OCD and Social Anxiety: How They’re Alike and How They’re Different
Obsessive Compulsive Disorder (OCD) and Social Anxiety Disorder (SAD) have one terrible thing in common: Lots of anxiety. While they are distinct conditions, they can appear together. In fact, those diagnosed with OCD are at risk for several co-occurring disorders, including depression and other conditions that involve anxiety.
It’s believed that around 11% of people diagnosed with OCD also have social anxiety. But how are these conditions the same and how are they different? This article will discuss the features of each.
OCD is not a common illness, with approximately 2% of adults in the US diagnosed. While many people tend to self-diagnose themselves as being so OCD, this is largely a reflection of how misunderstood the condition is by society. OCD is not a disease marked by a preference for order or organization and it does not slightly bother or annoy the sufferer; it terrorizes them. It causes continuous uncertainty that appears in cycles of egodystonic, disturbing, and intrusive thoughts (obsessions) and the rituals (compulsions) that sufferers engage in as a way to control their anxiety. Living with OCD is akin to living with perpetual doubt, which is why OCD is appropriately called the “Doubting Disease.”
OCD comes in a variety of “flavors” or subtypes and people can, in theory, have OCD that grabs onto just about anything. Some people have Contamination OCD where they fear germs, contamination, or communicable disease. Others have Harm OCD where they fear hurting or killing others. Some have Relationship OCD where they fear their spouse leaving or cheating on them. Others have Sexual Orientation OCD where they repeatedly question their sexuality. Some people even have OCD that manifests as them questioning whether or not they’re actually alive.
The flavor of OCD dictates the subject matter of the intrusive thoughts and the compulsions that follow.
For example, someone with Contamination OCD who fears that touching handrails might expose them to AIDS will adopt compulsions around washing their hands over and over, checking their hands for evidence of another person’s blood, or getting tested for HIV.
Repeatedly engaging in vigorous and thorough handwashing is one of the better known symptoms of OCD but people whose OCD does not revolve around contamination will not wash their hands compulsively (and perhaps not at all). Instead, they’ll engage in rituals that align with their OCD flavor.
For instance, someone with Harm OCD may fear that they’ll run over a pedestrian while driving. To modulate this anxiety, they may retrace their steps to check the road for a bloodied body lying hurt in the middle of the street. They may examine their vehicle for evidence of impact. They may watch the evening news for reports of hit and runs. They may check the local police blotter for the same. But they won’t wash their hands compulsively unless they have Contamination OCD as well.
OCD sufferers engage in compulsions in a futile attempt to gain certainty. The reason it’s futile is that true certainty is impossible to get. Someone with Checking OCD who repeatedly checks to make sure their front door is locked will get temporary relief each time they check. But, eventually, the OCD thought comes back asking the sufferer, “Are you 100% sure the door was locked? Are you 100% sure you didn’t just imagine that it was locked? Are you 100% sure that the windows were locked too?” OCD is an illness that is never satisfied and it requires the impossible: Its sufferer to be 100% certain, 100% of the time. This is why the obsessions and compulsions perpetuate the way they do.
What are Intrusive Thoughts?
If OCD were a dish, intrusive thoughts would serve as the main ingredient; they are the catalyst that causes the disorder to be disruptive. But, even so, intrusive thoughts are not unique to people with OCD; pretty much everyone has them from time to time. The difference lies in how a person responds to the intrusive thoughts.
Take someone without OCD or another mental disorder. They may be driving to work or taking a shower and an intrusive thought may pop into their head. It might include content that’s disturbing and unsettling. The non-OCD person may think, “Hmm…that’s weird.” Then they’ll disregard the thought and move on with their day, not giving it another glance. Next time an intrusive thought intrudes, they’ll respond similarly, labeling the thought as meaningless.
Now, take someone with OCD. They may experience a thought that is similar to the person above, but instead of shrugging it off, they take the thought seriously. They give it power, they fret about it, and they analyze it, believing it must mean something about them or serve as an ominous sign that something bad is on the horizon. To modulate the anxiety that this causes, they engage in compulsions to make sure their intrusive thoughts either: 1) Aren’t already true or 2) Won’t come true.
