Social anxiety vs autism highlights key differences between the two conditions. Social anxiety involves a strong fear of being judged by others, while autism is a neurological difference that affects how people understand and communicate with others.
Autism also influences how individuals process sensory information like sights and sounds. Distinguishing social anxiety vs autism is crucial because each requires different types of support.
People with autism often engage in repetitive behaviors, which is less common in social anxiety. Many individuals with autism experience anxiety, making it challenging to differentiate between social anxiety vs autism.
The prevalence of autism varies across countries, as shown below:
Social Anxiety
Social anxiety disorder is also called social phobia. It is a mental health problem that causes strong fear in social situations.
People with social anxiety worry about being judged or embarrassed. They also fear being rejected by others.
The DSM-5 and ICD-11 say the main sign is a big fear of being judged in social places. This fear makes people avoid social events. It can cause trouble at school, work, or in daily life.
| Aspect | DSM-5 Clinical Definition | ICD-11 Clinical Definition |
|---|---|---|
| Core Fear | Intense fear or anxiety in social situations involving possible scrutiny by others | Excessive fear of negative evaluation in social situations |
| Duration | Symptoms persist for 6 months or more | Not explicitly specified in the excerpt |
| Impact | Causes significant distress or impairment in social, occupational, or other important areas of functioning | Emphasizes avoidance and anxiety symptoms impacting functioning |
| Avoidance Behavior | Social situations are avoided or endured with intense anxiety | Avoidance is a key feature |
| Proportionality of Fear | Fear or anxiety is out of reasonable proportion to the social context, considering sociocultural factors | Fear is excessive or disproportionate |
| Exclusion Criteria | Not attributable to substance use, medical conditions, or other mental disorders | Not detailed in the excerpt |
| Special Subtype | Performance-only type limited to public speaking or performing | Not specified |
Note: Social anxiety disorder often starts when someone is a child or teen. It can last for many years if not treated.
Core Features
The main signs of social anxiety disorder are:
- Fear or worry in social places where others may watch.
- Worry about showing signs of anxiety and being rejected.
- Feeling upset during social times.
- Avoiding or staying in social places but feeling very uncomfortable.
- Fear and worry that are stronger than the real situation.
- Symptoms that last six months or longer.
- Trouble in social life, school, or work.
- Symptoms not caused by other health problems or drugs.
These signs help doctors and mental health workers find social anxiety disorder.
Symptoms
People with social anxiety disorder have many symptoms. These can be physical, mental, or actions. Common symptoms are:
- Strong fear or worry about social places, like meeting new people, speaking in public, or eating in front of others
- Fear of doing something that will cause embarrassment or rejection
- Social places almost always cause fear or worry
- Avoiding social or performance places, or staying but feeling upset
- Physical symptoms: blushing, sweating, shaking, feeling sick, fast heartbeat, headaches, dry mouth, dizziness, tight muscles, and a shaky voice
- Mental symptoms: negative thoughts about social skills, automatic negative thoughts, and focusing on possible mistakes
- Actions: avoiding eye contact, staying quiet, or leaving early
- Trouble standing up for themselves, feeling less than others, and being very sensitive to criticism
- In kids, symptoms can be crying, tantrums, holding onto adults, not talking, or being very shy
These symptoms can make it hard to make friends, do well in school, or do a good job at work. Social anxiety disorder can affect many parts of life, but treatment and support can help people handle their symptoms and have a better life.
Causes
Social anxiety disorder happens because of many reasons. These include things like genes, how someone thinks, and their life experiences.
Scientists say genetics are important. If you have family with social anxiety, you might get it too. Twin studies show that about 30-40% of the risk is from genes. This means the disorder can run in families.
Brain differences also matter. People with social anxiety have a more active amygdala. The amygdala is the part of the brain that controls fear. If the amygdala connects differently with other brain parts, it can cause more anxiety. The orbitofrontal cortex is one of these brain areas.
How people think also plays a role. Many people with social anxiety have negative thoughts. They may think others will judge them or see their mistakes. These beliefs often start when they are young. Bad experiences, like being teased, can make these thoughts stronger.
Life experiences are important too. The way parents act can change a child’s risk. Strict or controlling parents can make kids less confident.
