Christy’s Story
Christy is a 32-year-old receptionist at a real estate office. One day while alone at the office, she started to feel very lightheaded, dizzy and unable to catch her breath. The feeling gradually got worse, to the point where she felt like she might be having a heart attack. Eventually, the feeling subsided but Christy quickly made a trip to the hospital emergency room fearing the worst –- that something was wrong with her heart or that she had a terrible illness.
The doctor couldn’t find any physical or medical cause for Christy’s symptoms. This only made Christy feel worse because she was sure that there was something terribly wrong. Since then, Christy has had many similar episodes or “panic attacks” in different situations without warning. As a result, she has started to avoid going places where it might be difficult to escape if she were to have an attack.
John’s story
John has been a stock clerk at a grocery store for 5 years. When he was in high school, John suffered from severe anxiety when faced with situations where he was the center of attention or asked to perform. During these “anxiety attacks,” his heart would beat fast, his hands would shake, his face would turn bright red, and he would have trouble catching his breath. John was so sure that his classmates were making fun of him that he eventually left school without a diploma.
John now works the night shift at the grocery store so that he can avoid having to speak to customers. He feels at ease working alone in the store at night and only feels anxious when others are around. He spends most of his weekends alone. Although he desperately wants a girlfriend, he is too afraid to have conversations with the women he meets.
The stories of Christy and John illustrate the differences between panic disorder and social anxiety disorder (SAD). What are the main differences? Many areas are useful to consider when distinguishing between panic disorder and SAD:
Types of Symptoms
- People with panic disorder may feel dizzy, lightheaded and faint, or as if they are having a heart attack or about to lose control or go crazy.
- Although people with SAD may also experience a racing heart or shortness of breath, these symptoms are usually accompanied by other symptoms such as shaking hands, blushing or sweating.
Duration of Symptoms
- People with panic disorder may feel bad for a long time (up to a day) after the attack.
- People with SAD tend to feel better once out of the anxiety-provoking situation.
Beliefs About the Cause of Symptoms
- People with panic disorder believe that there is a medical problem or disease responsible for their symptoms.
- People with SAD know that their anxiety is the result of fear triggered by social and performance situations.
Getting Help
- People with panic disorder will usually go to the hospital emergency room or doctor’s office after their first episode in search of a medical diagnosis.
- People with SAD tend not to seek help, and may not realize that they have a treatable mental illness.
Anxiety Triggers
- Panic attacks experienced by someone with panic disorder are unpredictable and happen in a variety of situations.
- People with SAD experience anxiety only in specific social and performance situations, or in anticipation of being in those situations.
Avoidance
- People with panic disorder may avoid going places for fear of having a panic attack and being unable to escape. These places are not limited to social situations and may include such things as elevators, bridges, buses or trains. If this fear becomes overwhelming and prevents them from leaving a “safe” area such as their home, they are said to also suffer with agoraphobia.
- People with SAD avoid situations that involve possible embarrassment or scrutiny by others. They may avoid careers or turn down promotions that involve social contact, or they may isolate themselves completely from social contact.
Role of a Companion
- People with panic disorder and agoraphobia usually prefer being with a trusted companion when in a feared situation.
- People with SAD may feel even more anxious being with another person in an anxiety-provoking situation.
Dual Diagnosis
Is it possible to be diagnosed with both panic disorder and SAD? If criteria are met for both disorders, then both diagnoses are appropriate. In those cases, one disorder usually develops later in life, such as someone with SAD who later goes on to develop panic attacks in non-social situations.
Treatment
In terms of treatment, many of the same medications used for treating SAD are also prescribed for panic disorder. However, therapy designed for social anxiety will not be effective in treating panic disorder, and the reverse is also true. Cognitive-behavioral therapy techniques are used in treating both disorders, however the focus for panic disorder is usually on thoughts about bodily sensations, while the focus for SAD is on being more realistic about the abilities of yourself and others.
In the end, a qualified mental healthcare professional will make a diagnosis and recommend treatment based on your particular symptoms. The best way to ensure that you receive proper diagnosis and appropriate treatment is to seek help from a professional with experience in treating anxiety disorders. If you are not sure where to start, your doctor will be able to refer you to a qualified professional.
Sources:
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author; 1994.
Hales RE, Yudofsky SC, eds. The American psychiatry publishing textbook of clinical psychiatry. Washington, DC: American Psychiatric; 2003.