Interestingly, the OCD sufferer isn’t convinced of their thoughts deep down. They may even be 99% sure that their thoughts are nonsense. But, as mentioned above, OCD demands 100% certainly and this forces the sufferer to engage in compulsions just to be safe. If they don’t, OCD pesters them with questions of “What if?” If OCD were a commercial product, “What if?” would be its tagline, appearing large and bold on television screens.
OCD sufferers essentially buy what OCD is selling, engaging in compulsions because OCD tells them, “What if you don’t and then something bad happens?”
OCD and Dysfunctional Beliefs
One of the foundations of OCD is the dysfunctional beliefs that define the disorder. In general, those with OCD tend to struggle with the following:
Hyper-responsibility: OCD convinces sufferers that they are responsible for things in which they don’t actually have control or things that are well outside of reasonable duty. For instance, an OCD sufferer may believe that they need to count to lucky 21 every time they see a plane flying overhead in order to keep that plane flying safely (when, in reality, that’s the pilot’s job). In another example, someone with OCD may believe it’s their responsibility to check local playgrounds for shards of glass, fearing if they don’t a child could swallow the glass and die. The sufferer may believe this even if they didn’t bring anything glass into the playground area and even if they have never set foot on the grounds before.
Thought-action fusion: Thought-action fusion is the belief that a thought is on par with an action. For example, someone with OCD who thinks about pushing an elderly woman down a flight of stairs will erroneously assume that thinking this is the same as doing it. Thus, they’ll engage in a compulsion that reassures them, such as checking the bottom of the stairs for evidence.
Control of thoughts: An inability to control thoughts is not limited to OCD (everyone has this limitation) but those with OCD want desperately to control their thoughts, specifically because those thoughts terrify them. The attempt to gain this control is, in part, why intrusive thoughts are so much more potent and frequent in OCD when compared to the normal population. The OCDer tries repeatedly not to think their thoughts and this assures they think of them more often. The reason lies in a conundrum: You can’t tell yourself not to think about something without actually thinking about it.
Overestimation of risks: OCD sufferers tend to overestimate risks in two ways. First, they see risk where no risk exists. In one of the examples addressed above, someone with OCD may believe they need to count to a certain number in order to keep a plane from crashing; in reality, a failure to count presents absolutely no threat or causation of tragedy.
A second way OCD sufferers overestimate risk is by taking theoretical risks and making them actual ones. For instance, if someone with Contamination OCD kisses someone else, they may believe they contracted HIV from that kiss. In theory, this is possible if the person they were making out with had HIV, if they were engaged in deep kissing for a long period of time with limited open air exposure, if either party’s saliva didn’t neutralize the virus (as it’s proven to do), and if both kissers had fresh and open cuts in their mouths. In reality, this risk is effectively zero (so much so that the CDC states that this is only a route of transmission if something “very unusual” happens). But the OCD mind takes the theoretical and their imagination runs wild, turning the theoretical into the actual.
Perfectionism: About 30% of the population identifies as a perfectionist, so this isn’t limited to OCD by any means. But it is a common feature in OCD and tends to work alongside intrusive thoughts. For instance, someone with OCD may think that if they don’t draw a picture perfectly or perfectly arrange their pencils on their desk, something bad will happen.
Certainty: All hail certainty! If OCD is about one thing, it’s about this the very most. OCD feeds on certainty, repeatedly telling the sufferer that they must chase it. This pursuit is elusive, of course, because being completely certain isn’t possible and that leads the OCD sufferer on a wild goose chase, performing lots of compulsions along the way.
For example, someone with Health Anxiety OCD may fear that they have something wrong with their heart. They may visit their doctor and request testing. They may undergo an EKG, an echo, bloodwork, and an MRI. But even when all of these things come back normal, their OCD will tell them, “Maybe the doctor missed something. Maybe the lab mixed up the results. Maybe the MRI tech took pictures that were blurry. Maybe they mixed your images up with someone else’s.”
