In This Article
What is SAD?
Social anxiety disorder (SAD) is an intense, long-standing, and debilitating fear of social situations.
Some situations that may be fearful to someone with SAD include public speaking, one-on-one conversations, making phone calls, and attending social gatherings.
Someone with SAD often fears that they will embarrass themselves or be negatively judged and criticized by others in social situations.
They may experience intense anxiety during one or more social situations, fear talking to others, and often avoid situations where their social anxiety can worsen.
People with SAD also experience a lot of physical sensations when in fearful social settings, such as blushing, sweating, muscle tension, and breathlessness.
Anxiety in response to a social situation can occur before, during, or after a social situation, with many experiencing anxiety throughout.
SAD can differ in range and severity, with some fearing most social situations, whilst others may experience anxiety in one or two specific social settings.
What is APD?
Avoidant personality disorder (APD) is a mental health disorder characterized by extreme social anxiety combined with a distorted and debilitating self-image that violently disrupts everyday life.
APD is considered a cluster C personality disorder. Personality disorders are a specific kind of mental health issue where patterns of thought and behavior affect daily life.
Those with personality disorders often experience difficulty in their professional and personal life since they have difficulty understanding other people and common situations.
People with APD often report having low self-esteem, overwhelming feelings of inadequacy, hypersensitivity to criticism, and constant fear of rejection.
They will usually try to avoid any and all social interactions as much as they can, only interact with people they strongly believe will not reject them, and will purposely isolate themselves.
Those with APD often want and even crave social connection, but their disorder keeps them from being able to participate in healthy social interactions.
Can you have both?
It was originally thought that APD only occurred in association with SAD. However, it is now believed that APD can occur in the absence of SAD.
That being said, around one-third of those with APD are also diagnosed with SAD. SAD is also thought to be the most common co-occurring condition in those with APD, with a study finding that as many as 48% of those diagnosed with APD also met the criteria for SAD (Hummelen et al., 2007).
SAD vs. APD
There is debate over whether APD is a more severe type of SAD. Often, they are diagnosed together and can overlap in symptoms. Both share an intense fear of being embarrassed or judged in social situations.
They may often be described as shy, awkward, or fearful and demonstrate similar behaviors such as avoiding social situations, avoiding interaction with strangers, and socially isolating themselves from others.
However, while APD typically involves patterns of avoidance in most or all areas of life, SAD may only involve avoidance in a few specific social situations. Therefore, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) continues to categorize them separately.
Most of the differences between APD and SAD are in how severe and debilitating the person’s symptoms are. Those with APD have more severe anxiety compared to those with SAD.
They are also more likely to socially isolate themselves and be less able to function and form relationships than people with SAD.
Those with SAD are more likely to put themselves into social situations despite feeling anxious as they are more likely to endure the anxiety, rather than those with APD who would find these situations too distressing and avoid them as much as possible.
People with APD would also be less likely to pursue jobs that require any kind of social interaction with others.
There are also differences in self-worth between those with APD and those with SAD. People with SAD can have healthy self-esteem and confidence despite their condition.
In contrast, people with APD have fundamental feelings of inadequacy and inferiority, which drives them towards extreme social inhibition as they seek to avoid rejection, embarrassment, and judgment.
The differences may lie in how a person views their own experience and perceives their pain. Those with SAD understand on a basic level that their anxiety is irrational and that the world doesn’t judge them as harshly as they judge themselves.
Those with APD, however, lack this insight and hold deep-rooted feelings of insecurity and worthlessness that they believe are the truth. They are more likely to suffer strong feelings of shame and self-loathing, believing that they are socially inept.
Comparable to APD, those with SAD do not see themselves as inferior – aside from their social awkwardness, they see themselves as equal to those without SAD.
Is APD more than social avoidance?
While SAD typically involves patterns of avoidance in a few or most specific social situations, those with APD may avoid most or all areas of life.
Although social avoidance is a defining feature of APD, some theorists posit that APD is characterized by a broader pattern of avoidance that extends beyond social situations.
Findings from a study have revealed that there are some associations between APD and emotional and novelty avoidance, as well as avoidance of various non-social events (Taylor et al., 2004).
Meaning that those with APD are likely to try to avoid certain emotional states as well as seek new experiences or try anything new.
Is APD an anxiety disorder?
Since there are similarities between the symptoms of SAD and APD, some researchers argue that APD should be re-classified as an anxiety disorder.
