Social Anxiety vs Autism: Understanding the Differences and Overlaps

The major difference between social anxiety and autism is how they are classified; autism is considered a neurodevelopmental condition, while social anxiety is a mental health condition. Despite this, the two diagnoses share a number of similarities. Autistic individuals and people with social anxiety communicate and experience social situations differently than others. While they have many overlapping traits, social anxiety and autism are ultimately very different. Individuals with either diagnosis can benefit greatly from supports like psychotherapy and, for some, medication. A mental health professional must determine whether an individual is autistic, has social anxiety or both to provide truly tailored and holistic support. 

Autism spectrum disorder is a neurodevelopmental disability, meaning it affects the development of an individual’s brain and nervous system. Autistic individuals experience differences from neurotypical peers in:

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Communication and social approaches

Neurotypical social norms typically aren’t intuitive to autistic people, who may interpret social cues differently than others do. They tend to prefer direct communication styles and approach communication in a more literal way. 

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Sensory and cognitive processing

Autistic people often experience sensory differences, meaning they’re more or less sensitive to sensory inputs like bright lights or loud noises. Autistic individuals also tend to exhibit detail-driven and logical, principled thinking. They often excel at recognizing patterns.

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Special interests and repeated behaviors

Autistic individuals may have a strong preference for repetition and sameness and often struggle to adapt to unforeseen changes to their plans and routines. Many autistic people also exhibit intense or unique interests, often having special interests that they can sustain deep focus on and spend a great deal of time exploring.

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Ultimately, autism is dimensional. Autistic people can display greatly varying degrees of autistic behaviors and traits. Autistic individuals also vary in the type and level of support that they need. The autism spectrum is incredibly diverse, and autism can mean very different things to different people.

Social anxiety disorder, formerly called social phobia, is an anxiety disorder marked by a persistent, intense fear of social judgment. People with social anxiety feel self-conscious and anxious in social settings, such as meeting new people, speaking during meetings, asking questions during a presentation or making phone calls. They often fear humiliation and rejection and can be incredibly harsh critics of their own behaviors after social interaction. This fear and anxiety leads to avoidance of social situations.

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Social anxiety disorder is not the same as being shy or wanting to be liked. For people with social anxiety, these feelings of anxiety and fear can be very distressing. Plus, physical symptoms of social anxiety can feel crippling. These symptoms include:

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• Elevated heart rate
• Nausea
• Muscle tension
• Feelings of pressure in the chest
• Shortness of breath
• Lightheadedness
• Shaking
• Sweating

People with social anxiety may try to stay away from settings like parties, professional networking opportunities and crowded places like grocery stores. Social anxiety can also affect behaviors that other people may not think twice about. For example, individuals with social anxiety may avoid using public restrooms or stopping into a shop to buy something they need to evade potential embarrassment and anxiety.

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Social anxiety is fairly common. It’s estimated that 12.1% of U.S. adults have met the diagnostic criteria for social anxiety disorder at some point in their lives.

Social anxiety and autism are distinct diagnoses, but they share many traits and behaviors. Plus, social anxiety is very widespread among the autistic population. Researchers estimate that up to 50% of autistic individuals have social anxiety––which is much higher than the estimated 12% lifetime prevalence of social anxiety among all U.S. adults. Even when they occur separately, social anxiety and autism have a fair amount in common.

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Social and communication differences

Autistic individuals and people with social anxiety both demonstrate social and communication differences from other groups. While these differences can stem from different places, they share many outward similarities, including:

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• Trouble making eye contact
• Difficulty starting conversations
• Discomfort with small talk

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Some of these similarities are driven by different factors. For example, people with social anxiety may quickly break eye contact because it makes them feel anxious. Autistic individuals are more likely to avoid eye contact in the first place because it feels overwhelming or uncomfortable. For autistic individuals, these are innate differences, and for people with social anxiety, these differences are driven by fear or nervousness. 

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Preference for predictability in social settings

Autistic people have a strong preference for routine and predictability, which manifests in many areas of their lives, including social settings. They often fare better when they know details about a social situation in advance, such as who will be at an event, what activities are planned and where quiet areas or bathrooms are located.