Or the sufferer will find momentarily relief. But the next time they experience the slightest chest pain or a palpitation, they’ll find themselves back at square one. And this sends them down the rabbit hole, chasing certainty once more.
One of the biggest symptoms of OCD are compulsions. Many of these compulsions are visible (such as handwashing) but mental compulsions are frequent too. In other words, the absence of visible compulsions doesn’t mean someone doesn’t have OCD. Not only that, but sufferers are extremely clever at keeping their compulsions secretive and may perform them unbeknownst to family and friends.
The nature of the compulsions vary based on the flavor of OCD and the intrusive thought that the sufferer is trying to modulate. Someone who believes they have been exposed to asbestos may jump into the shower and scour their body whereas someone who is afraid that they’ve hurt their child, may ask their child for reassurance or check them for wounds.
Regardless of subtype, there are symptoms present in the vast majority of sufferers, including:
- Experiencing intrusive thoughts that terrify the sufferer and go against the sufferer’s true desires (the thoughts are egodystonic in nature)
- Engaging in physical or mental compulsions or rituals that intend to rid the sufferer of the anxiety caused by the intrusive thoughts
- Engaging in repeated behaviors that make no sense to observers and that sufferers themselves may not be able to explain (for example, someone with OCD may experience the need to walk through a doorway in a way that feels “just right’ but they may be unable to say what “just right” entails)
- Engaging in compulsions that are more important than other tasks, such as getting to school on time for first bell or arriving at work on time for a meeting
- Engaging in compulsions instead of performing everyday routine activities (such as showering or sleeping)
- Seeking reassurance from friends, family, or through things such as news reports or internet searches
- Being preoccupied with minor details
- Engaging in avoidance behaviors (for instance, a sufferer whose OCD tells that they’re going to push someone in front of a train may avoid walking anywhere near train tracks)
- Experiencing symptoms with a severity that ebbs and flows based on what is going on in the sufferer’s life (OCD sufferers tend to experience more potent symptoms around times of stress and/or during the holidays)
- Experiencing shame that may cause the sufferer to hide their disorder and/or behave secretly
OCD appears to develop due to a complex dance among genetics, environment, abnormal structures in the brain, and abnormal brain function. Communication is an issue in certain areas, including the orbitofrontal cortex, the anterior cingulate cortex, the striatum, and the thalamus. People with OCD may also have a hyperactive amygdala and low levels of serotonin and/or dopamine. These are neurotransmitters that influence a person’s mood, anxiety, reward, and ability to handle stress.
Some people are genetically predisposed to OCD, though this does not guarantee its appearance. And behavioral conditioning, such as the compulsions those with OCD engage in, appears to solidify the disorder. It doesn’t cause it, per say, but OCD will likely never become disruptive if those with it don’t take their intrusive thoughts seriously and engage in rituals as a result.
OCD Risk Factors
There aren’t any risk factors within a person’s control that can decrease the odds of getting OCD. In other words, it’s not triggered by smoking or drinking alcohol (though these can make symptoms worse). But there are a few things that increase an individual’s risk, including:
- Having an immediate family member who has OCD, an OCD-related disorder, or autism
- Being a preteen or in late adolescence (OCD can appear at any time though it’s most likely to happen in these age ranges)
- A history of trauma (Someone who has repeatedly been cheated on by their significant other, for example, may be at greater risk of developing Relationship OCD rather than another subtype)
When OCD already exists, there are certain things that can trigger a flareup or worsen symptoms, including a head injury, stress, or transitions.
Children who have strep or a scarlet fever can develop OCD-like symptoms seemingly overnight. In these cases, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) may be the cause. This can lead to OCD behavior or tics in children who have never presented with symptoms before or cause a dramatic increase in symptoms in children whose OCD is moderate or less severe otherwise. Once the underlying infection goes away (e.g., the strep throat), the symptoms abate but they’ll flair up again if the child is reinfected.
