Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this systematic review and meta-analysis, it was found that individuals with social anxiety disorder (SAD) had more difficulty recognizing facial expressions.

2. Individuals with SAD were also found to have a slower reaction time for recognizing happy facial expressions than controls.

Evidence Rating Level: 1 (Excellent)

Social anxiety disorder (SAD) is a highly prevalent disorder that may be further complicated by difficulties with emotional expression recognition (EER). To date, the data investigating whether individuals with SAD have impaired performance in categorizing facial expressions of emotion has been mixed. As a result, the present study aimed to determine the degree to which individuals with SAD could accurately recognize facial expressions of emotion.

Of 6,541 identified records, 16 (n=788) studies were included from various databases from inception to January 2022. Studies were included if participants had a diagnosis of SAD and were evaluated on an EER task using a validated face database with accuracy and/or reaction time as an outcome measurement. Qualitative studies, case studies, reviews, and meta-analyses were excluded. The review was performed using PRISMA guidelines. The risk of bias was assessed using the risk of bias assessment tool for non-randomized studies (RoBANS). The primary outcome was accuracy in facial expression recognition and reaction time.

The results demonstrated that individuals with SAD had a harder time recognizing facial expressions. Furthermore, those with SAD had a slower reaction time for recognizing happy facial expressions, while those with a mental health comorbidity had a harder time recognizing happy facial expressions than controls. Despite these results, the study was limited by the inclusion of small sample sizes, which may have affected the study’s power. Nonetheless, the present study demonstrated that individuals with SAD may experience difficulties with recognizing facial expressions.

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