Overview of social anxiety disorder

Social anxiety disorder (social phobia) is associated with a persistent, excessive fear or anxiety of social situations in which the person may be exposed to the scrutiny of others. The fear may be experienced in one or more social situations, including performing in front of others (eg speaking in public), social interactions and being observed (eg eating or drinking in public). The person anticipates that they will be negatively evaluated by others, and fears that they may say something or act in a way that is humiliating or embarrassing. The phobic situations are avoided, or endured with intense anxiety or distress. Unlike common, transient social fears, fear or anxiety in social anxiety disorder is recurrent and lasts for at least 6 months.

If a person experiences social anxiety in discrete performance situations only (eg public speaking) and does not avoid other social situations, they are considered to have performance anxiety rather than social anxiety disorder.

The disorder often begins in childhood. Anxiety in children can manifest as tantrums, shyness at school, crying, clinging or immobility, and may lead to significant impairment in social and academic functioning. For a diagnosis of social anxiety disorder in children, anxiety must be identified in both peer settings and during encounters with adults.

Comorbid problem drug and alcohol use and major depression are common. Assess patients for these comorbidities and implement treatment.

For information on diagnosing and differentiating anxiety disorders, see Overview of anxiety and associated disorders.