PANDAS is largely considered a pediatric condition, though it can appear in adolescents as well. It hasn’t been studied much in adults and while researchers believe it’s unlikely that PANDAS would first appear in adulthood, it doesn’t seem entirely impossible.
Unfortunately, OCD is not a curable disorder but treatment is available to help sufferers live as normal a life as possible.
Some of these include:
Medication: Not everyone responds to medication and any one person’s response appears to be influenced by genetics. When medication does work, SSRIs (medications that increase serotonin) are usually used as a first-line treatment. These include Zoloft, Prozac, Paxil, Luvox, and Lexapro. SNRIs (medications that increase serotonin and norepinephrine) are used as well. These include Effexor, Cymbalta, and Pristiq. Tricyclic antidepressants (such as Anafranil) may be prescribed too.
Therapy: Even when medication works, it does not serve as an alternative to therapy. Rather, medication intends to make therapy easier. Overall, the most effective type of therapy is cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). In ERP, the OCD sufferer exposes themselves to their intrusive thought (either on purpose or as part of their everyday routine). They are then instructed to refrain from performing their anxiety-reducing compulsions. The reason this is effective is because compulsions reinforce the intrusive thoughts and tell the sufferer that the thoughts are aligned with reality. Thus, refraining from them takes power away from the obsessions. And this is the key to healing.
ERPs are extremely hard for the sufferer to perform successfully because they cause so much anxiety and distress. That’s why they usually begin with lower level obsessions before moving onto the harder ones.
Acceptance and commitment therapy (ACT) may be used to help with ERPs. While this therapy is somewhat new, it’s becoming increasingly called upon in OCD treatment. In ACT, the OCD sufferer is taught to look at their thoughts as dispassionately as possible and then refrain from reacting to them. This helps the person with OCD see that thoughts are merely thoughts and have no power to change reality.
In ACT, sufferers may use visual imagery, creativity, or songs to diffuse their thoughts. For example, if they have a thought that they left their coffee pot on and a fire is engulfing their living room, they’ll be instructed to sing something like, “I am having the thought that my living room is on fire.” This is much different than the OCD thought of, “My living room is on fire.”
Mindfulness may be used as well in conjunction with ERP or ERP and ACT.
TMS: In severe cases, Transcranial Magnetic Stimulation (TMS) is sometimes used. While this is more often prescribed for depression, some doctors are using it for OCD as well.
TMS involves a non-invasive procedure that uses magnetic fields to regulate the deeper areas of the brain believed linked to OCD. Those undergoing TMS typically have daily treatment for several weeks followed by maintenance appointments.
Lifestyle changes: Lifestyle changes won’t rid someone of OCD altogether, but they can decrease symptoms and prevent flareups to some degree (though therapy and/or medication are still required for effective treatment).
Overall, it’s recommended that those with OCD:
- Eat a healthy diet that includes fruit, vegetables, whole grains and limits red meat, saturated fat, sugar, and processed foods
- Reduce their intake of caffeine, alcohol, or tobacco
- Adopt a regular exercise routine
- Practice yoga, mindfulness, or meditation
- Take part in support groups
- Talk to others about their disorder
Social Anxiety Disorder, Explained
Social Anxiety Disorder is sometimes called “social phobia” and manifests as a condition characterized by fear of social humiliation or rejection. According to the DSM-5 criteria, in order to be diagnosed, sufferers must experience the following:
- An intense fear of being judged, embarrassed, or humiliated in social situations
- Anxiety that blows things out of proportion or overestimates the threat to their reputation (sufferers may believe that a minor faux pas will result in everyone unfriending them)
- A tendency to avoid social situations wherever possible (of note, this is not necessarily limited to large social gatherings and those with social anxiety may even avoid walking into the breakroom at work because someone else is already in there)
- Anxiety that is so intense and present that it interferes with daily life
- Anxiety that is not explained by other underlying conditions (such as a medical condition, substance use, or medication)
- A recognition that the fear and anxiety are unreasonable (children might not recognize this)
- Symptoms that last for a duration of at least six months in those under 18
Social Anxiety Disorder can appear in the broad sense or the limited. In the former, the anxiety is present in virtually all social situations and leads to extreme shyness and avoidance of these situations. In the latter, it’s limited to specific situations (such as public speaking or playing a soccer game in front of spectators) and the sufferer may not experience social anxiety otherwise.
