Peer Reviewed
Feature Article Psychiatry and psychology

Assessing and managing social anxiety disorder

Jeanette Milgrom, Graham D Burrows

Of primary importance in assessing a patient with social anxiety disorder is judging the degree of functional impairment. Most patients with the condition will also have at least one comorbid psychiatric disorder, which should be assessed also.

Key Points
    • Social anxiety disorder, or social phobia, is an incapacitating fear of social or performance situations.
    • Symptoms range from excessive shyness to overwhelming and disabling panic.
    • Most patients with social anxiety disorder will have at least one comorbid psychiatric disorder, such as major depression, another anxiety disorder, avoidant personality disorder, or substance use disorder.
    • Generalised social anxiety disorder is the more potentially disabling form and is typically chronic and unrelenting, extending to all aspects of a patient’s social interactions and often associated with a family history. Comorbid disorders are more common.
    • Nongeneralised social anxiety disorder is an excessive fear of one or a limited number or kinds of social situation, such as public speaking or eating in public.
    • Causes of social phobia are multifactorial and thought to include prior experiences, negative thinking, genetic predisposition and, for some, a paucity of social skills.
    • Current recommended treatment options include cognitive behavioural therapy and pharmacotherapy. Antidepressants are the first line pharmacotherapy; anxiolytics may sometimes be useful as short term or adjunctive measures.
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