If a family is not supportive or is very critical, anxiety can get worse. Bad things like bullying or trauma can also cause social anxiety.
Some cultures expect people to act a certain way. This can add pressure and make social anxiety worse.
Note: Social anxiety often starts when kids are young or in their early teens. Family history and early life events can shape how the disorder grows.
Impact
Social anxiety disorder changes many parts of a person’s life. People with this disorder often stay away from social events.
They may avoid parties, talking in groups, or meeting new people. Because of this, they may have fewer friends and less support.
Studies show social anxiety disorder lowers quality of life. In one study, about 26% of college students had symptoms.
These students had more trouble with daily life and felt less happy. They were afraid of being judged, talking to strangers, and going to events. These fears made them skip important things. This made school and work harder.
Social anxiety disorder usually starts before or during the teen years. It can last for many years if not treated. People may have trouble finishing school or finding a job. They may also find it hard to keep close friends. The disorder can cause sadness and make life less fun.
Only about 1 in 5 people with social anxiety get help. Many do not know their symptoms can be treated. They may live with the disorder for a long time before getting help.
Social anxiety disorder can also hurt mental health. People may feel lonely, sad, or hopeless. They may stop doing things they used to enjoy. Getting help early can make life better, so support is important.
Autism
Autism, also called Autism Spectrum Disorder (ASD), is a neurodevelopmental condition. It changes how people talk, act, and behave.
Doctors use the DSM-5 and ICD-11 to help diagnose autism. Both say that autism is a spectrum. This means each person with autism can be different.
The ICD-11 says autism has three main parts:
- Ongoing trouble with social interaction and communication.
- Restricted, repetitive, or inflexible behaviors, interests, or activities. These can include unusual reactions to sights, sounds, or other sensory things.
- Symptoms that cause problems in daily life. These start early in life, but sometimes show up later.
The DSM-5 says autism lasts for a person’s whole life. People with autism can have different levels of intelligence and language skills. Some people need a lot of help, while others need less.
Note: Autism is not an illness you can catch or cure. It is a difference in how the brain works.
Core Features
Autism has two main core features. These help doctors know if someone has autism.
Social communication and interaction difficulties
- People with autism may find it hard to talk with others.
- They may not use eye contact or facial expressions like most people.
- They often have trouble making friends or knowing social rules.
Restricted and repetitive behaviors
- Many people with autism repeat movements, words, or actions. For example, they might flap their hands or say the same thing over and over.
- They may like routines and get upset if things change.
- Some have strong interests in certain topics or objects.
- Sensory differences are common. Some people are very sensitive to sounds, lights, or textures. Others may not notice these things at all.
Autism symptoms must start early in life, even if they are easier to see as the person gets older. The amount of help needed is different for everyone. Some people need a lot of support, while others need only a little.
Symptoms
Symptoms of autism can look different for each person. Most people with autism show signs in two main areas: social communication and repetitive behaviors.
Social communication symptoms:
- Trouble having a back-and-forth talk
- Hard time sharing interests or feelings
- Problems with eye contact, facial expressions, or gestures
- Trouble making or keeping friends
- Not answering when called by name
Repetitive behaviors and interests:
- Repeating movements like rocking or hand-flapping
- Lining up toys or objects
- Needing routines and getting upset with changes
- Strong focus on certain topics or objects
- Repeating words or phrases (echolalia)
Sensory symptoms:
- Overreacting or underreacting to sounds, lights, touch, or smells
- Unusual interest in how things feel, look, or sound
Other signs can be late talking, a flat or robotic voice, and not playing pretend games. Some kids like to play alone or avoid eye contact and hugs.
Symptoms can be mild or severe. Each person with autism is different, so their strengths and challenges are not the same.
Early signs of autism often show up before age three. Parents and teachers may notice these signs if a child does not meet usual milestones or acts differently from other kids.
Causes
Scientists know that autism spectrum disorder (ASD) comes from both genes and the environment.
There is not just one cause for everyone. Many things work together to shape how autism looks in each person.
Genetic Factors
Genes are very important in autism. Studies show that autism often happens in families. If one identical twin has autism, the other twin often does too.
Some gene changes can raise the chance of autism. These genes help brain cells connect and talk to each other.
