Autism and social anxiety

The short answer

The key question is: what is behind the difficulty?

• In social anxiety, you usually know what to do in a conversation. Fear gets in the way. When you feel safe, with people you trust, things often flow.
• In autism, social situations can be hard even when you feel calm. You may find unwritten rules confusing, find eye contact uncomfortable, need routine, or be overwhelmed by noise and light.

Both can lead to the same thing: avoiding people. That is why they are easy to confuse. And many people have both.

What autism is

Autism is a lifelong difference in how the brain develops. It affects social communication and how you process the world. Autistic people often have strong focused interests, a need for predictability, and different reactions to sounds, light, touch or smells. Signs are present from early childhood, even if they are noticed late.

Autism is not an anxiety problem. But anxiety is very common in autistic people.

How common is anxiety in autism?

A study that combined research on autistic adults found that 27% had an anxiety disorder at the time of the study. 42% had had one at some point in their lives. The figures varied widely between studies, and questionnaires gave higher numbers than interviews. This review did not give a single figure for social anxiety alone.

This makes sense. Social situations that are confusing, tiring or sensory-heavy, and experiences of being teased or excluded, can teach anyone to fear being judged.

Telling them apart

The official guides say something similar. People with social anxiety usually have social skills and relationships that fit their age, with problems showing mainly around unfamiliar people or under stress. In autism, social communication differences are a core part of the picture.

On forums, people trying to sort this out often describe the difference as fear versus confusion: “I know what to say but I’m scared” versus “I don’t know what is expected”. Several describe getting an autism diagnosis in adulthood, after years of being told they “just” had social anxiety.

Why mistakes happen

Clinicians say it is genuinely hard to separate social anxiety from autism. Two problems come up:

• Overshadowing: when a person has an autism diagnosis, their anxiety may be put down to autism and not treated. Or when someone looks socially anxious, autism may be missed.
• Hard to put feelings into words: some autistic people find it hard to name their emotions. That makes anxiety harder to spot.

People who learned to “mask” (copy others to fit in) can be harder to recognize as autistic. Some are only diagnosed after years of being treated for anxiety alone.

What helps

If you are autistic and also socially anxious, the anxiety can still be treated. The therapy built for social anxiety can be adapted for autistic people: more concrete, more visual, with attention to sensory needs and less pressure on eye contact. There is less research on what works best for autistic adults with social anxiety. It is one of the open questions.

Some things to keep in mind:

• Not every hard situation is a fear to face. If a place is too loud or bright, the answer may be ear defenders, not exposure.
• Don’t try to train away autism. Treatment for social anxiety should target the fear, not make you act less autistic.
• Look for a clinician with autism experience. See finding a therapist.

Should you get assessed?

If you recognize autism traits in yourself, an autism assessment can help you understand your life. Waiting times are long in many countries, and assessment for adults is not always easy to get. A diagnosis is not needed to start working on social anxiety. Both questions can be raised with your doctor. See talking to your doctor.