Managing Social Anxiety Disorder

Priyam K. Mithawala, PharmD, BCPS; Natai M. Thomas, PharmD Candidate 2022


US Pharmacist. 2021;46(5):23-27. 

In This Article

Abstract and Introduction


Anxiety disorders, which are the most common psychiatric illnesses, often go undiagnosed or undertreated. Social anxiety disorder (SAD) involves the persistent, intense fear of being observed or judged in social situations, such as public speaking or interactive settings, and affects a person's quality of life by impacting relationships, work or school, and social activities. Common comorbidities in patients with SAD include cardiovascular, neurologic, gastrointestinal, respiratory, autoimmune, and endocrine disorders. Psychological and pharmacologic approaches are used to treat SAD. It is important to consider treatment guidelines and patient-related factors in choosing the best therapy for a patient with SAD, and pharmacists' comprehensive knowledge of drugs and ability to evaluate drug therapy are essential in treatment management.


Anxiety disorders are the most common psychiatric illnesses, with up to 33.7% of the population experiencing an anxiety disorder during the lifetime, but they often go undiagnosed or undertreated.[1] In persons aged 18 years and older, the 1-year prevalence rate for anxiety disorders is 21.3%, and that for social anxiety disorder (SAD) is 8.0%.[2] SAD, which affects more women than men, typically begins in childhood or adolescence but occasionally develops later in life.[3] SAD involves the persistent, intense fear of being observed in social situations, such as performance or interactive settings.[4] A typical example is public speaking, which often provokes fear of scrutiny or judgment by others.[2] SAD affects a person's quality of life by impacting social activities, relationships, work, or academic studies.[5] There is no definitive cause for SAD, but researchers believe that a genetic component—with several plausible candidate genes—may be responsible.[2]

Several self-screening instruments are used as diagnostic aids, along with the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).[6] The previous edition (DSM-IV) replaced the term "social phobia" with "social anxiety disorder" to differentiate SAD from other specific phobias, and SAD became the primary term when DSM-5 was published in 2013.[6–8]DSM-5 also included a "performance-only" specifier instead of the "generalized" specifier in DSM-IV.[7,8] This change has helped clarify diagnosis because performance-only SAD has distinct symptoms.[7,9] Additionally, for clinical diagnosis of SAD, the patient must have experienced persistent fear (lasting at least 6 months) in one or more social or performance situations (i.e., activity leads to intense fear of humiliating oneself in public).[10] However, before a diagnosis is made, the healthcare professional should conduct a differential diagnosis to rule out mental or somatic symptom disorders and certain physical illnesses.[11] Various therapeutic options are available for anxiety disorders, including psychotherapy and pharmacotherapy.[11]