Obsessive compulsive disorder - OCD treatment and therapy from NOCD

OCD and Social Anxiety Disorder: Are They Related?

By Stacy Quick, LPC

Nov 14, 20238 minute read

“I shouldn’t have said that…now everyone’s probably judging me.” “They’re looking at me. Do I have something in my teeth?” “I’m going to say I feel sick so I don’t have to go to this meeting.” Everyone has likely had the occasional unwanted, anxious thought in a social situation. When the anxiety these thoughts bring begins to affect your well-being and quality of life, things get more serious. Chronic anxiety in social situations could be symptomatic of OCD, social anxiety disorder, or both.

Social anxiety disorder, like OCD, is marked by excessive worry and anxiety, and both conditions can drive individuals to avoid situations involving their fears altogether. But that’s not all they have in common. Understanding the commonalities between OCD and social anxiety disorder, as well as the qualities unique to each condition, can help distinguish between them and guide you in seeking support for what you’re experiencing.

Understanding OCD and social anxiety disorder

OCD is characterized by the presence of intrusive thoughts, images, or urges, known as obsessions, and compulsions, physical or mental actions done in an attempt to alleviate the distress and anxiety brought on by an obsession. Social anxiety disorder involves chronic and intense fears surrounding social interactions and situations. While the two conditions can be closely related in many ways (so closely that OCD is often misdiagnosed as an anxiety disorder), examining their characteristics can shed light on several key differences.

Fears vs. obsessions: Both OCD and social anxiety disorder can include fears of social rejection or being thought of in a negative light that may lead to physical symptoms. Obsessions surrounding social rejection aren’t uncommon among people with OCD. So what distinguishes a fear from an obsession? Obsessions are often less plausible and may be ego-dystonic, or in conflict with a person’s values. Where someone with social anxiety may wonder, “Am I being judged?” or “Are they looking at me,” someone with OCD may wonder, “What if I’m coming across as creepy or weird?” or “What if I do or say something inappropriate?”

Responding to triggers: The content of thoughts related to social anxiety disorder is often extremely similar to thoughts related to OCD. The primary difference seems to lie in the triggers of these thoughts and how they’re responded to. Someone with OCD may have tendencies to ruminate and obsess over aspects of both recent events and events from years past. There may be no evidence of the person having acted the way they think they did, and their imagined behaviors may even contradict their personal beliefs, but unlike fears based in social anxiety disorder, responding to OCD-related fears with logic won’t be helpful in easing the anxiety a person feels.

Avoidance behaviors: These conditions can also both involve significant avoidance behaviors, although for different reasons. With OCD, avoidance is often a compulsion, or an action triggered by a need to avoid perceived threats or feared possibilities. With social anxiety disorder, on the other hand, avoidance is usually a safety-seeking behavior done in response to specific triggers that provoke anxiety, often social situations. In both cases, however, the avoidance presents the same problem: it only serves to strengthen the cycle of anxiety in the long run.

Compulsions unique to OCD: In addition to avoidance, OCD can make individuals engage in other physical or mental compulsions in an attempt to alleviate their anxiety, whereas social anxiety disorder is unlikely to involve these actions. The following are few examples of compulsions related to social interactions that people with OCD may engage in:

  • Asking others for reassurance: “Was there anything offensive about what I said during that conversation? There wasn’t, right?”
  • Mentally reviewing their behavior to reassure themselves: “I must have said something inappropriate at that party. To make sure I didn’t offend anyone, I’m going to review every word I said and analyze how people reacted.”
  • Overthinking, or ruminating on social interactions: “I can’t believe I did that. They probably think I’m such a creep.”
  • Assuming how others feel based on their body language or tone of voice: “She didn’t say anything when I walked in. She must be mad at me.”
  • Imposing rules and restrictions on their social interactions: “If I say an odd number of words, something bad will happen. To avoid this, I’m going to carefully count my words and ensure they’re always even.”