However, social anxiety may start as a fear of one situation before evolving into a fear of multiple situations before evolving further to where the sufferer fears virtually any interaction with people.
Social Anxiety Disorder is fairly common with 7.1% of adults in the US afflicted. Those who have it range in their severity. Some people may only fear large gatherings and parties while others may struggle with talking to a cashier at a store or ordering a pizza on the phone. Some people may struggle with performing certain tasks in front of others, such as eating, drinking, putting on makeup, or using the restroom.
Social Anxiety Disorder and Dysfunctional Beliefs
Social Anxiety Disorder, like OCD, involves a series of dysfunctional beliefs harbored by the sufferer. These tend to dictate how they feel about situations and themselves.
Overall, these beliefs include:
Perfectionism: People with Social Anxiety Disorder tend to have higher levels of perfectionism than the general population and this perfection is most potent around social functions. For instance, someone may erroneously believe they have to behave perfectly or say everything perfectly at a party and the idea of imperfection (such as tripping while walking into a room) may cause them extreme discomfort.
Thought-action fusion: Thought-action fusion is the concept of confusing thoughts for actions or assuming that they’re directly linked to one another. It is a mainstay of OCD, but it’s present in other mental conditions including anxiety disorders.
Overestimation of threats: Because Social Anxiety Disorder is caused, in part, by an overreactive amygdala (the threat center of the brain), those with the condition tend to grossly overestimate danger in regard to social activity. For instance, someone may fear that telling a bad joke at a party will result in them losing friends or getting an unfavorable reputation when, in reality, most people won’t even give it another thought.
Overgeneralization: Overgeneralization is common in a variety of mental disorders and those without mental conditions tend to do it as well. This is the tendency to apply generalities to individual experiences. In keeping with the above example, if someone with Social Anxiety Disorder tells a joke to one person who fails to laugh, they may assume that no one will ever find them funny. The danger in overgeneralization is that it causes people to jump to conclusions, conclusions that – more often than not – are incorrect.
Shoulds: The concept of “shoulds” involves someone telling themselves that they “should” be this way or “should” be that way. Though this is prevalent in the general population, those with Social Anxiety Disorder may feel it more potently, especially in regard to social activity.
A need for certainty: The need for certainty is omnipresent and omnipotent in OCD. In Social Anxiety Disorder, it’s there as well. People with the latter condition may exhibit uncertainty about what others think about them and whether or not they really like them.
Social Anxiety Disorder Symptoms
The exact symptoms of social anxiety vary from person to person. However, in general, most people experience a combination of physical, emotional, and avoidance symptoms. These include:
- Disabling shyness or extreme discomfort in social situations
- Fear and anxiety that interferes with work, school, or the ability to perform everyday activities
- Fear of being judged or humiliating yourself
- Fear of engaging in small talk or interaction with strangers or acquaintances
- Fear of showing signs of nervousness (including physical signs like shaking, turning red, or speaking in a cracked voice)
- A strong dislike for being the center of attention or a tendency to avoid these situations
- Avoidance of social functions or events
- Avoidance of new people
- Experiencing extreme self-consciousness in social situations
- Analyzing behavior after social functions to assure nothing embarrassing or offensive was said
- Experiencing anxiety about an upcoming social event
- Expecting social situations to result in “worst case scenario” outcomes
- Performance anxiety when doing things such as speaking in public (while lots of people in the general population experience fear of public speaking as well, those with social anxiety tend to experience symptoms that are far more debilitating)
- Panic attacks during social situations
- Temper tantrums in children or the refusal to speak to others
- Physical anxiety symptoms such as a rapid heart rate, sweating, blushing, upset stomach, dizziness, breathlessness, muscle tension, or the feeling that the mind has gone blank
- Difficulty with everyday social skills, such as making eye contact, eating in front of others, starting conversations, or entering a room that’s already filled with people
- Difficulties dating
- Difficulties using a public restroom
- Difficulties interacting with people at work or school
Social Anxiety Disorder Causes
Similar to OCD, there is no one cause of Social Anxiety Disorder but scientist know what makes the condition more likely. It’s believed to result from a combination of genetics, brain structure, environmental factors, innate predisposition, and serotonin.
