Feature

Obsessive-Compulsive Disorder (OCD)

Social Anxiety Disorder

Core Symptoms

- Obsessions: Persistent, intrusive thoughts/impulses causing marked anxiety

- Compulsions: Repetitive acts/rituals performed to reduce anxiety

- Fear of social scrutiny or negative evaluation in social/performance situations

- Avoidance of social events or enduring with intense distress

Insight

Typically has insight that obsessions/compulsions are excessive or irrational (unlike OCPD)

Usually recognises the anxiety as excessive or out of proportion to the actual threat

Subtypes/Presentation

- Often comorbid with depression/anxiety

- Obsessions can be contamination, symmetry, harm thoughts

- Compulsions commonly include checking, washing, counting

- Generalised: Anxiety across most social interactions

- Non-Generalised: Anxiety limited to specific situations (e.g., public speaking)

Condition

First-Line Therapy

Pharmacotherapy

Additional Notes

OCD

- CBT with Exposure and Response Prevention

- SSRIs (often higher doses, at least 6–12 months)

- Clomipramine for SSRI-resistant or severe cases

Monitor for comorbid depression/anxiety. Combination of therapy + medication often most effective.

Social Anxiety Disorder(Generalised)

- CBT (exposure-based)

- SSRIs (e.g., sertraline, escitalopram)

- Venlafaxine if SSRIs fail

Evaluate for severity and functional impairment. Gradual exposure to feared social settings is key.

Social Anxiety Disorder (Non-Generalised)

- Specific situational therapy

- Propranolol 10–40 mg 30–60 mins before anxiety-provoking event

- Diazepam PRN before event (if no contraindications)

Focus on situational triggers (e.g., public speaking). Propranolol helps with physical symptoms (tremor, palpitations); avoid in asthma, PVD, bradycardia.