Diagnosis and Clinical Characteristics
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
SAD is characterised by an exaggerated and persistent fear of being negatively evaluated in social and performance situations.[6] The disorder is associated with physical, cognitive and behavioural disturbances. The generalised subtype consists of fears of most interactional and performance situations, while the non-generalised (or circumscribed) subtype is restricted to a few specific situations, such as public speaking or dating.[4,5]
The generalised subtype or generalised social anxiety disorder (GSAD) is associated with greater comorbidity, chronicity, and functional impairment.[7] The avoidance of feared situations impacts on daily routine, work, academic and social activities and relationships. More than 80% of patients with SAD have a lifetime history of at least one other psychiatric disorder, most commonly major depression, panic disorder, generalised anxiety disorder, agoraphobia and substance use disorders.[5-7] There is also considerable overlap between SAD and avoidant personality disorder.[6,7]
SAD generally runs a chronic course and precedes mood, anxiety and substance use disorders. Even in the absence of comorbidity, SAD is associated with significant distress, including financial problems, increased suicidal thoughts, reduced work and school performance, poor social support and greater use of psychotropic medications.[5] Despite significant suffering, only 50% of patients with SAD ever seek treatment and when they do, it is usually when a comorbid condition develops and necessitates treatment.[8]