Overall, some of the suspected guilty parties include:
Genetics: Like OCD, Social Anxiety Disorder has a strong genetic component. In fact, it may even have one stronger than the one exhibited in OCD. In Obsessive Compulsive Disorder, about 25% of cases are believed to be hereditary. In Social Anxiety Disorder, 30-40% of cases may be a result of genetics.
Serotonin: In OCD, low levels of serotonin are believed to be a major cause of the condition. In Social Anxiety Disorder, serotonin is also implicated though not to a degree that is as clear-cut. Scientists believe that the serotonin transporter gene SLC6A4 is strongly linked to social anxiety but there are differing views as to the context.
Most older studies suggest that Social Anxiety Disorder is linked to low levels of serotonin and SSRIs, which increase serotonin, are often prescribed. But, to make things more difficult, some research suggests that social phobias are tied to too much serotonin rather than too little.
So, the juries still out exactly how serotonin plays a role though most people agree that it does play one somehow. It’s always possible that too low and too high levels can both be culpable in causing an imbalance in socialization.
The Amygdala: The job of the amygdala is to scan the environment for threats; it’s the part of the brain that initiates fight or flight. In Social Anxiety Disorder (as well as OCD), the amygdala is hyperactive. This causes the brain to perceive threats when no threats exist, putting the sufferer in a heightened fear response.
Environment: Sometimes, Social Anxiety Disorder is the result of learned behavior. For example, someone who experiences social ostracization (or even perceived ostracization) or experiences an embarrassing social situation (such as tripping during a dance recital) is at higher risk of developing the condition.
Having a parent with the disorder increases risk too. While part of this is due to genetics (as mentioned above), part is also the result of learned behavior. Children tend to learn by observing their parents. If mom or dad paces the kitchen in anticipation of a social event, the child may learn to correlate socialization with anxiety.
Social Anxiety Disorder Risk Factors
There are factors that increase the odds of developing Social Anxiety Disorder, though these certainly don’t act as a guarantee that it will develop (just as their absence does not guarantee that it won’t develop).
Overall, some of the most common risk factors include:
Having a Family Member with Social Anxiety Disorder: Anyone who has an immediate family member with the disorder (a mom, a dad, or a sibling) is more likely to have it themselves.
Past Social Trauma: People who experience teasing, rejection, or bullying as children are more likely to develop problems with social anxiety. They may also be more likely to develop it if they grew up in a family with a lot of conflict.
Innate Temperament: Social Anxiety Disorder is more likely to develop in people who are innately shy or reserved than it is in those who are extroverted and comfortable being the center of attention.
Pressure at Work or School: More often than not, Social Anxiety Disorder begins during the teen or young adult years seemingly out of the blue. However, it’s possible that high-pressure situations, such as giving a work presentation or singing a solo in the school play, can trigger it as well.
Having an Attention-Causing Physical Symptom: People who have something that draws attention to themselves, such as a large birthmark on their face, may be more likely to develop Social Anxiety Disorder.
Being Female: Though it’s not a wide margin, it is significant in term of statistics. About 8% of those who have Social Anxiety Disorder are women whereas 6.1% are men.
Being a Teenager: It’s not a hard and fast rule, but Social Anxiety Disorder tends to present in adolescence, perhaps because it’s during a time when peer pressure is at its apex.