One of the most important differences between the conditions is their classification. Personality disorders, like APD, are characterized by abnormal personality traits and tendencies that inhibit a person from functioning and interacting normally.
Personality disorders are difficult to treat as personality traits tend to remain the same across a person’s life.
Anxiety disorders, however, are a group of disorders that lead people to feel anxious, nervous, or worried in certain situations.
Anxiety disorders are highly treatable with therapies such as cognitive behavioral therapy (CBT) and exposure therapy and being treated with medications.
Causes of APD
Studies on twins have revealed that genetic factors account for about half of the variance in APD. For many, however, painful experiences of trauma, neglect, and rejection by family members or peers appear to lie at the heart of the condition.
People diagnosed with the condition often report high childhood physical and emotional abuse rates, which disrupts healthy psychological development and impairs the ability to form healthy attachments while simultaneously causing them to internalize criticism and shame.
Some other risk factors for developing APD can include personality traits such as being introverted, having high neuroticism, and having an aversion to risks. Likewise, being socially isolated may also be a risk factor for developing APD.
Causes of SAD
It is not known exactly what causes SAD, but it is thought that genetics may also play a part. If there is a family history of social anxiety or depression, then this could be a probable cause for an individual to also develop this.
Specifically, those with a parent or sibling with an anxiety disorder may be at a higher risk of developing SAD.
However, it could be that growing up in the same environment as a family member with anxiety teaches the individual anxious behaviors, which can put them at risk for developing SAD.
Moreover, other environmental factors such as life stressors, bullying, work, school, or traumatic life events could trigger the onset of SAD.
SAD may also be more likely to develop in individuals with certain personality traits, such as being introverted or being high in neuroticism.
Treatment
The symptoms of APD itself can create significant barriers to treatment since therapy requires the very social interaction that the individual tries to avoid. It can also be very difficult to treat APD, especially if the individual has had the symptoms for a long time.
However, therapy can still be very helpful, but there may be some things to consider for those with APD seeking treatment:
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The program size – it may be that a smaller, intimate treatment program can help someone with APD feel more at ease and avoid being overwhelmed by social interaction.
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The type of therapist – it can be useful to look for a therapist who is knowledgeable about APD and compassionate and experienced with managing avoidance symptoms.
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Variations of therapies – those with APD may find that non-verbal therapies, such as art or music therapy, early in the treatment can offer the space to express themselves without the expectation of social interaction.
Approaches to treatment for those with APD should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
It is thought that CBT and schema therapy may be promising treatment options to tackle this.
Likewise, group therapy can help people with APD learn how to develop relationship and communication skills in a safe space. No specific medications are used to treat APD, but antidepressants and anti-anxiety medication may help relieve some severe symptoms.
Social anxiety is often more treatable than APD and has been shown to respond well to a combination of medication and talking therapy.
Anti-anxiety medications such as benzodiazepines and antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), are known to be effective in treating some SAD symptoms.
CBT is the most common form of therapy for those with SAD. This is because CBT tackles the negative and unhelpful thoughts and behaviors of those with SAD.
These thoughts and behaviors can get challenged and reconstructed into healthier thoughts and behaviors with the therapist’s help. A technique in CBT is exposure therapy, which can help the person with SAD to gradually expose themselves to fearful social situations so that they become less fearful over time.
This technique can help those with SAD engage in the social situations they wish to be a part of, and it helps them challenge the idea that others will negatively judge them.
References
Guy-Evans, O. (2022, March 15). The Difference Between GAD and Social Anxiety Disorder. Simply Psychology. simplypsychology.org/difference-between-gad-and-social-anxiety-disorder.html
Hummelen, B., Wilberg, T., Pedersen, G., & Karterud, S. (2007). The relationship between avoidant personality disorder and social phobia. Comprehensive psychiatry, 48(4), 348-356.
Lampe, L., & Malhi, G. S. (2018). Avoidant personality disorder: current insights. Psychology research and behavior management.
Taylor, C. T., Laposa, J. M., & Alden, L. E. (2004). Is avoidant personality disorder more than just social avoidance? Journal of personality disorders, 18(6), 571-594.
Weinbrecht, A., Schulze, L., Boettcher, J., & Renneberg, B. (2016). Avoidant personality disorder: a current review. Current psychiatry reports, 18(3), 1-8.
