Expert: Trey McGowan - 8/11/2010

Question
Hi, I have a question regarding the differences between social anxiety, depression and aspergers. I'm 27 year old, and from an early age I can remember always feeling ill-at-ease and out of place when put in social situations. This worsened as i hit my teens and I eventually turned to alcohol and drugs to help me relax around people, sometimes getting high before classes, etc. I underachieved at school (even before I started taking drugs), suffered from undiagnosed depression (finally diagnosed in early 20's) and self-harmed. I no longer drink/do drugs, but find when I am talked into socialising (generally against my better wishes), i tend to drink to excess, just to have something to do with my hands and something to focus on other than the feeling of awkwardness of being there and trying to keep track of conversations. However, I'm often a fairly good communicator when it comes to one-on-one situations or with people I've had the chance to get to know well and feel comfortable with. Unfortuantely I never verbly communicate nearly as well as I can when I've had time to think through what I'm saying fully, and type it.
Social issues aside, I also tend to be obsessive about various topics which interchange. At school, I was obsessed with music to the point where nothing else mattered (both listening to and playing), and this exclusion of everything else has been a hallmark of my obsessions since. This contributed to my lack of academic success at that stage, despite potential. I was convinced that I was going to be a musician who would die before the age of 30 (a figure seemingly arbitrarily chosen). My interest in this eventually waned, and I became obsessed with being a rich business person, doing nothing but researching how to achieve this, but not actually doing anything. Next my obsession was in learning biology, then going to Australia, and so on, to the exclusion of anything else. My current obsessions are exercise and studying (finally going to university) and I'm determined to stick to these.
I currently have a girlfriend who has aspergers, diagnosed while she was a child. There seems to be little difference between the kinds of symptoms she exhibits and mine, especially when we compare our times at school, depression etc. The difference was that I had more 'friends' because I self-medicated and attempted to socialise, whereas she, convinced she had an incurable problem therefore thought it pointless to try, did not. These days, if anything, she's perhaps slightly more social than I am, or at least more willing to try, whereas I'm very content in my own company and have no desire to make friends or meet others, nor any desire to drink or take drugs. Although, like I said when I do socialise, I drink to excess, although this is probably a separate matter.
I suppose my question is: has my girlfriend been misdiagnosed, and did she just suffer from social anxiety and depression like I was diagnosed with? Or was I misdiagnosed as an adult when perhaps I have aspergers? It may be  useful to note that aspergers had previously diagnosed in my girlfriends family, whereas it has not been in mine, despite similar personality traits on both sides. Thanks.

Answer
Hi there, Lee!

As I am not a doctor, nor a psychologist, I unfortunately can't tell you whether there was misdiagnosis on either side. Even in an adult, diagnosis takes some observation, as well as a number of questions which I can't ask.

I can, however, tell you the answer to the crux of your question: the difference between the two is that Asperger's is a developmental Disorder, whereas social anxiety is often more a symptom than the primary disorder itself. While Asperger's can indeed cause social anxiety, there are a number of other things which can cause it as well: natural shyness, depression, anxiety, low self image, and bullying, to name just a few. In addition, a primary diagnosis of social anxiety can be symptomized by the above. In effect, it is a difference between how pervasive they are as to whether social anxiety is the primary diagnosis or a secondary one.

Asperger's Syndrome brings with it a host of other symptoms, which social anxiety may not. It is these additional symptoms that a diagnostician must look for in order to make a full and official diagnosis. Things like intelligence, learning skills, childhood development, and physical symptoms will need to be looked at. Therefore, if you feel you have been misdiagnosed, I suggest that you speak with your doctor and bring the issue up with them.

Questions? Comments? Feedback? Follow-ups? Feel free to send!

Trey