Social Anxiety Disorder Treatment
Treatment for Social Anxiety Disorder tends to look different based on individual circumstances. However, it most commonly involves the following:
Therapy: Similar to OCD, cognitive behavioral therapy (CBT) is used for treating social anxiety. But, because Social Anxiety Disorder does not involve as many compulsions, exposure response prevention (ERP) is not as heavily involved. Still, people with Social Anxiety Disorder do use ERP when it comes to avoiding avoidance. Sufferers are instructed to refrain from skipping parties or avoiding social functions and they may be better able to avoid this avoidance by practicing exposures to social situations and honing social skills. These help build confidence.
Sufferers may additionally be instructed to refrain from asking others for reassurance and encouraged not to ask friends if they said anything embarrassing, acted in a humiliating way, or did something to make others judge them.
Some people with social anxiety may apologize unnecessarily, erroneously assuming they hurt someone or offended them somehow (this compulsion is common in OCD as well). So, sufferers will be instructed not to ask for forgiveness as a matter of routine.
CBT involves helping those afflicted recognize their negative thoughts and thought patterns and then alter those patterns. They may engage in role-playing in an effort to further enhance confidence when in actual social situations.
Medications: Like with OCD, selective serotonin reuptake inhibitors (SSRIs) often act as a front-line treatment for those with Social Anxiety Disorder. But, as previously addressed, the role of serotonin isn’t that cut and dry in social anxiety, which means SSRIs could make the disorder worse if high levels of serotonin are contributing to the condition.
Even so, they are helpful in many and that’s why Zoloft, Paxil, Prozac, or Lexapro may be prescribed first. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are essentially cousins to SSRIs and they may be used as well.
When high levels of serotonin act as a cause of Social Anxiety Disorder, when people don’t respond to SSRIs or SNRIs because of their underlying genetics, or when side effects prove too difficult to deal with, other medications are used. These include:
- Other types of antidepressants
- Anti-anxiety medications such as Valium or Xanax
- Beta-blockers that block adrenaline and result in less shakiness, lower blood pressure, a slower heart rate, and better control of limbs and voice
- Herbs such as St. John’s Wort, kava, valerian, theanine, or passionflower (While these may prove helpful, they can cause liver damage or react with already prescribed medications and so it’s recommended that no one consume them without first consulting with their doctor)
Some of these medications (such as anti-anxiety meds or beta-blockers) may not be intended for daily use and instead prescribed for consumption prior to a particularly intense event (such as giving a best man speech at a wedding).
Lifestyle Changes: The lifestyle changes that are beneficial to OCD are also beneficial in social anxiety. All in all, anything that cultivates a healthy lifestyle – from working out to eating fruits and vegetables – can help control the symptoms of Social Anxiety Disorder by controlling underlying stress. It’s possible that a lack of a healthy lifestyle can act as a trigger. For example, someone with social anxiety who tends to drink too much may worry that they embarrassed themselves at a party or said something offensive to their roommates while they were under the influence.
What doesn’t act as treatment?
In both OCD and Social Anxiety Disorder, sufferers may erroneously believe that avoiding triggers will make the disease go away. But this does the opposite and reinforces the disorder. Then, it inevitably causes the disorder to latch onto other areas.
For example, someone with Harm OCD who fears running over people while driving may believe that simply taking public transportation or riding their bike everywhere will cure them of their disorder. But avoiding driving reinforces the OCD and gives it more power. It doesn’t work, either, as OCD latches onto something else. If the Harm OCD sufferer gives up driving, the OCD may tell them that they’re going to stab people with knives or strangle them with their own hands.
In Social Anxiety Disorder, the concept is similar. Avoiding social situations reinforces the disorder and gives it more power in the long run. Someone with social anxiety who refuses to go to big parties may soon find that they’re bothered by small parties too and, eventually, get-togethers among a few friends. The disorder may eventually worsen to where the sufferer struggles interacting with coworkers or delivery men.
