Panic and Social Anxiety Disorders

By: Michael May, LCPC, DBT Therapist

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Anxiety disorders are the most commonly diagnosed mental health problems, reportedly affecting nearly 40% of the adult population, and nearly a quarter of the child/adolescent population in the U.S. Despite this prevalence, only approximately a third of those struggling with these disorders actually receive treatment. 

Two of the more commonly diagnosed anxiety disorders are Social Anxiety Disorder and Panic Disorder. Although these two disorders represent distinct diagnostic categories, subtleties in presentation can sometimes create difficulties for effective diagnosis and treatment. 

Social Anxiety Disorder is a disorder characterized by an individual’s subjective experience of excessive anxiety in response to social situations. Often, this excessive anxiety is typically bolstered by crippling levels of self-consciousness and/or excessive concerns that they will be judged or ridiculed by others. Panic Disorder is an anxiety disorder that is characterized subjectively by excessive preoccupations with potential future occurrences of panic attacks. Objectively, family members and healthcare professionals may observe these individuals begin to avoid public situations. While panic attacks are the predominant characteristic of Panic Disorder, panic attacks can (and often do) occur within the context of many anxiety disorders. 

Accurate diagnosis can be accomplished by ascertaining whether the individual’s anxiety appears to be prompted by ongoing preoccupations about the occurrence of future panic attacks (Panic Disorder) or whether the anxiety appears to be prompted primarily by concerns relating to perceived social scrutiny or judgments (Social Anxiety Disorder). While an individual with Social Anxiety Disorder may experience panic attacks, they are far less prominent.

A number of factors exist that can complicate effective diagnosis and treatment of these disorders. It is important to understand that, like many other mental health diagnoses, these two disorders can carry unhelpful stigmatizing connotations. For example, individuals who struggle with anxiety within social contexts may avoid openness about these difficulties due to their belief that they will be judged as “socially inept.” Individuals who are struggling with Panic Disorder may present at Emergency Departments believing that what they are experiencing is a heart attack. Unfortunately, when they are informed that what they actually are experiencing is a panic attack, these individuals often experience high levels of shame and invalidation. 

It is imperative that conversations with patients regarding these matters be had in light of these stigmas. Engagement should be characterized by validation and genuine concern to facilitate a more open dialogue, and therefore, a more accurate assessment.