Some of these genes are called NRXN1, NLGN3, and SHANK proteins. These genes help brain cells make connections. This affects how people learn and act.
Environmental Factors
The environment also affects the risk of autism. These things can happen before birth, during birth, or after birth. Some exposures can raise the chance of autism, especially with certain genes.
| Factor Category | Specific Factors | Evidence Summary |
|---|---|---|
| Genetic Factors | Heritable component from twin and family studies; synaptic genes (NRXN1, NLGN3, SHANK proteins) | Twin studies estimate 80-90% heritability; synaptic genes play a key role in ASD development |
| Environmental Factors – Prenatal | Advanced parental age, maternal health conditions (diabetes, immune disorders), medication use (valproate), exposure to toxicants (pesticides, phthalates, heavy metals, air pollutants) | Older parents and certain health conditions increase risk; valproate use strongly linked to ASD; common toxicants also play a role |
| Environmental Factors – Natal | Fetal complications, oxygen deprivation, premature or late birth | Birth complications and lack of oxygen raise ASD risk |
| Environmental Factors – Postnatal | Infections, vitamin deficiencies, chemical exposures | Postnatal exposures may add to risk, but effects are less clear |
| Factors Not Associated | Vaccinations, maternal smoking, alcohol use | Large studies show no link between these and ASD |
Note: Vaccines, smoking, and drinking during pregnancy do not cause autism. Many big studies have shown this is true.
Examples of Environmental Factors
- Prenatal: Older parents, health problems in the mother, some medicines during pregnancy, and chemicals like pesticides or air pollution.
- Natal: Problems at birth, like not enough oxygen or being born too early or too late.
- Postnatal: Infections, not enough vitamins, and chemical exposures after birth.
Things like makeup, weed killers, and cleaning products can have chemicals linked to autism risk. These chemicals are common, so they may matter along with genes.
Autism does not come from bad parenting, food, or feelings. It happens because of a mix of genes and things in the environment. These things affect the brain before, during, and after birth.
Social Anxiety vs Autism
Key Differences
Social anxiety and autism are not the same. They can look alike, but they have different causes. Autism spectrum disorder starts when a child is very young.
It changes how someone talks and acts with others. People with autism may not understand social cues. They might do the same things over and over. Loud sounds, bright lights, or certain textures can bother them.
Social anxiety disorder often starts in the teen years or early adulthood. It is about being very afraid of being judged or embarrassed. People with social anxiety know the social rules. But they feel scared when they think others are watching them. They may stay away from social events because of this fear.
Autism is a neurodevelopmental condition. It changes how the brain grows and works. Social anxiety is an anxiety disorder. It comes from being afraid of what others think.
The biggest difference is that autism lasts a lifetime and affects how people talk and act. Social anxiety is about fear and staying away from social places.
Doctors use different ways to find out which condition someone has. For autism, they watch how a person talks and acts from a young age. For social anxiety, they look for fear and staying away from social places for at least six months.
Comparison Table
The table below shows how autism and social anxiety are different:
| Aspect | Autism Spectrum Disorder (ASD) | Social Anxiety Disorder (SAD) |
|---|---|---|
| Onset | Early childhood, often before age 3 | Usually adolescence or early adulthood |
| Causes | Neurodevelopmental differences; affects social communication and sensory processing | Fear of judgment and social scrutiny; anxiety-driven |
| Social Behaviors | Difficulty interpreting social cues; repetitive behaviors; prefers routines | Recognizes social cues but sees them as threatening; avoids social situations |
| Sensory Processing | Sensory sensitivities common; may lead to overload | Sensory processing typical; heightened awareness of social cues |
| Diagnostic Criteria | Persistent social communication deficits and repetitive behaviors from early development | Intense fear of social scrutiny, avoidance, and physical anxiety symptoms lasting 6+ months |
| Communication | Deficits in nonverbal cues, eye contact, and social understanding | Communication skills intact but affected by fear of negative evaluation |
| Symptom Duration | Lifelong, present across settings | Can change over time, often linked to specific situations |
| Treatment | Behavioral, speech, and occupational therapies; sensory integration | Cognitive-behavioral therapy, exposure therapy, medication |
Overlapping Symptoms
Social anxiety and autism can have some of the same signs. This can make it hard to tell them apart. Both can make it tough to be in social places.
