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
Other diagnostic factors
- post-event processing
- attentional biases
- social skills deficits
- crying, tantrums, or "freezing"
- selective mutism
Risk factors
- psychiatric comorbidity (e.g., anxiety, mood, and substance-use disorders)
- genetic
- temperamental factors
- parenting style
- psychological disorder
- life stressors
- environmental factors
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- blood glucose
- serum thyroid-stimulating hormone
- toxicology screen (urine and blood)
Treatment algorithm
adults: no comorbidity
adults: comorbidities
children and adolescents
Contributors
Authors
Craig N. Sawchuk, PhD
Professor
Department of Psychiatry and Psychology
Mayo Clinic
Rochester
MN
Disclosures
CNS declares that he has no competing interests.
Jason P. Veitengruber, MD
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
Professor
Department of Psychological Sciences
Vanderbilt University
Nashville
TN
Disclosures
BOO declares that he has no competing interests.
Stacy Shaw Welch, PhD
Director
Anxiety and Stress Reduction Center of Seattle
University of Washington
Seattle
WA
Disclosures
SSW declares that she has no competing interests.
Peer reviewers
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.
Jeffrey M. Lohr, PhD
Professor
Department of Psychology
University of Arkansas
Fayetteville
AR
Disclosures
JML declares that he has no competing interests.
David F. Tolin, PhD
Professor
Institute of Living
Yale University
New Haven
CT
Disclosures
DFT 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.
Differentials
- Phobias
- Panic disorder
- Agoraphobia
More DifferentialsGuidelines
- 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
More GuidelinesPatient leaflets
Anxiety
Panic attacks
More Patient leaflets
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