The Difference Between GAD and Social Anxiety Disorder

What is GAD?

Generalized anxiety disorder (GAD) is a mental health disorder that is characterized by uncontrollable and excessive worry about many different occurrences and situations.

Individuals with GAD may worry about issues such as finances, health, and safety, which is more exaggerated than normal levels of worry.

Those with GAD may often report feeling as if something bad is going to happen and tend to expect disaster. They may not be able to pinpoint the exact reason why they feel tense and find it difficult to calm themselves down when anxious.

GAD Symptoms

Those who experience GAD often report a combination of psychological and physical symptoms. These symptoms can include the following:

• Persistent worry or anxiety surrounding a number of areas.

• Worries are out of proportion to the impact of the events.

• Tendency to overthink plans and solutions to all possible worst-case outcomes.

• Inability to control worries.

• Perceiving a lot of situations as threatening.

• Being unable to relax.

• General feelings of being on edge.

• Avoiding situations where anxiety can worsen.

• Sweating

• Tiredness

• Trouble sleeping

• Nausea

• Stomach aches

• Headaches

• Muscle tension

• Light-headedness

How is GAD diagnosed?

For a diagnosis of GAD to be made, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that worries and anxieties must occur more often than not over a period of at least six months.

The worries must be difficult to control and may easily shift from one topic to another.

There should be at least three physical or cognitive symptoms to meet a diagnosis, and the anxiety must be severe enough that it may interfere with areas of normal functioning.

What is SAD?

While it is normal to experience some anxious feelings in certain social situations, for some, these anxious feelings can occur in most or all social situations. They can be so intense that it negatively affects their lives.

Social anxiety disorder (SAD) is an intense, long-standing, and debilitating fear of social situations.

Those with SAD often fear that they will embarrass themselves or be judged negatively and criticized by others in social situations.

The anxiety in response to a social situation can occur before, during, or after a social situation, with many experiencing this in all three instances.

SAD can differ in range and severity, with some fearing most social situations, whilst others may experience anxiety in one or two social settings.

Some of the anxiety-provoking settings can include public speaking, one-on-one conversations, parties, phone calls, giving presentations, and initiating and maintaining conversations.

Symptoms of SAD

Those who experience SAD often have a combination of psychological and physical symptoms. These symptoms can include the following:

• Intense anxiety during social situations.

• Worrying of being embarrassed.

• Fear of situations where there is the possibility of being negatively judged.

• Fear of physical symptoms.

• Fear of talking to strangers.

• Feeling as if the mind has gone blank.

• Avoiding situations where social anxiety can worsen.

• Sweating

• Rapid heartbeat

• Blushing

• Nausea

• Muscle tension

• Feeling breathless.

How is SAD diagnosed?

The DSM states that SAD is a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny from others.

The social situations must almost always provoke fear or anxiety, which is out of proportion to the actual threat. Thus the social situations are either avoided or endured with intense fear or anxiety.

The fear, anxiety, or avoidance must be persistent, typically have lasted for at least six months, and causes clinically significant distress or impairments in social, occupational, or other important areas of functioning.

Similarities

Shared traits

Both GAD and SAD are anxiety disorders and are characterized by persistent worry that is disproportionate to any actual threat. Those with GAD and SAD experience physical symptoms associated with their anxiety.

Their anxiety triggers the fight-or-flight response. It produces many of the same physical symptoms associated with being faced with actual danger (e.g., sweating and a fast heartbeat).

Catastrophizing, a cognitive distortion, is central to both GAD and SAD. Catastrophizing is the belief that disaster is imminent when this is highly unlikely.

For those with GAD, they may catastrophize about their family’s safety, believing that something bad is going to happen to them. Those with SAD may catastrophize about how bad a presentation will go – believing that they will stumble over their words, forget what to say, and everyone will be negatively judging them.

A study also found that people with GAD and those with SAD are similar in relation to negative feedback. They found that both disorders are associated with high sensitivity to negative feedback and the perspective of negative consequences being a core feature of both (Khdour et al., 2016).

Keeping anxiety going

Those with GAD or SAD may often use avoidance as a coping mechanism meaning they will try to avoid a feared situation as much as possible to reduce their anxiety.

Avoidance can rapidly decrease anxiety, but it can worsen anxiety in the long run. Long-term effects of avoidance can result in an increase in physical symptoms, a loss of confidence about coping, and increased use of safety behaviors.

Safety behaviors are another way that people with GAD or SAD can cope with their anxiety. These behaviors include relying on medication, having an exit plan, excessive phone use, or having a person go with them to fearful settings.

Although safety behaviors can help reduce feelings of anxiety, people can become too dependent on them. These behaviors prevent people from challenging themselves to see that the perceived threat is not that threatening.

Avoiding anxiety-provoking situations and using safety behaviors can keep the anxiety going and worsen it, resulting in more avoidance and safety behaviors.

Hence, this is known as the vicious cycle of anxiety, as it will continue for people with GAD or SAD until they take steps to break the cycle.

Similar complications

Mostly due to wanting to avoid situations, people with GAD or SAD may isolate themselves for fear of either social situations or their generalized worries.

Isolating themselves could result in unhappiness with life and potentially lead to other issues, such as depression.

