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Editorials

Social anxiety disorder

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7414.515 (Published 04 September 2003) Cite this as: BMJ 2003;327:515

Social Anxiety Misdiagnosed as Asperger's Syndrome (AS)

EDITOR - Schneier rightly draws attention to the importance of
diagnosis and treatment of social anxiety, a treatable condition. As a
Consultant in Child Psychiarty and Learning Disabilities with a special
interest in Autism, I have encountered a number of children and adults
with a diagnosis of Asperger's Syndrome who in my opinion have an anxiety
disorder, like school refusal or social phobia. As Asperger's Syndrome is
a life long, basically untreatable condition, it seems extremely important
to distinguish it from social anxiety which has an overall much better
prognosis.

Reasons for the over diagnosis of Asperger's Syndrome may be several,
for instance, easier access to educational support with such a diagnosis;
relief of guilt feelings for some people to have such a dignosis; the
increasing media publicity; the misconception that there is a mild variety
to Aspergers' Syndrome (which would be similiar to claims of a mild variety
of schizophrenia); but mostly to in my view an unacceptable widening or
faulty application of the diagnostic criteria. Autistic Spectrum Disorder
as described by Lorna Wing, is clearly described as a contiuum along the
intellectual ability scale, but still requires impairments of social and
communication skills and a narrowing of interests. The ICD10 criteria are
also quite clear, and if applied properly should diagnose the majority of
cases. If there is doubt, more prolonged observation and a careful
developmental history will confirm the diagnosis.

Some patients with chronic social anxiety may appear to have similar
impairments, but usually do not have the early history. They are able to
communicate quite normally in familiar situations, and have a normal
understanding of other people's feelings and social situations although
lacking social skills. They are appropriately sensitive peole who should
not be placed together with people with Asperger's Syndrome who lack
empathy and insight.

Competing interests:  
None declared

Competing interests: No competing interests

08 September 2003
Gerta Barton
Consultant in Child Psychiatry and Learning Disabilities
Manor House, Bierton Road, Aylesbury, Bucks HP20 1EG