PTSD Symptoms and Diagnosis The Relationship Between PTSD and Social Anxiety Disorder Guilt and Shame in PTSD Patients May Lead to SAD By Matthew Tull, PhD Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on May 03, 2020 Reviewed Verywell Mind articles are reviewed by mental health professionals. Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by David Susman, PhD Reviewed by David Susman, PhD David Susman, PhD is a licensed clinical psychologist with experience providing treatment to individuals with mental illness and substance use concerns. Learn about our Review Board Print Felbert + Eickenberg / STOCK4B / Getty Images Trending Videos Close this video player PTSD and social anxiety disorder (SAD) commonly co-occur, and there are a number of possible reasons why people with PTSD, as compared to those without the diagnosis, may be more likely to develop fears of social situations. What Is Social Anxiety Disorder? SAD (sometimes also called "social phobia") is considered an anxiety disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, to be diagnosed with SAD, you need to have a frequent and unending fear of social situations or situations where you are expected to perform in some way. In these situations, you come into contact with unfamiliar people or experience the possibility of scrutiny by others. You may also experience fear in appearing anxious or acting out in a way that will bring about embarrassment or humiliation. Moreover, your upcoming contact with a feared situation almost always causes anxiety, maybe even in the form of a panic attack. You recognize that the fear you experience in response to social situations is unreasonable or greater than it should be, and you avoid situations you fear. If you have to be in those situations, you do so with high levels of anxiety and distress. These symptoms interfere considerably with many aspects of your life (work, relationships, etc.) and are not due to medication, a substance (i.e., alcohol), a medical condition or other disorder. Symptoms of Social Anxiety Disorder Rates of SAD Among People With PTSD Studies vary in the rates of SAD found along with PTSD, ranging from 14% to 46%. This percentage is variable because it depends on the group of people a study is examining. For example, research shows that populations with the highest rate of both SAD and PTSD are veterans with PTSD and people who seek out treatment for PTSD. Why Are PTSD and SAD Related? A number of theories have been proposed to explain why PTSD and SAD are related. First, the symptoms of PTSD may make a person feel different, as though they can't relate or connect with others. A person with PTSD may have difficulties communicating or interacting with others for fear of coming into contact with trauma-related reminders. All of this may feed the development of SAD. In addition, many people with PTSD feel high levels of shame, guilt, and self-blame, and these feelings may lead to SAD. Finally, there is evidence that SAD among people with PTSD stems from depression. People with PTSD often experience depression, which may lead to social withdrawal, isolation, and a lack of motivation that could contribute to the development of SAD. Overall, research suggests that the link between PTSD and SAD is complex, stemming from multiple factors including a person's genes, history of trauma, and psychological vulnerabilities, like fear of being negatively evaluated by others. Further studies will hopefully help experts tease apart the precise relationship between PTSD and SAD. Getting Help If you have PTSD and SAD, it is important to seek help. Fortunately, there are many effective treatments for SAD. In addition, there are treatments for PTSD that have been shown to be successful in reducing symptoms. By getting treatment for PTSD, you may also notice that your symptoms of SAD are lower as well. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. McMillan KA, Sareen J, Asmundson GJ. Social Anxiety Disorder Is Associated With PTSD Symptom Presentation: An Exploratory Study Within A Nationally Representative Sample. J Trauma Stress. 2014;27(5):602-609. doi:10.1002/jts.21952 Kashdan TB, Julian T, Merritt K, Uswatte G. Social anxiety and posttraumatic stress in combat veterans: relations to well-being and character strengths. Behav Res Ther. 2006;44(4):561-583. doi:10.1016/j.brat.2005.03.010 Charuvastra A, Cloitre M. Social Bonds and Posttraumatic Stress Disorder. Annu Rev Psychol. 2008;59:301-328. doi:10.1146/annurev.psych.58.110405.085650 Additional Reading Collimore KC, Carleton RN, Hofmann SG, Asmundson GJ. Posttraumatic Stress and Social Anxiety: the Interaction of Traumatic Events and Interpersonal Fears. Depress Anxiety. 2010 Nov;27(11):1017-26. By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Helpful Report an Error Other Submit