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The short answer? Maybe. Research suggests that there could be shared genetic and environmental factors at work in cases involving a co-occurrence of OCD and social anxiety disorder. In both conditions, studies indicate that a family history of OCD or social anxiety disorder can be a precursor for the development of either condition. Childhood stress and trauma can also increase the risk of developing these conditions. These shared risk factors may indicate an overlap in the etiology, or manner of causation, of OCD and social anxiety disorder.

What does social anxiety in OCD look like?

Even years after an event or interaction has taken place, people with OCD may still question if they have done something wrong or offended someone. A good example of this is the following: 

Donna is, by most accounts, a highly successful doctor. She is respected and admired by her friends, family, and colleagues. Recently, though, she began to have thoughts about something that happened over ten years ago. On one hand, she knows this is illogical. As she tells the story, years ago, she was an active social media user. She posted, like many people, photos of her life and travels—nothing too serious or controversial. Donna has always been mindful and conscientious about how her opinions could potentially offend others and recently, the idea of “cancel culture” has begun to weigh on her. She remembers a time when she posed in some photos at a cultural event in a stereotypical manner. At the time, it didn’t feel offensive to her, but now she feels horrible about it. It feels like she was culturally appropriating and now she thinks that anyone who has seen that post thinks less of her. She has become consumed with guilt and avoids anyone who she fears may have seen it. 

This fear of having said or done something offensive can be devastating. This experience isn’t all that different from those of people who suffer from social anxiety disorder.

What does social anxiety disorder look like?

In social anxiety disorder, these things can also be true. The thoughts here are triggered by social interaction or as a result of a situation. The following example illustrates what social anxiety disorder can look like:

Manny has been invited to a work party to celebrate his promotion. It is a low-key event at a restaurant and there will be several of his coworkers there. Normally, Manny wouldn’t attend after-work events, as they aren’t really his scene, but this time, he feels he has to go because the event is in his honor. Ever since he was invited last week, he’s felt the anticipatory anxiety building and building. On more than one occasion, he has dreamt up possible excuses that could allow him to get out of attending the event. Thoughts swirl through his brain about what he will say, and who will ask what, and he replays them over and over again. All he wants to do is avoid the party. 

How to manage OCD and social anxiety disorder

Many people deal with both social anxiety disorder and OCD, but it’s also possible for someone with OCD to experience obsessions about social interactions without qualifying for a diagnosis of social anxiety disorder. While the two conditions will be diagnosed separately based on the diagnostic criteria for each condition, they can usually both be treated at the same time.

If you are struggling with both of these disorders, it’s important to seek a qualified professional who is well-versed in treating OCD and social anxiety disorder simultaneously. Treatment for each condition may have many similarities, but will likely have a few distinct differences.

At the crux of treatment will be the addressing of avoidance behaviors, because anxiety grows when we feed it. In other words, the more we do what OCD says or what anxiety tells us, the more we start to believe that we cannot tolerate the feelings that we try so hard to avoid. We can never learn that we are capable if we’re constantly avoiding our feelings or doing something to ease them. In order to live a life in recovery from OCD and social anxiety disorder, we must learn that we cannot avoid the situations that bring about difficult feelings and thoughts. 

ERP can help with OCD symptoms and social anxiety

Exposure and response prevention (ERP) therapy can help us learn that. Exposures, a key component of ERP, can be particularly helpful for both conditions because alleviating our worries tends to require putting ourselves in the situations that cause them. Through the process of gradually exposing ourselves to discomfort, we learn that we can tolerate it. Over time, this decreases the amount of distress and anxiety that we feel.

ERP is most effective under the guidance of a therapist who specializes in it. At NOCD, all of our therapists specialize in OCD and receive ERP-specific training from some of the top OCD experts and researchers in the world. When you work with an NOCD Therapist, they’ll provide you with a personalized treatment plan designed to meet your unique needs, teach you the skills to begin your OCD recovery journey, and support you every step of the way.

To prevent cost from being a barrier to accessing treatment, we offer affordable options and partner with many insurance plans. You can learn more about starting OCD treatment with an NOCD therapist by scheduling a free call with our team.

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