People with either one may not look at others or may feel nervous around people. Both can cause sweating or a fast heartbeat when talking to others.
But the reasons for these signs are not the same. People with social anxiety stay away from others because they are scared of being judged.
People with autism may stay away because they do not understand social cues or because loud sounds or bright lights bother them.
Some signs that both can have are:
- Trouble talking with others
- Staying away from social places
- Physical signs like sweating or shaking
- Not looking people in the eye
Some things make them different:
- Autism has repetitive actions, a strong need for routines, and is sensitive to sounds or lights.
- Social anxiety is about being afraid of what others think, but social skills are usually okay.
Doctors look for lifelong trouble with talking and repetitive actions to diagnose autism. They look for strong fear of social places and staying away because of worry to diagnose social anxiety disorder.
People can get confused. Some think all social avoidance is from anxiety. But in autism, it is often because of trouble understanding others or being bothered by sounds or lights.
Social anxiety and autism need careful checks, because someone can have both. Getting the right diagnosis helps people get the help they need.
Telling Them Apart
Real-Life Scenarios
It is easier to see the differences between social anxiety disorder and autism spectrum disorder with real-life examples.
The table below shows how each one might look in daily life:
| Aspect | Social Anxiety Disorder (SAD) | Autism Spectrum Disorder (ASD) |
|---|---|---|
| Eye Contact | Looks away because they fear being judged or embarrassed | Looks away because it feels strange or too much |
| Sensory Experience in Social Settings | Worries about being watched or judged in crowded places | Gets upset by loud sounds, bright lights, or lots of talking |
| Root Cause of Social Difficulty | Is afraid others will think badly of them | Has brain differences that change how they understand people and senses |
| Reaction to Sudden Changes | Dislikes changes because they feel nervous about social situations | Gets upset by changes because they need things to stay the same, not just for social reasons |
| Communication Style | Talks normally when calm, but may speak softly or stumble when anxious | Uses different body language, may talk in a direct way, and often talks about favorite topics |
| Social Motivation | Wants friends but feels too nervous to join in | May talk to others in a different way; wanting friends can be different for each person |
| Interests | May not talk about favorite things in public because of worry | Has strong interests that can be a good thing when shared |
“I have both. My social anxiety was worse in middle and high school. It felt easier to stay quiet than say something wrong. My social anxiety comes from being scared to perform in front of people. My autism means I do not always know how to act or notice small social hints.”
Carly Jones MBE, an Autistic woman and British Autism Advocate, shares her story:
“People thought I had social anxiety disorder. I took medicine, but it made me feel numb. I do not have social anxiety disorder. I am just socially anxious because I am Autistic… the real reason for my social anxiety and old eating problems was Autism.”
These examples show that social anxiety and autism can look alike, but the reasons for the behaviors are not the same.
Questions to Ask
To tell the difference between social anxiety disorder and autism spectrum disorder, certain questions can help:
- How does the person feel when around others?
- Are these feelings always there, and for how long?
- Does the person stay away from social places?
- Does fear of being with others make life harder?
- How does the person act when invited to social events? (Staying away may mean social anxiety, while going but not joining in may mean autism.)
- What are their social habits? (A child who stays alone and does not join may have autism, while a child who joins but stays quiet or looks worried may have social anxiety.)
- When did the signs start?
- What does their early life show?
Doctors use these questions, plus watching and talking, to help find the right answer.
When to Seek Help
People should get help if they notice changes in mood or actions that last. Getting help early can really help, since anxiety often happens with autism.
For social anxiety disorder, people should talk to a doctor or mental health worker if:
- They feel strong fear or worry in social places where others might watch.
- The fear or worry lasts six months or more.
- The worry or staying away causes trouble at school, work, or with friends.
- The fear is much bigger than the real situation.
- They stay away from or go to social places but feel very scared.
- The signs are not caused by another health problem or drug.
Doctors may send people to experts if they see these signs. Getting help early helps kids and adults handle signs and live better. Knowing the differences between social anxiety and autism can lead to better help and care.
Diagnosis
Evaluation Process
Finding out if someone has social anxiety disorder or autism takes a few steps. It often begins when a parent, teacher, or the person notices problems with social skills or odd actions.
