What is it about?
Some people with Social Anxiety Disorder don’t look “shy.” In therapy or treatment settings, they may come across as aloof, sarcastic, emotionally flat, guarded, or even oppositional — sometimes raising concerns about antisocial traits. This paper explains how those same behaviors can be better understood as protective strategies in response to social threat and shame (for example, trying to avoid exposure, regain a sense of control, or preserve dignity). Using the case of “Marko,” the article offers a practical, function-focused way to tell the difference between true antisocial pathology and a shame-driven, defensive form of social anxiety, including a clinician-friendly table that reframes look-alike behaviors by what they are doing for the person.
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Why is it important?
This distinction matters because mislabeling a defensive, shame-based presentation as “antisocial” can increase stigma, trigger mistrust, and derail treatment. When clinicians interpret guardedness or irritability as character pathology rather than self-protection, the alliance can rupture and interventions may become overly confrontational or disengaged — creating iatrogenic harm. A function-focused lens supports more accurate differential diagnosis and more effective treatment planning: maintaining curiosity, reducing blame, addressing shame and emotion regulation (including suppressed anger), pacing exposure appropriately, and managing strong therapist reactions that these presentations can evoke. The goal is better outcomes through better understanding.
Perspectives
I wrote this article because treating a client like “Marko” made me rethink how social anxiety can look in real clinical work. His presentation didn’t fit the stereotypical image of social anxiety, and working with him pushed me to look past the surface behaviors and focus on what they were doing for him—especially in moments of shame, threat, and feeling exposed. I’ve been interested in social anxiety subtypes for a long time, and I’ve seen similar “hard-to-read” presentations in other patients, but Marko’s case was the most striking. This paper is my attempt to translate that learning into a practical, non-stigmatizing way for clinicians to differentiate defensive, shame-driven social anxiety from true antisocial pathology and to respond in a way that protects the alliance and improves treatment direction.
Martin Stork
Universidade do Minho
Read the Original
This page is a summary of: Mean to an end: Differentiating externalizing presentations of social anxiety from antisocial personality disorder., Practice Innovations, February 2026, American Psychological Association (APA),
DOI: 10.1037/pri0000321.
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