Social anxiety disorder is characterised by an excessive fear of social and performance situations where the individual is afraid of being embarrassed or negatively evaluated by others.
One of the most common and impairing mental disorders with a high risk for comorbid anxiety, depressive, and substance-use disorders; it may be associated with severe impairments in daily functioning, including reduced quality of life, difficulty forming relationships, and impaired school and work performance.
Assessment is based on self-reporting, clinical interview, and behavioural observation.
Selective serotonin-reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, and cognitive behavioural therapy are considered the first-line treatments.
Long-term clinical management and monitoring are typically required, as patients are prone to relapse following discontinuation of acute treatment.
The condition involves an excessive fear of social or performance situations. The individual will often fear being embarrassed, or worry about being negatively evaluated by others. Anticipatory anxiety and situational avoidance are common, and the individual may endure social situations with a high level of discomfort. The scope of the anxiety may be focused on specific types of social situations or generalised to almost any social encounter.
History and exam
Key diagnostic factors
- presence of risk factors
- anticipatory anxiety and worry
- muscle tension
Other diagnostic factors
- post-event processing
- attentional biases
- social skills deficits
- crying, tantrums, or 'freezing'
- selective mutism
- psychiatric comorbidity (e.g., anxiety, mood, and substance-use disorders)
- temperamental factors
- parenting style
- psychological disorder
- life stressors
- environmental factors
1st investigations to order
- clinical diagnosis
Investigations to consider
- blood glucose
- serum thyroid-stimulating hormone
- toxicology screen (urine and blood)
adults: no comorbidity
children and adolescents
- Panic disorder
- Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)
- Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders
Anxiety: what is it?
Anxiety: what treatments work?More Patient leaflets
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