OCD and Social Anxiety Disorder: Differential Diagnosis

A new commenter confuses OCD with social anxiety disorder. Though I don’t know SA very well, they are clearly different illnesses. The problem is that there is overlap in all of the anxiety disorders, and in some cases, SA and OCD are both present.

You’re right about OCD including unwanted thoughts, but the shyness, nervousness, and anxiety sound more like social anxiety disorder or avoidant personality disorder.

No, nervousness and anxiety are prominent in all anxiety disorders. As far as shyness, this is just the kind of person that gets OCD. Social anxiety is a tough one, but OCDers don’t usually have this too bad. Most of the ones I deal with are more or less social on a regular basis. They’re hanging around people, but they are nervous.

It depends why they are avoiding people.

According to the DSM, if you are avoiding people due to one of the other Axis I disorders, then rule out SA. Keep in mind that people with schizophrenia and folks with some personality disorders like schizoid, schizotypal and paranoid personality disorders may also avoid people.

SA people avoid people due to massive anxiety relating to being around others. The anxiety is related to embarassment over doing something stupid or humiliating.

OCDers might avoid people due to the obsessions and the way that people react to them – heavy duty rejection. SA people are afraid they are going to be rejected in social situations, and social anxiety is pretty prominent.

Social anxiety is not necessarily so prominent in OCDers, but some have obsessions that tend to come out when they are around others. I dealt with this woman once who was afraid that when she talked to other women, she secretly made lesbian remarks to them. So she was nervous when speaking to women.

OCDers tend to be pretty nervous all the time. It’s not something that peaks when they get around others.

Harm OCD is a bad one, because they are afraid that they will hurt someone. It leads to a lot of avoidance.

If OCDers are treated well and treated as if they are normal people and not rejected or treated like shit, they will often hang around people a lot. And if you get rid of the obsessions, some will actually become social butterflies, since the obsessions might be the only reason for the introversion.

It’s true that extroverted obsessionals are quite rare, but that’s due to the nature of the illness. It only hits people with a certain personality, and that person is an introvert.

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9 thoughts on “OCD and Social Anxiety Disorder: Differential Diagnosis”

  1. Actually, it looks like you’re the one who is confusing SAD with OCD. That is, you’re misclassifying symptoms of SAD as being symptomatic of OCD. I doubt all or even most OCD sufferers are necessarily shy or introverted. (Furthermore, shyness and introversion themselves are distinct though correlated constructs.) Although, OCD sufferers usually experience embarrassment which is secondary to their OCD.

    1. Nope. I have OCD. Not only that, but I’ve had it for 28 years, diagnosable, and actually before that, undiagnosed. And I’ve been studying it quite intensively for 20 years.

      Definitely, extroverted obsessionals are quite rare. Dr. Ian Osborn states this in his book Tormenting Thoughts and Secret Rituals.

      As far as shyness goes, I don’t have any figures, but I used to spend time with them in chatrooms on the Net, and it was pretty hard to get a lot of them to talk. A lot of one word answers, etc. I talked to one OCD guy with Harm OCD who supposedly had not been out of his house in 4 years. Now, that’s an exaggeration, but you get the picture. Harm OCD is associated with a lot of avoidance.

    2. Fully 24% of persons with OCD meet criteria for Social Phobia. It’s the most common disorder in people with OCD. Since people with social anxiety (not a disorder) are 10X more common than people with social phobia, I would wager that a Hell of a lot of OCDers have social anxiety.

  2. Just to add more to your case history data: Since late adolescence I have suffered from some form of depression, or I thought that it was depression that ailed me. In college and a few times after I underwent counseling (severe crises), but abandoned the counseling as soon as I got some immediate relief. I now don’t think that depression was fundamental to what disturbed me, I believe OCD (you can’t imagine some of the obsessions I’ve been through…hmm..well, yes I guess you can) was/is the fundamental problem with added on anxiety and depression, likely provoked by the OCD. I think that you are on the mark regarding anxiety and OCD. Who wouldn’t be socially anxious and depressed with OCD?

    Anyway, for the past 2 years I have been on Lexapro (10 mg /day) and the Lexapro has brought IMMENSE relief. I will probably be on this Lexapro for the rest of my life and that is fine with me because I don’t notice any adverse side effects. Lexapro has been a life saver. Just to note, for others who may be under a pharmaceutical regimen, prior to the Lexapro I tried a course of Paxil. Paxil had no effect at all. Additionally, I put on about 40 pounds while on Paxil. Paxil may work better where some form of depression is the fundamental problem. Lexapro is noted to alleviate OCD. Whatever, consult your MD before you go on pharmaceuticals.

    Have a good day.

    1. Great news! I take Lexapro myself, but more like 20mg a day instead of 10mg. I wish I could get by on only 10mg.!

      Yes, OCD is depressing. That’s why 2/3 of OCDers are depressed. I suspect an awful lot of them have social anxiety (non-clinical) secondary to their OCD too. When you have OCD, a lot of people treat you like shit because they think there is something wrong with you.

  3. I had OCD before and I am totally cured and free now. I have been suffering for almost 25 years! That is true.
    No drugs or medication can treat OCD or SAD. But a natural method if done properly can definitely “switch off” all your ocd symptoms, be it intrusive thought, harmful thoughts, sexual thoughts or whatsoever.
    I am the living proof. Ocd,sad,anxiety attack are all can treatble conditions.

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