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Social anxiety disorder

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 7 Aug 2025
Last updated: 12 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of psychiatric comorbidity
  • positive family history of social anxiety
  • anticipatory anxiety and worry
  • tachycardia
  • hyperventilation
  • sweating
  • flushing
  • muscle tension
Full details

Other diagnostic factors

  • post-event processing
  • attentional biases
  • social skills deficits
  • crying, tantrums, or "freezing"
  • selective mutism
Full details

Risk factors

  • psychiatric comorbidity (e.g., anxiety, mood, and substance-use disorders)
  • genetic
  • temperamental factors
  • parenting style
  • psychological disorder
  • life stressors
  • environmental factors
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • blood glucose
  • serum thyroid-stimulating hormone
  • toxicology screen (urine and blood)
Full details

Treatment algorithm

ONGOING

adults: no comorbidity

adults: comorbidities

children and adolescents

Contributors

Authors

Craig N. Sawchuk, PhD
Craig N. Sawchuk

Professor

Department of Psychiatry and Psychology

Mayo Clinic

Rochester

MN

Disclosures

CNS declares that he has no competing interests.

Jason P. Veitengruber, MD
Jason P. Veitengruber

Associate Professor

Department of Psychiatry and Behavioral Sciences

University of Washington School of Medicine

Seattle

WA

Disclosures

JPV is an author of a reference cited in this topic.

Bunmi O. Olatunji, PhD
Bunmi O. Olatunji

Professor

Department of Psychological Sciences

Vanderbilt University

Nashville

TN

Disclosures

BOO declares that he has no competing interests.

Stacy Shaw Welch, PhD
Stacy Shaw Welch

Director

Anxiety and Stress Reduction Center of Seattle

University of Washington

Seattle

WA

Disclosures

SSW declares that she has no competing interests.

Peer reviewers

​Stefan G. Hofmann, PhD

Alexander von Humboldt Professor

Department of Psychology

Philipps University Marburg

Germany

Disclosures

SGH is an author of a number of references cited in this topic.

Fallon R. Goodman, PhD

Assistant Professor of Psychology

George Washington University

Washington

DC

Disclosures

FRG declares that she has no competing interests.

Richard P. Swinson, MD, FRCPC, FRCPsych

Emeritus Professor

Medical Director

Anxiety Treatment and Research Centre

McMaster University and St Joseph’s Hospital

Hamilton

Canada

Disclosures

RPS declares that he has no competing interests.

David Baldwin, MD

Professor of Psychiatry

University of Southampton

Southampton

UK

Disclosures

DB has acted as a consultant for and held research grants from Cephalon, Eli Lilly, GSK, Lundbeck, Organon, Pfizer, Pharmacia, Roche, and Wyeth and has also acted as a consultant to Asahi, AstraZeneca, Grunenthal, Pierre Fabre, Servier, Sumitomo, and Wyeth. He has accepted paid speaking engagements in industry-supported satellite symposia and is co-author of the BAP evidence-based guidelines on the treatment of anxiety disorders. He is also a Medical Patron of Anxiety UK.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. May 2013 [internet publication].Full text

Katzman MA, Bleau P, Blier P, et al; Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(suppl 1):S1.Full text  Abstract

Williams T, Hattingh CJ, Kariuki CM, et al. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database Sys Rev. 2017 Oct 19;(10):CD001206.Full text  Abstract

Schaffer A, McIntosh D, Goldstein BI, et al. The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders. Ann Clin Psychiatry. 2012 Feb;24(1):6-22. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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