Those with GAD or SAD may also find it difficult to maintain going to school or work due to their worries. This can negatively impact their academic and occupational outcomes if not treated.

Likewise, those with GAD or SAD may find making and keeping friends hard. Their disorders may also put a strain on their already-established relationships.

Similar causes

There can be some similarities in the possible causes of GAD and SAD. For instance, genetics may play a role in both developments since individuals with immediate family members with an anxiety disorder may be more likely to develop GAD or SAD.

Personality traits can also play a role in the development of GAD and SAD. Someone with a timid temperament, pessimistic outlook or someone who tends to avoid anything dangerous may be more prone to GAD or SAD.

Moreover, those who are high in the personality trait neuroticism may be more likely to develop an anxiety disorder compared to those low in neuroticism (Zhang, 2020).

A brain region named the amygdala seems to be a key area in anxiety. The amygdala is a part of the limbic system involved in the processing and regulating of emotions, including fear.

It is thought that people with exaggerated anxiety and fear in certain situations may be caused by a hyperactive amygdala or an issue with the fear network of the brain.

Finally, those with GAD and SAD may have similarities in their past experiences, which may have been a cause for their anxiety disorder. They may have experienced a significant life change or traumatic or negative experiences such as bullying, which could have contributed to their current fears and worries.

Similar treatments

Both GAD and SAD can be treated similarly. Medications such as antidepressants, beta-blockers, and benzodiazepines have been shown to be effective for both anxiety disorders.

Likewise, therapeutic treatments, especially cognitive behavioral therapy (CBT), are recommended for both disorders.

CBT is often shown to be most effective as it tackles the worrying thoughts and behaviors that go along with these thoughts.

CBT can help challenge people with anxiety and break the vicious cycle which keeps anxiety going.

GAD Vs. SAD

Below are some of the main differences between GAD and SAD:

Different thoughts

Although the thought patterns and cognitive distortions can be similar for those with GAD and SAD, it is the content of the thoughts which distinguishes the two conditions.

Those with GAD worry about various topics, from health and finances to relationships. Those with SAD, however, will only have intense fear about social situations such as meeting new people, speaking in front of others, or being observed.

The thoughts of those with SAD typically center around fear of negative evaluation or rejection, usually finding it challenging to begin conversations for fear of being negatively judged.

Social worries are not uncommon in those with GAD; however, their focus tends to be on ongoing social relationships rather than on fear of evaluation.

For instance, someone with GAD may worry uncontrollably about an argument they had with their partner.

Differences in beliefs

Whilst those with GAD and SAD will both have irrational beliefs, the types of beliefs they have differ. For those with SAD, their anxious beliefs will stem from the idea that they believe there is something wrong within themselves.

In contrast, the anxiety for those with GAD will often stem from the belief that there is something wrong with the world rather than something being wrong with themselves.

Differences in avoidance

While both GAD and SAD are characterized by a high degree of avoidance, the reason for the avoidance is likely to differ for both.

For example, someone with GAD may avoid attending a work meeting due to worries of not preparing enough and thinking they won’t be able to finish everything in time.

Whereas someone with SAD may avoid work meetings out of fear of being judged by their colleagues and worrying about having nothing to say at the meeting.

Difference in age of onset

There is a difference in the average age of GAD and SAD develop. The average age of onset for SAD is 13 years old, while it is 31 for those with GAD.

That being said, many people with GAD report they experience symptoms long before they seek treatment so the actual average age of onset may be a lot lower.

Differences in treatment

Although the therapeutic treatment options for those with GAD and SAD are similar, the focus of the therapy is different. Therapy for SAD will often involve challenging the individual’s feelings of being judged and fear of embarrassment in social situations.

However, therapy for GAD will focus on controlling an individual’s multiple worries.

GAD and SAD at the same time

Commonly, people who have anxiety disorders are likely to present with features of more than one disorder. GAD and SAD may occur together, with many people starting out with GAD and going on to develop social anxiety.

Likewise, someone with SAD may go on to expand their worries to other areas of life and eventually develop symptoms of GAD. Having either of these anxiety disorders is also thought to increase the likelihood that someone may experience a depressive episode or other types of anxiety disorders, such as obsessive-compulsive disorder ( OCD ) or agoraphobia.

If someone does have both GAD and SAD, luckily the treatments such as medications and CBT are shown to be effective for treating both disorders.

References

Guy-Evans, O. (2021, June 16). Social Anxiety Disorder – Diagnosis and Self Help. Simply Psychology. simplypsychology.org/social-anxiety-disorder.html

Guy-Evans, O. (2022, Feb 16). Generalized Anxiety Disorder. Simply Psychology. simplypsychology.org/generalized-anxiety-disorder.html

Khdour, H. Y., Abushalbaq, O. M., Mughrabi, I. T., Imam, A. F., Gluck, M. A., Herzallah, M. M., & Moustafa, A. A. (2016). Generalized anxiety disorder and social anxiety disorder, but not panic anxiety disorder, are associated with higher sensitivity to learning from negative feedback: behavioral and computational investigation. Frontiers in integrative neuroscience, 10, 20.

Zhang, F. (2020). Neuroticism. The Wiley Encyclopedia of Personality and Individual Differences: Models and Theories, 281-286.)