Anxiety, Social Disorder

Key Features

Essentials of Diagnosis

• Excessive worrying in social settings

• Inability to perform in front of others as expected for age

• Avoidance of events or settings that are social in nature or involve large groups

General Considerations

• Characterized by significant, persistent fear in social settings, or performance situations

• Results in overwhelming anxiety and inability to function when exposed to unfamiliar people and/or scrutiny

• Seen more often in older children and adolescents than in younger children

Clinical Findings

• Common manifestations

  • Consistent avoidance of social functions

  • Persistent somatic complaints that occur in a social setting and resolve in the absence of social exposure

• Children are at increased risk for depression and school avoidance

• They can also experience panic attacks

• There is high comorbidity between substance use disorders and anxiety disorders

Diagnosis

• Child's and family's lives are significantly disrupted

• Parents often describe a pattern of overly accommodating their child's avoidance and/or incentivizing their child to attend routine social, extracurricular, or family functions

Treatment

• Cognitive-behavioral therapy (CBT) is mainstay

• If ongoing CBT therapy is not effective, then psychopharmacologic agents may be helpful

• Selective serotonin reuptake inhibitors have demonstrated efficacy for children with social anxiety disorder

Outcome

Prognosis

• Early age of onset, more severe avoidance, and the presence of panic symptoms are all predictors of persistence over time

References