The Difference Between GAD and Social Anxiety Disorder

Though several changes were made in the classification of anxiety disorders with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 for short), social anxiety disorder (SAD) and generalized anxiety disorder (GAD) continue to coexist within the same diagnostic category.

Yet, even though they share some features, GAD and SAD (sometimes called social phobia) are distinct problems.

Both GAD and SAD are characterized by persistent anxiety that is excessive or disproportionate to an actual threat. What is meant by "threat," however, differs between the two.

People with social anxiety disorder sometimes experience physical symptoms associated with their anxiety, as do those with GAD. Biased thinking—in many cases catastrophizing (imagining worst-case scenarios)—is central to both types of anxiety disorders as well.

Though the types of thought traps can be similar, it is the thought content that distinguishes GAD from social anxiety disorder. People with GAD tend to worry about a range of topics. Worries may be about major life issues—such as health or finances—but they are also about many minor, day-to-day stresses that others would tend not to perceive as intensely.

Social worries are not uncommon in those with GAD, however, their focus tends to be about ongoing relationships rather than on fear of evaluation. For example, a young man with GAD may worry uncontrollably about the implications of a fight with his girlfriend. A mother with GAD may be overly concerned with whether or not she made the "right" decision to have her child switch schools and if her daughter will have a smooth transition.

People with social anxiety disorder, on the other hand, tend to worry about meeting new people, being observed, and performing in front of others (for example, speaking up in class or playing an instrument in a band.) Their thought content typically centers on negative evaluation and possibly rejection.

For example, a man with social anxiety disorder may have difficulty starting a conversation at a work happy hour for fear that he will appear anxious, say "something stupid," and be ridiculed by his colleagues. A single woman with social anxiety disorder may avoid dating altogether because of anxiety about humiliating or embarrassing herself on a date.

A common thread here, again, is a pathological degree of worry that is impacting the individual’s ability to develop or maintain relationships, fulfill basic obligations, and meet his or her personal and professional potential.

Given that the other components of the anxiety cycle—emotions and thoughts—overlap, it follows that the behavioral differences between GAD and social anxiety disorder are subtle. Both conditions are characterized by a high degree of avoidance, but the reason underlying the avoidance is likely to be different.

Let’s say that a man calls in sick on the day of a presentation at work. If this man has GAD, he might be avoiding the meeting out of fear that he has not put enough effort into preparing his talk and he that he will never finish it in time. If this man has social anxiety disorder, he might be avoiding the meeting out of concern that no one will like his ideas or that others might notice if he sweats while he talks.

The average age of onset is later for GAD than social anxiety disorder, age 31 for the former and age 13 for the latter. That said, those with GAD often have symptoms long before they seek treatment.

The stressors of adolescence and early adulthood, when people are typically experiencing many social transitions (for example, schools, friendships, or romantic relationships), may exacerbate social anxiety symptoms. The responsibilities of adulthood (for example, finances, parenting, or career decisions) can amplify GAD symptoms.

In older individuals, the content of worry and associated behaviors may change slightly. For example, older people with social anxiety disorder may experience anxiety and embarrassment about appearance or an impairment (for example, poor hearing or tremulous movements) that leads them to avoid or severely minimize social interactions.

The presentation of GAD in older adults (the most common of the anxiety disorders in this age group) is typified by expression of physical symptoms more readily than psychological symptoms. Later in life, people with GAD are more apt to experience uncontrollable worry about the health of family members or their own well-being.

It is not uncommon for individuals with GAD to meet criteria for another psychiatric diagnosis in the course of their lifetime, or even simultaneously. The most commonly co-occurring problem is depression.

However, a substantial subset of individuals struggles with co-occurring GAD and social anxiety disorder. GAD and post-traumatic stress disorder (PTSD) also commonly occur together.

Fortunately, the treatments for GAD and social anxiety disorder overlap. Many medications are helpful for both problems. Cognitive behavioral psychotherapy is the first-line psychotherapy for these conditions. This type of treatment helps the individual to address biases in thinking and to eliminate as much avoidant behavior as possible.

While GAD and SAD share the symptom of anxiety, they differ in the thought content associated with that anxiety as well as the reasons underlying behaviors caused by the disorder. Both conditions can significantly reduce the quality of life, and it's important for people with these conditions to seek out treatment.

Both psychotherapy and medications can reduce uncomfortable symptoms and allow people to live their lives as fully as possible.