Unfortunately, these disorders don’t offer an easy escape and, in order to get through them, sufferers must face them head on.
The Similarities Between OCD and Social Anxiety Disorder
OCD and Social Anxiety Disorder possess similarities, likely because of the anxiety that’s at their root. Overall, some of the most consistent consistencies include:
- Disabling anxiety and discomfort that interferes with everyday life
- Pathological doubt and uncertainty
- Early age of onset (preteen to teen with OCD and teen with Social Anxiety Disorder)
- Perfectionistic tendencies
- Dysfunctional beliefs
- Abnormal levels of serotonin
- A strong genetic component
- A tendency to avoid certain situations for fear that they’ll trigger discomfort
- Experiences of shame and embarrassment
- Underlying conditions that are exacerbated by stress
- Compromised social function (either directly or indirectly)
- A tendency to ask for reassurance from friends or family members
- The potential of the conditions to worsen and become more debilitating over time
- Similar treatments (though neither OCD nor Social Anxiety Disorder has a quick cure)
The Differences Between OCD and Social Anxiety Disorder
OCD and Social Anxiety Disorder may have a lot in common but they possess plenty of differences, too. These include:
- OCD anxiety is dictated by the subtype of OCD (someone with Health Anxiety OCD will worry about different things than someone with Relationship OCD) whereas Social Anxiety Disorder always involves fear of social situations
- People with OCD tend to realize they have a disorder more often than those with Social Anxiety Disorder who may simply assume they’re shy or naturally reserved
- While people with Social Anxiety Disorder may experience intrusive thoughts, they don’t appear to be the main ingredient the way they are in OCD
- OCD involves time-consuming compulsions that are performed as a way to neutralize intrusive thoughts (i.e., obsessions) whereas those with Social Anxiety Disorder don’t engage in similar compulsions though they may engage in some (such as asking a fellow partygoer for reassurance that they didn’t do anything bad the night before)
- The anxiety and worries of OCD frequently focus on other people (e.g., the sufferer may worry that their mother will die if they don’t clean their bathroom a certain way) whereas the anxiety surrounding Social Anxiety Disorder tends to focus on the suffer themselves
- Social Anxiety Disorder may sometimes continue to only present under unique circumstances (such as when the person needs to give a class presentation or they’re performing with their band) whereas OCD tends to start in specific situations before broadening and becoming so present that sufferers may feel that they’re surrounded by it (this broadening can happen in Social Anxiety Disorder as well)
When OCD and Social Anxiety Occur Together
It’s always possible for someone to have OCD and Social Anxiety Disorder concurrently, but – even in the absence of Social Anxiety Disorder – OCD alone can dramatically affect social skills. For example, those with OCD may abandon social relationships out of fear that they won’t be able to hide their compulsions if they have friends around.
They may also refrain from social functions if they feel those functions will trigger compulsions. For instance, someone with Contamination OCD may avoid large parties due to the germ potential or someone with Harm OCD may refrain from dining with friends out of fear that they’ll stab someone. People with OCD may even dismiss social relationships because performing compulsions is too time-consuming.
In children and adolescents particularly, peer pressure can make underlying OCD worse as sufferers feel an increase in shame or embarrassment. This is compounded by the tendency of children to make fun of or bully those who are different and some peers may tease OCD sufferers for engaging in compulsions or acting in a way that they perceive to be abnormal. Experiencing this can further ostracize the OCD sufferer, increasing stress and ultimately symptoms.
The above is different than OCD that occurs at the same time as Social Anxiety Disorder. When both conditions are present, it’s important that they’re both addressed in treatment.
Because OCD and Social Anxiety Disorder are treated similarly (with CBT and medication) management may be straight-forward. On the other hand, at least some people may experience Social Anxiety Disorder because of higher levels of serotonin. Thus, the SSRIs nearly universally used for OCD can decrease social functioning. This makes getting tailor-made treatment from someone experienced in both disorders extremely important.