A doctor or specialist will ask about early childhood, how the person acts with others, and if they do things over and over.
For social anxiety disorder, the doctor checks for a big fear of being judged or embarrassed in groups. For autism, they look for lifelong trouble with talking to others and repeating actions.
The steps in the process are:
- Talking with the person and their family.
- Using forms or tests to learn more.
- Watching how the person acts with others.
- Looking at school records and early growth.
For autism, doctors may use special tests like the Autism Diagnostic Observation Schedule (ADOS). It can take a few visits to get all the facts. Early checks are important, especially when signs of both social anxiety and autism show up.
Tip: Finding out early helps kids and adults get the right help and makes life better later on.
Who to Consult
Many experts can help find out what is going on. The table below shows who can help and what they do:
| Condition | Qualified Professionals | Diagnostic Methods and Notes |
|---|---|---|
| Social Anxiety Disorder | Psychologists, Psychiatrists | Talking, DSM-5 rules, and special tests |
| Autism Spectrum Disorder | Psychologists, Psychiatrists, Developmental Pediatricians, Neurologists, Speech-Language Pathologists | Teamwork; looking at early life, watching actions, DSM-5 rules, and special tools |
| Not Qualified to Diagnose Autism | Licensed Clinical Social Workers, Speech Therapists, Board Certified Behavior Analysts | They can help but cannot give a final answer |
| Psychiatric Nurse Practitioners | May diagnose autism depending on training and state regulations | Rules change by place and training |
In the U.S., doctors for kids, family doctors, and nurse helpers may start the checks. In the U.K., psychologists and psychiatrists often lead the team. In Canada, doctors for child growth and brain doctors are important.
Importance of Accurate Diagnosis
Getting the right answer is important for care and support. Social anxiety disorder and autism can look alike, but they need different help.
The table below shows why getting it right matters:
| Aspect | Explanation |
|---|---|
| Overlapping Symptoms | Both can cause staying away from others and not looking at people, which can lead to mistakes. |
| Treatment Differences | CBT helps with social anxiety by lowering fear. ABA and special CBT help with autism. |
| Co-occurrence Recognition | Some people have both. Knowing this means better, personal help. |
| Early Detection Benefits | Finding out early lets people get help that makes life better. |
| Screening Recommendations | Checking for autism when looking at social anxiety stops missed cases. |
Some people with autism hide their actions to fit in, which can make it look like social anxiety disorder. Getting the right answer means people get the best help, like regular CBT for social anxiety or special CBT and ABA for autism. Help may change as people grow, so families, teachers, and doctors need to work together.
Knowing how social anxiety and autism are different helps people get the right help.
The table below shows the main ways they are not the same:
| Feature | Autism Spectrum Disorder | Social Anxiety Disorder |
|---|---|---|
| Onset | Starts when a child is very young | Starts in the teen years or later |
| Core Symptoms | Trouble with talking and routines | Scared of being judged, avoids people |
| Physical Signs | Repeats actions, gets too much from senses | Sweats, shakes, face turns red |
Getting the right answer helps people do better. Families can get help early, special classes, and support from the community. If you are not sure if it is social anxiety or autism, talk to a trained expert. There is help for people at every age.
FAQ
What is the main difference between social anxiety and autism?
Social anxiety is mostly about being afraid of what others think. Autism changes how someone talks, understands people, and senses things. Autism usually starts when someone is very young. Social anxiety often begins later in life.
Can someone have both social anxiety and autism?
Yes, a person can have both at the same time. Many people with autism also feel social anxiety. Each one needs its own kind of help and support.
How do doctors tell social anxiety and autism apart?
Doctors check when the signs first showed up. They look at why someone has trouble in social places. They also see if there are any repeated actions. Doctors use questions, lists, and watch how someone acts to decide.
Do people with autism always avoid social situations?
No, not all people with autism stay away from others. Some want friends but find social rules hard. Others avoid groups because loud sounds or bright lights bother them, or they do not get social hints.
Can social anxiety go away with treatment?
Yes, many people get better with therapy like CBT. Medicine can help too. Getting help early really matters.
Are repetitive behaviors only seen in autism?
Repeating actions, like flapping hands or saying words again and again, is common in autism. People with social anxiety do not usually do these things.
