Social Anxiety vs Autism
Social Anxiety vs. Autism
Social anxiety and Autism co-occur at high rates, particularly among high-masking Autistic individuals. Many Autistic people I work with have been initially diagnosed with social anxiety while their underlying Autism has been missed. This article aims to help differentiate between the two, emphasizing the importance of accurate diagnosis.
Contents:
How Autistic Masking Contributes to Anxiety
Social anxiety is often a misdiagnosis for high-masking Autism. Here are some ways in which Autistic masking contributes to anxiety:
Hypervigilance: Masking requires a high level of hypervigilance—constantly adapting one’s body language, tone, language, and scripts to fit in.
Judgment Sensitivity: High-maskers develop a keen eye for judgment and criticism. They perceive social missteps, update their behavior based on perceived judgment, and become highly anxious in social situations as a result.
Overlap Between Social Anxiety and Autism
Social anxiety is particularly common among all Autistics, with prevalence estimates as high as 50% (Bellini, 2004; Maddox & White, 2015; Spain et al., 2016). This is significantly higher than the 7-13% prevalence in the non-Autistic population (NICE, 2013a).
Given the high prevalence of social anxiety disorder within the Autistic population, clinicians should routinely offer Autism screening when diagnosing social anxiety.
Social Anxiety Defined
Social anxiety involves pervasive anxiety in social situations and interactions, where individuals fear being judged, embarrassed, or humiliated in front of others. Symptoms include:
Worry about embarrassing or humiliating oneself
Fear of negative judgment
Intense fear of interacting with strangers
Fear of being noticed as anxious
Avoidance of situations where one might be the center of attention
Anxiety in anticipation of social events
Ruminating on social performance
Expecting the worst in social situations
For a deeper dive into the diagnostic criteria for social anxiety, check out this blog post that walks through the diagnostic criteria of social anxiety.
Autism Defined
To meet the diagnostic criteria for Autism, a person must have persistent differences in three areas of social communication and interaction plus at least two of four types of repetitive behaviors. Here’s a strength-based overview (adapted from Matt Lowry’s strength-based diagnostic version of diagnostic criteria)
A) Different social communication and interaction as evidenced by the following:
Differences in communication- the tendency to go off on tangents, the tendency to talk passionately about special interests, and the tendency to not engage in small talk. Social initiation may be limited. Small talk often relies on pre-scripted or pre-rehearsed sentences.
Differences in nonverbal communication including stimming while talking, looking at something else while talking, and being bored with conversations. Also includes difficulty intuitively understanding shifts in context and non-verbal body language.
Due to the above differences in communication, autistic people tend to be shunned by neurotypicals and therefore are conditioned to believe that they're somehow less social. May also experience reduced social motivation or interest and may get pleasure from solo activities.
B) Repetitive behavior or interests as evidenced by at least two of the following:
Stimming or engaging in echolalia.
Security in routines. Autistic people do not have a sensory filter, so the world is perceived as a constant state of chaos; routines and expectations give comfort to overwhelmed autistic people.
SPecial INterests (SPINS). Due to hyperconnected brains, autistic people feel more passionately about what they love, so when we have a special interest, we tend to fawn over and fixate on it.
Hyper or hypo-reactivity to stimuli. Again, due to hyper-connections. We feel things more intensely. Sometimes, however, we feel things less intensely because we tune them out in favor of other stimuli.
For more of a deep dive on the diagnostic criteria for autism, you can check out this blog post that walks through the DSM-5 criteria for autism.
Understanding the Differences Between Social Anxiety Disorder and Autism
Given the significant overlap, it can be challenging to differentiate between social anxiety and Autism, especially when they co-occur. Here are some areas to consider:
Cross-Neurotype Interactions
Autism: Autistic individuals often feel more comfortable and experience less anxiety when interacting with other Autistics. Shared communication styles and mutual understanding can reduce social strain. If the person only experiences anxiety and stress when interacting outside of their neurotype, this is likely due more to the strain of navigating cross-neurotype interactions and not a true social anxiety disorder.
