Differentials
Phobias
SIGNS / SYMPTOMS
Excessive or unrealistic fear of specific objects or situations, rather than fears of being negatively evaluated by others or rejected. Anxiety is cued by anticipated or actual exposure to the phobic stimuli.
INVESTIGATIONS
Structured clinical interview.
Panic disorder
SIGNS / SYMPTOMS
High anticipatory anxiety across various social situations.
Recurrent, unexpected panic attacks in the absence of phobic cues.
Patients may interpret their intense physical symptoms as threatening or dangerous. The fear of social consequences can be common in panic disorder. However, the focus of the fear is on the experience of panic attacks as opposed to being negatively evaluated, criticised, or rejected by others.
INVESTIGATIONS
Structured clinical interview.
Agoraphobia
SIGNS / SYMPTOMS
Fear of social situations in which escape is perceived to be difficult, or help might not be available if they become incapacitated by their anxiety. The focus of the fear in agoraphobia is more about experiencing intense anxiety when leaving a safe place and potentially being trapped as opposed to fearing rejection or scrutiny from others.
INVESTIGATIONS
Structured clinical interview.
Generalised anxiety disorder
SIGNS / SYMPTOMS
Anxiety is more diffuse in nature, characterised by pervasive worry across several domains, such as health, relationships, finances, and job/school. Anxiety is not specifically cued by social situations or fears of negative evaluation.
INVESTIGATIONS
Structured clinical interview.
Post-traumatic stress disorder
SIGNS / SYMPTOMS
Onset follows a potentially life-threatening stressor. Additional differential symptoms include emotional numbing and re-experiencing the trauma.
INVESTIGATIONS
Structured clinical interview.
Separation anxiety disorder
SIGNS / SYMPTOMS
Anxiety sensations are cued by perceived and actual separation from family members, rather than fears of being negatively evaluated or criticised by others.
INVESTIGATIONS
Structured clinical interview.
Avoidant personality disorder (APD)
SIGNS / SYMPTOMS
Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. APD may also be distinguished by non-social avoidance, including avoidance of novel situations and positive affect.[43] About 36% of social anxiety cases are comorbid with APD, leading some authors to argue that APD is a more extreme and severe version of generalised social anxiety disorder.[44][45]
INVESTIGATIONS
Structured clinical interview.
Social (pragmatic) communication disorder
SIGNS / SYMPTOMS
Persistent difficulties dating from the developmental period, inappropriate verbal and non-verbal communication that is not explained by low cognitive ability. May have difficulties understanding social relationships, including inappropriate responses during social interactions.
INVESTIGATIONS
Structured clinical interview.
Substance misuse
SIGNS / SYMPTOMS
Panic and anxiety sensations are caused by the direct physiological effects of substance misuse or as a result of substance withdrawal.
INVESTIGATIONS
Urine and blood testing for illicit substances.
Hyperthyroidism
SIGNS / SYMPTOMS
Patients may have unexplained weight loss, palpitations, tremor, muscle weakness, or unexplained protrusion of the eyes.
INVESTIGATIONS
Serum thyroid-stimulating hormone is low in hyperthyroidism.
Alcohol-use disorder
SIGNS / SYMPTOMS
Alcohol-induced symptoms show onset with alcohol use and offset after the alcohol has been metabolised.
INVESTIGATIONS
Urine and blood alcohol testing.
Body dysmorphic disorder
SIGNS / SYMPTOMS
People with body dysmorphic disorder fear being negatively evaluated because they look unattractive, abnormal, or ugly, whereas people with social anxiety disorder fear being negatively evaluated by others because of how they act or what they say.
INVESTIGATIONS
Structured clinical interview.
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