is different to the motives of socially anxious individuals.
Obsessive compulsive disorder often also comes along with a certain intensity of shame and social retreat, which can complicate the diagnosis. Here the exploration of the nature of the driving forces lays the foundation of the professional’s conclusion.
Body Dysmorphic Disorder
People suffering from body dysmorphic disorder are convinced to be physically ugly and tend to describe themselves as hideous. This constitutes their main motivation to avoid social situations (Stangier, Heidenreich, & Peitz, 2009). While socially anxious people might also be concerned about rejection and negative evaluation based on their looks, there is a whole range of other factors they might consider reasons to be rejected and therefore avoid specific social scenarios.
In the course of a psychotic disorder it often comes to social retreat, which in few cases can be of a fearful nature
(Stangier, Heidenreich, & Peitz, 2009). It has been pointed out that individuals with psychotic symptoms can experience a sensation of lack of clarity in situations with many people present, which qualifies as their main motivation to avoid such social situations.
Psychic disorders can be the result of physical conditions. This also accounts for anxiety related disorders and symptoms. Therefore, it is crucial to check for physical causes of the anxiety in order to address the right problem (Stangier, Heidenreich, & Peitz, 2009).
Substances & Medication-Induced Anxiety
Many pharmacological and illegal drugs can cause anxiety symptoms. Substance abuse and drug addiction often come along with social anxiety disorder (Stangier, Heidenreich, & Peitz, 2009). In most of these cases, the social phobia leads to the substance abuse disorder. The most common addiction among social anxiety sufferers is that of alcohol (Kessler et al., 1997), in which the individual drinks in order to calm the anxiety. Some do so only occasionally, at family gatherings for instance, others develop a habit of drinking daily.
There are cases, however, in which the substance abuse disorder precedes the development of social anxiety symptoms (Wagner, Stangier, Heidenreich, & Schneider 2004). This could be an alcohol addict who is worried about others noticing his or her shaking when being sober. It has been pointed out that in these cases a diagnosis of social anxiety disorder is usually not indicated.
SAD In Combination With Other Psychological Disorders
Social anxiety often comes along with other psychological disorders. This can not only complicate the diagnosis, but also worsen the symptoms and exacerbate functionality of the individual (Klein, Hofmeijer-Sevink et al., 2012; Wittchen, Fuetsch, Sonntag, Müller, & Liebowitz, 2000). Overall, around two thirds of social anxiety sufferers have to deal with an additional psychological disorder (Acarturk, de Graaf, van Straten, ten Have, & Cuijpers, 2008). Needless to say that the quality of life of those individuals is affected more negatively than of people suffering only from SAD (Wittchen et al., 2000). It has been found that SAD sufferers with an additional disorder experience more chronic social anxiety than those without one (Schneier, Spitzer Gibbon, Fyer, & Liebowitz, 1991). Additionally, with a co-occurring disorder often comes along a greater number of feared social situations (Szafranski, Talkovsky, Farris, & Norton, 2014). While the number of feared situations and psychological disorders are correlated, there are many people who only exhibit social anxiety disorder but a great number of feared situations. The same accounts for people with various additional psychological issues, who sometimes exhibit only few feared social scenarios.
The psychological disorders that most commonly co-occur with social anxiety are divided into four groups: