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Generalised anxiety disorder (GAD) and social anxiety disorder are both anxiety disorders, but they centre on different fears. In GAD, worry spreads across many areas of everyday life, such as work, money, health and family, and is hard to control. In social anxiety disorder, the fear is narrower: that you will act in a way, or show anxiety, that other people will judge negatively.
NICE in the UK treats them differently. For GAD, it uses stepped care, ending in a choice between therapy and medication based on your preference. For social anxiety disorder, the first offer is individual CBT built for social anxiety. Medication comes in mainly when someone declines CBT and prefers a drug. Pregabalin is an option for GAD, but NICE advises against routinely offering its drug class for social anxiety.
Still unsure whether what you feel is a disorder at all? Start with anxiety the feeling versus anxiety the disorder.
Ask what you are afraid will happen. The World Health Organization's ICD-11 manual puts it plainly. In GAD, "the main focus of worry is negative consequences that can occur in multiple everyday situations (e.g. work, relationships, finances)". In social anxiety disorder, it is restricted to "concerns about one's behaviour or appearance being negatively evaluated in social situations".
DSM-5 (the American Psychiatric Association's manual) requires:
ICD-11 (the WHO system) describes either "free-floating anxiety" or excessive worry about negative events in several areas of life. It adds symptoms such as palpitations, sweating, trembling, nausea and dry mouth. It asks for symptoms lasting "at least several months, for more days than not", rather than a fixed six months.
ICD-11 notes that some people report only general apprehension and physical symptoms, without naming a specific worry.
DSM-5 describes marked fear of social situations where you may be scrutinised. The fear is that your actions, or visible anxiety, will bring embarrassment or humiliation. The situations almost always provoke fear and are avoided or endured. The fear is out of proportion, typically lasts six months or more, and causes distress or impairment. A "performance only" specifier applies when the fear is limited to speaking or performing in public.
ICD-11 gives examples such as having a conversation, eating while observed and giving a speech. It notes people may first describe blushing, sweating or trembling, rather than fear of judgement.
ICD-11 says anxiety and worry are normal under stress and can help focus attention. In GAD, the worry is "excessive, persistent and intense". Worry that fits truly extreme circumstances, such as a war zone, is not GAD if it occurs only there.
For social anxiety, ICD-11 says nerves about public speaking are common and shyness is a normal personality trait. The diagnosis applies only when social fear and avoidance are clearly beyond what is usual in your culture and cause significant distress or impairment.
For GAD, ICD-11 also requires other causes to be excluded, such as an overactive thyroid, caffeine, or alcohol withdrawal.
The prevalence figures use different DSM editions, so treat them as rough. