The first study of friends' perceptions suggest they know something's off with their pals but like them just the same.

Social anxiety disorder (SAD) can be devastating. In the worst cases, sufferers of the illness struggle with basic tasks, like signing a check in front of another person, and the majority routinely report less satisfying friendships and other relationships. A new study, however, suggests people with SAD might be underestimating how much others like them: While friends perceived the relationships somewhat differently, they reported higher levels of friendship intimacy and satisfaction than their SAD friends.

Researchers have known for a while that social anxiety disorder leads people to perceive their situations more negatively than others, specifically with regard to friendships. However, previous studies have generally relied on patients' own impressions of their friendships, and typically those impressions concern friendships in general rather than any specific relationship in particular. As a result, scientists who study SAD don't really know how bad patients' friendships are—maybe the disease really does harm friendships, or maybe it just harms one's perceptions of those friendships.

Compared with the control group's friends, friends of SAD sufferers perceived their friends to be less dominant in the relationship and also less well adjusted.

Sorting that out requires something no one seems to have done before: finding friends of people with SAD and asking them how they felt about their chums. That's precisely what Thomas Rodebaugh and a team at Washington University in St. Louis did. They asked 77 people diagnosed with generalized social anxiety disorder—meaning they experienced social anxiety in a number of different situations—and a control group of 63 people without SAD symptoms to bring a pal into the lab. There, both the primary participants and their friends filled out surveys concerning how much they liked each other, how close they felt to each other, and how satisfying they felt the friendship was.

The survey results indicated that people with SAD viewed their relationships more pessimistically compared with people in the control group. And, as Rodebaugh and team suspected they might, SAD sufferers reported feeling less close to their friends than their friends did to them. People with SAD also reported liking their friends less than the other way around and being slightly less satisfied with the relationship than their friends.

That's not to say that friends of those with SAD couldn't tell the difference. Compared with the control group's friends, friends of SAD sufferers perceived their friends to be less dominant in the relationship and also less well adjusted.

"We found clear evidence that SAD is related to self-report of impairment in specific friendships, consistent with the hypothesis that SAD is a fundamentally interpersonal disorder," the authors write in the Journal of Abnormal Psychology. "However, we found little evidence that friends experienced the same level of friendship impairment, despite them seeing differences" between those with and without social anxiety disorder. That, the authors explain, provides support for treatments that focus on helping people with the disorder see that they'll come across better than they think they will.