Social Anxiety: The baseline anxiety remains regardless of whether they are interacting with neurotypical or neurodivergent individuals. The fear of judgment and embarrassment is persistent across different social contexts.
Eye Contact
Social Anxiety: Initial eye contact followed by looking away as an emotional avoidance strategy.
Autism: Slower to make eye contact, often due to discomfort or lack of motivation (Lundin Kleberg et al., 2017; Disord et al., 2017).
Social Motivation
Social Anxiety: Individuals tend to feel sadness and strain when socially isolated.
Autism: Individuals may feel more comfortable with less social engagement. Many Autistic people have a high need for alone time and can be easily entertained by our own worlds and interests. Note that AuDHDers (individuals who are both Autistic and ADHD) tend to have higher levels of social motivation, and while social motivation can vary, the general trend is that Autistic people tend to have less of it.
Social Cues
Social Anxiety: Non-Autistic people with social anxiety will intuitively read social cues.
Autism: Autistic people either struggle to read social cues or will do so through their pre-frontal cortex (analyzing) (Todorov). High-masking Autists may be very good at reading social cues analytically. However, they will describe debilitating fatigue after being in situations where they must do this for prolonged periods. When discerning between social anxiety and Autism, it’s important to ask about masking to understand the person’s internal experience. An Autistic person will describe more masking behaviors.
Body Language
Social Anxiety: With social anxiety disorder, the person tends to have a heightened sensitivity to the body language of others.
Autism: In stereotypical Autism, the person will struggle to intuitively pick up the meaning of other people's body language. With high-masking Autists, the picture is more complex. High-maskers are more likely to be hypersensitive to emotional tone, which may be interpreted as an ability to intuitively interpret body language. However, a high-masking Autistic person may analytically study body language, using their prefrontal cortex to decode the meaning rather than intuitively understanding it.
Physical Manifestations
Social Anxiety: Physical manifestations of social anxiety often include sweating, trembling, blushing, and a shaky voice. These symptoms are driven by the intense fear of being judged or embarrassed in social situations.
Autism: Physical manifestations in Autism often involve self-soothing behaviors such as stimming, which includes repetitive movements and stimming like swaying, hand-flapping, rocking, or repeating phrases. These behaviors help Autistic people manage sensory input and regulate our emotions when in overwhelming environments.
Is It Social Anxiety Disorder or Autism?
While the distinctions above offer some brief insights, the reality is often more complex. Many people are trying to discern if they are Autistic in addition to having a social anxiety disorder. To gain a deeper understanding, it’s important to explore non-stereotypical presentations of Autism and Autistic masking, as these often intersect with social anxiety. Here are a few ways to dive deeper into Autism:
Learn About Non-Stereotypical Presentations of Autism: Explore the diverse ways Autism can present beyond traditional stereotypes.
Understand Autistic Masking: Learn how masking behaviors might resonate with your experiences, as masking and social anxiety are often connected.
Consider Taking Autism Screeners: Use these screeners as additional data points to understand your experiences better.
Connect with a Neurodivergent-Affirming Assessor: Find a professional familiar with non-stereotypical presentations of Autism.
Learn About the Autistic Criteria from Lived Experiences: Learn more about Autism diagnostic criteria and gain insights from those who share their personal journeys.
Explore Next Steps if You Think You Might Be Autistic: Understand what next steps to take if you suspect you are Autistic.
Follow Up Resources
Podcasts
On Divergent Conversations, a podcast I co-host with a fellow Autistic-ADHD therapist, we have a series where we walk through the diagnostic criteria for autism while drawing from our lived experience (you can find the first episode in the series here).
Books
Is This Autism is a must read for anyone consider if they might be Autistic.
Unmasking Autism is another fantastic book for those considering if high-masking autism may be part part of their experience
For more of a detailed walk through of the differences and similarities of social anxiety and autism you can check out our e-book on the topic.
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Summary
Social anxiety and Autism commonly co-occur. Symptoms of social anxiety can make it more challenging to detect Autism when present. Understanding the differences involves exploring the subjective experience of the individual to identify the source of their anxiety. For a deeper dive into Autism and social anxiety, check out the full ebook here.