People with social anxiety (SAD) and people with antisocial personality disorder (ASPD) are usually considered complete opposites. Those unfamiliar with the term ASPD may be more familiar with its outdated names: psychopathy and sociopathy. When you think of someone with social anxiety, a “psychopath” is probably the last thing you’d imagine. More likely, you imagine someone who is shy and passive, definitely not egotistical or reckless. Surprisingly however, research suggests that some SAD patients (21% of a large community sample) actually display symptoms of ASPD, complete with more risk-prone behaviours such as aggression and/or problematic substance use. 

To explore this interesting group of atypical SAD patients further, Galbraith et al explored the relationship between ASPD and SAD in their 2013 study. The study used self report surveys from civilians 18 years of age or older living in households or group living quarters. They used a sample of 1773 participants with SAD and no ASPD, 1212 with ASPD and no SAD, and 210 with both SAD and ASPD (total N = 3195). It is important to note that black people, hispanic people, and young adults (aged 18-24) were over-represented in this study, which limits its results to this particular sample group.

SAD–ASPD was related to more impairment and psychiatric comorbidity than only having SAD or ASPD. These patients had lower perceived health status, education level, individual income and several other indicators of healthy social and emotional functioning compared to having only one of the two illnesses. Interestingly, the SAD–ASPD group was also more likely to seek treatment for their SAD symptoms. More concerningly, they were also more likely to drink before/during antisocial acts than the SAD only group. Having SAD alongside ASPD (and vice versa) did not seem to provide any “protective benefits” for those living with both mental illnesses at the same time. Overall, SAD and ASPD were shown to be two separate but correlated disorders in this study.

Highlighting the existence of a seemingly contradictory combination of SAD and ASPD alongside the greater magnitude of challenges faced by those with SAD or ASPD alone has important clinical implications. These results encourage clinicians to look out for ASPD symptoms in SAD patients, instead of assuming their conduct is opposite to that of people with ASPD (and vise versa). This group of patients should then receive more individualised care for their increased psychiatric comorbidity.

Graphic: Anna Do

Source:

Galbraith, Todd, et al. “Comorbidity of Social Anxiety Disorder and Antisocial Personality Disorder in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).” Journal of Anxiety Disorders, vol. 28, no. 1, 2013, pp. 57–66, https://doi.org/10.1016/j.janxdis.2013.11.009.