Social anxiety disorder is characterized 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 behavioral observation.
Selective serotonin-reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and cognitive behavioral 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 generalized to almost any social encounter.
History and exam
Key diagnostic factors
- history of psychiatric comorbidity
- positive family history of social anxiety
- 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
Craig N. Sawchuk, PhD
Department of Psychiatry and Psychology
CNS declares that he has no competing interests.
Jason P. Veitengruber, MD
Department of Psychiatry and Behavioral Sciences
University of Washington School of Medicine
JPV is an author of a reference cited in this topic.
Bunmi O. Olatunji, PhD
Department of Psychological Sciences
BOO declares that he has no competing interests.
Stacy Shaw Welch, PhD
Anxiety and Stress Reduction Center of Seattle
University of Washington
SSW declares that she has no competing interests.
Richard P. Swinson, MD, FRCPC, FRCPsych
Anxiety Treatment and Research Centre
McMaster University and St Joseph’s Hospital
RPS declares that he has no competing interests.
Jeffrey M. Lohr, PhD
Department of Psychology
University of Arkansas
JML declares that he has no competing interests.
David F. Tolin, PhD
Institute of Living
DFT declares that he has no competing interests.
David Baldwin, MD
Professor of Psychiatry
University of Southampton
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.
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