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People with social anxiety also tend to favor predictability in social interaction. Like autistic individuals, they may prepare topics of conversation or responses to common questions in advance. They may also only feel comfortable attending social engagements if they know who will attend and if a familiar, trusted person will be there. Both groups can have difficulty adapting to changes in social plans, especially if they occur with little notice.

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Tendency to avoid social settings

Both autistic people and those with social anxiety are more likely to avoid social settings, especially ones with new people or big crowds. People with social anxiety do this to prevent situations where they may be judged or humiliated. For autistic individuals, staying away from these settings is often a way to avoid sensory overload or frustration from navigating neurotypical communication styles.

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“Performing” in order to be accepted

Masking is a well-documented behavior among autistic people. Autistic individuals who mask conceal their autistic traits to gain social acceptance and avoid mistreatment and stigma. Masking can be incredibly taxing on an autistic person, but many consider it a survival strategy; it allows them to move through life more easily and even to access opportunities, like employment, where they may otherwise face discrimination.

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People with social anxiety may also feel compelled to perform certain behaviors or traits to be accepted by others. These behaviors can feel similar to autistic masking since they make up an affected or augmented presentation of the self and often try to conceal anxiety and fear. Individuals with social anxiety may socially perform in this way to avoid judgment and rejection.

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Differences in self-esteem

Autistic people and individuals with social anxiety are more likely to have lower self-esteem. For autistic individuals, this is often a product of repeated misunderstanding and stigmatization of autistic behaviors and traits. Confronting these attitudes over time can be incredibly hurtful, and, especially without appropriate support, it can be easy for an autistic individual to internalize negative beliefs about their autistic traits and behaviors.

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Often, lower self-esteem and negative beliefs an individual has about themself can contribute to the initial development of social anxiety disorder. Social anxiety disorder also reinforces low self-esteem. The repeated fear of humiliation and harsh criticism of one’s own social behavior causes many people with social anxiety to feel poorly about themselves.

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Despite appearing similar in many ways, social anxiety and autism have some significant differences. 

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Classification

One key difference between autism and social anxiety is how they are classified. Autism is classified as a neurodevelopmental condition, while social anxiety is a mental health condition or mental illness.

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Neurodevelopmental conditions can affect a person’s social, language and motor skills, as well as attention, activity levels, cognitive processing, learning and other behaviors. Neurodevelopmental diagnoses are present for the duration of a person’s life.

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Mental health conditions affect an individual’s emotions, mood, thoughts, and behaviors while a person is experiencing active symptoms of the condition. Mental illnesses can come and go throughout a person’s life, especially with treatment to reduce symptoms. 

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Anxiety symptoms

Social anxiety disorder is an anxiety disorder. Anxiety disorders have narrower diagnostic criteria than neurodevelopmental disorders. This means that the criteria used to diagnose anxiety disorders is focused on feelings of fear and anxiety and their impact on a person’s life, rather than a broader range of neurologically-based social, behavioral, and sensory  differences that make up the criteria for autism and other neurodevelopmental diagnoses.

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Anxiety disorders also often entail symptoms that are not inherent to autism or other neurodevelopmental diagnoses, although many autistic people may also experience symptoms of anxiety. These include panic attacks and physical manifestations of anxiety, which can include an elevated heart rate, sweating, shaking, nausea or tightness of the chest.

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Age of onset

Autism is widely considered to be present from birth, and autistic traits and behaviors can be seen in infants as young as 18 months, although autism can be formally diagnosed at any point in a person’s life, if it is clear that features of autism were present during childhood.

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Social anxiety, on the other hand, is acquired. It can emerge at any time throughout someone’s life, but on average, signs of social anxiety start to show up around age 13.

A psychologist or therapist can diagnose both autism and social anxiety using the diagnostic criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The processes for diagnosing each condition are fairly different.

