Autism or Social Anxiety in Adults: Where They Overlap and How They Differ

Why the two are easy to confuse

Many adults arrive at this question after years of finding social life harder than it seems to be for other people. Small talk feels like work, parties are something to recover from, and there is a familiar urge to leave early or not go at all.

Both autism and social anxiety can produce that picture. The National Institute of Mental Health (NIMH) notes that diagnosing autism in adults is often more difficult than in children, partly because some autism signs can overlap with those of an anxiety disorder. A brief review in Future Neurology makes the same point from the other side: social anxiety, which centers on fear of negative evaluation and avoidance of social situations, may be mistaken for the social communication differences of autism.

Where they can look alike

On the surface, several experiences show up in descriptions of both. Here is what that shared ground can look like day to day.

• Eye contact: NIMH lists finding it difficult to make eye contact among signs of social anxiety disorder, and making little or inconsistent eye contact among behaviors common in autism
• Avoidance: NIMH notes that people with social anxiety may avoid places or events that cause distress, and this pulling back can look like the social differences of autism from the outside
• Conversation: NIMH describes difficulty with the back and forth of conversation in autism, and difficulty talking to people in social situations, even when wanting to, in social anxiety
• Worry: the Centers for Disease Control and Prevention (CDC) lists anxiety, stress or excessive worry among characteristics many autistic people have

What tends to differ

The useful question is often why social situations are hard, not only whether they are. A few differences tend to come up.

The reason behind the avoidance. NIMH describes social anxiety as fear in situations where a person may be scrutinized, evaluated or judged, along with worry about being humiliated or rejected. People may worry about an event for weeks beforehand and go over their performance afterward, looking for flaws. In autism, the difficulty is described differently: understanding unspoken social cues, adjusting to different social situations, or predicting what other people will do.

Sensory experience. NIMH notes that autistic people often have sensory differences, being more or less sensitive than others to light, sound, clothing or temperature. A loud restaurant may be hard because of the noise itself, not because of who might be watching. Sensory differences are not part of how social anxiety disorder is described.

Routines and interests. Autism also involves restricted interests and repetitive behaviors, such as a lasting, intense interest in specific topics, or becoming upset by small changes in routine. These are not part of social anxiety.

When it started. NIMH explains that autism signs generally appear in the first two years of life, even if they are recognized much later. Social anxiety disorder usually starts in childhood or adolescence, and NIMH notes its symptoms may come and go and are often worse during times of stress or change.

When it is both

This is not always an either-or question. A systematic review in Clinical Child and Family Psychology Review notes that many autistic people experience anxiety in social situations, and that social anxiety disorder often occurs alongside autism.

The same review found that being bullied or mistreated by peers was linked with more social anxiety in autistic people. That makes sense: years of being misunderstood can teach anyone to expect judgment. The authors also note that camouflaging, meaning hiding autistic traits to fit in, can overlap with the self-monitoring that keeps social anxiety going, which is one reason the two can be hard to separate.

If parts of this sound familiar, these can be signs worth talking through with a professional. They cannot tell you which explanation, if either, fits you. Our free autism signs checklist can help you decide whether to talk to someone. It is an informal checklist, not a screening test, it is not validated and it cannot diagnose.

How an evaluation sorts it out

According to NIMH, an adult autism evaluation asks about social interaction and communication, sensory issues, repetitive behaviors and restricted interests. It may include a conversation with family members about early development, which can help ensure an accurate diagnosis. For social anxiety, NIMH notes that a provider asks when symptoms began, how long they have lasted and how they affect daily life.

A careful evaluation keeps both possibilities open. It looks at your childhood, at the present, and at the reasons behind what is hard. It may find autism, social anxiety, both or neither, and nobody can tell you the result ahead of time.

If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services.

How we can help

Locascio Wellness offers an adult autism evaluation carried out entirely by secure video. Evaluations are offered only to people physically located in Pennsylvania, West Virginia or Arizona. An evaluation usually involves an intake appointment, then one or two sessions, then a written report, which at the moment is usually ready about a month after the first evaluation appointment. The findings are explained in plain language, with time for your questions.

Evaluations are private-pay and are not billed to insurance, with a sliding scale available. See what evaluations cost. The first step is the short evaluation request form or a free 15-minute consultation on our booking page.

Therapy is a separate service, and you do not need a diagnosis to start. For support with worry, avoidance and confidence in social situations, therapists on our team offer anxiety therapy by secure video, with a therapist licensed where you live. Whatever the explanation turns out to be, social life can become more manageable, and many people find it easier once they understand why it has been hard.