Social Anxiety and GAD (Generalized Anxiety Disorder)
Can you have social anxiety and GAD? Yes, you can. In fact, GAD accounts for the most frequent co-occurring anxiety disorder of socially anxious people (Barlow, 1986).
Between 25 – 33% of individuals with SAD also meet the criteria for generalized anxiety disorder (Turner, Beidel, Borden, Stanley, & Jacob, 1991; Mennin, Heimberg, & Jack, 2000).
Due to their similarity in symptoms, it has been suggested to look at specific physiological characteristics to distinguish between SAD and GAD (Szafranski, Talkovsky, Farris, & Norton, 2014).
Research indicates that while GAD rather relates to cognitive processes, social anxiety disorder is strongly associated with physiological arousal (Gross, Oei, & Evans, 1989).
Generally speaking, GAD refers to elevated cognitive anxiety symptoms related to external stimuli (Szafranski, Talkovsky, Farris, & Norton, 2014). Many affected people, for instance, worry excessively about their finances or their health.
When SAD and GAD co-occur, the two disorders can worsen their symptoms reciprocally. Oftentimes, these individuals find themselves affected more negatively and experience a greater symptom severity compared to those affected by only one of the two conditions (Mennin et al., 2000).
Social Anxiety and OCD (Obsessive-Compulsive Disorder)
People who suffer from OCD usually experience obsessive thoughts or imaginative scenarios passing through their minds. In order to reduce the anxiety caused by these obsessive impulses, they engage in compulsive rituals and behavior.
A common example is the mother who is plagued by images of her children being involved in an accident. In order to reduce the excessive anxiety caused by these imagined scenarios, she checks in on her children frequently and repeatedly to make sure they are safe.
Quality of life can be affected drastically by OCD, as personal relationships, professional duties, and other important areas of life can get heavily impaired over time (Hollander, Stein, Fineberg, Marteu, & Legault, 2010).
The proportion of SAD sufferers that is affected by OCD is much lower than it is for generalized anxiety disorder. Around 4% of socially anxious people meet the criteria for an OCD diagnosis (Acarturk et al., 2008).
When the two disorders show up together, therapy aiming to reduce social anxiety symptoms can be affected by the ritualistic behavior of the individuals related to social situations (Szafranski, Talkovsky, Farris, & Norton, 2014).
Social Anxiety, Panic Disorder & Agoraphobia
Due to their overlap of symptoms, it can be difficult to differentiate SAD and panic disorder.
What marks the difference between a panic-like anxiety state in social anxiety is its strict appearance in social situations. In panic disorder, it is necessary that panic attacks also occur outside of social situations (Norton, Dorward, & Cox, 1986).
Agoraphobia, on the other hand, overlaps with social anxiety in terms of avoidance of social situations. Affected individuals fear it might be difficult to escape from the situation when having a panic attack or it could result in embarrassment and humiliation (Craske & Barlow, 1993).
SAD sufferers are over five times more likely to be affected by panic disorder than the average person (Chartier, Walker, Stein, 2003). The same numbers apply for agoraphobia.
Social Anxiety and PTSD (Posttraumatic Stress Disorder)
It has been reported that around 7% of people with a primary diagnosis of SAD also meet criteria for PTSD (Zayfert, DeViva, & Hofman, 2007). For people with a primary diagnosis of PTSD, 43% qualified for a diagnosis of SAD.
When social anxiety and PTSD occur together, symptom severity and functional impairment usually exacerbate.
The likelihood of additionally suffering from depression and other anxiety disorders is elevated for individuals with posttraumatic stress disorder and co-occurring social anxiety (Zayfert, DeViva, & Hofman, 2007).
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