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How autism is diagnosed

An autism evaluation generally centers on a comprehensive clinical interview with the individual seeking assessment. To receive a diagnosis, an individual must meet the following diagnostic criteria from the DSM-5-TR:

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• Persistent differences in social communication and interaction across multiple contexts
• At least two of the following characteristics:some text
  • Repetitive movements and behaviors
  • A strong preference for sameness and routine
  • Intense, restricted interests
  • Sensory hyper- and/or hyposensitivity
• The above behaviors and traits are present during early childhood, interfere with daily life and are not better explained by other developmental disorders

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Clinicians may also ask individuals to complete questionnaires. These tools are intended to provide more information on sensory and social differences an individual might have experienced throughout their life. They can also help clinicians to compare an individual's reported symptoms to the reports of a wider group of people, including those with and without autism diagnoses.

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Autism assessments also often incorporate interviews with people close to the individual, especially those who knew them during their childhood and can speak to the presence of autistic traits at an early age.

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How social anxiety is diagnosed

The diagnostic process for social anxiety is typically less time-intensive and involves fewer steps than an autism diagnosis. Social anxiety disorder can be diagnosed from only a clinical interview. 

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Clinicians may also use questionnaires to help diagnose social anxiety. To be diagnosed with social anxiety, an individual has to meet these criteria from the DSM-5:

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• Consistent, intense fear or anxiety about one or more social situations, rooted in fear that the situation(s) will lead to judgment or embarrassment
• The anxiety or fear is out of proportion to the situation at hand
• The anxiety or fear interferes with day-to-day life
• The anxiety or fear is not attributable to a medical condition, medications or other substances

Several supports are available for autistic people and individuals with social anxiety. Many of the same interventions can help people with either diagnosis, but their intents differ. Treatments for social anxiety are meant to reduce social anxiety symptoms, possibly until a person no longer meets the diagnostic criteria for social anxiety. Interventions for autism, on the other hand, typically don’t seek to change autistic traits. Rather, the focus is on treating co-occurring anxiety and depression while also supporting autistic individuals’ coping and self-advocacy skills.

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Therapy

For both autism and social anxiety, psychotherapy is often the first line of support. Psychotherapy, also called talk therapy, can be incredibly effective at improving mental health outcomes for both groups.

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Cognitive behavioral therapy (CBT) is widely considered the gold standard for psychotherapy, and it can be helpful for both autistic people and those with social anxiety. CBT helps individuals identify and interrupt unhelpful or harmful patterns of thought and behavior.

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For autistic people, CBT (and other psychotherapeutic approaches) primarily help by treating symptoms of anxiety and depression, which are very common among autistics. For individuals with social anxiety, CBT targets the negative beliefs they may have about themselves and others that contribute to their social anxiety.

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Medication

Providers may also prescribe medication to help with symptoms of social anxiety, as well as symptoms of anxiety and depression in autistic individuals.

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Antidepressants

Antidepressants are the medication most commonly prescribed to manage these symptoms, specifically selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). These medications must be taken every day. They build up in a person’s system over time and typically take several weeks to take effect.

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Anti-anxiety medications 

Clinicians may also prescribe medications for both diagnoses to take as needed for acute anxiety symptoms. These medications work quickly and can be taken in anticipation of a stressful event or once anxiety or panic has onset. They include:

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• Beta-blockers: These can help de-escalate physical manifestations of anxiety, such as rapid heart rate, sweating or shaking. They can be particularly helpful for individuals with social anxiety related to performance, such as public speaking.
• Benzodiazepines: These are sedative medications that are highly effective at reducing symptoms of anxiety quickly. Some people can build resistance to benzodiazepines and can require higher doses over time, and they can become habit-forming. For this reason, they are often prescribed only for short periods when a person is anticipating or experiencing significant distress. They are not a long-term solution. 

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Each individual may respond to medications in different ways. If you are considering medication to help with symptoms of anxiety or depression, a psychiatrist can review your medical history and work with you to make the right plan. They can also help you explore other options if a medication isn’t working for you.

If you’re autistic––or think you might be––Prosper Health can provide answers and support. Prosper Health provides telehealth autism assessments designed for adults and covered by insurance.

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We can also provide ongoing support for autistic adults who struggle with social anxiety. Our therapists are neurodiversity-affirming and specialize in working with autistic adults. They know how to support autistic people through many common challenges, including social anxiety, autistic burnout and more. 

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Prosper Health’s therapists can work with you to develop a treatment plan that is tailored to your individual needs to reduce your anxiety and help you thrive.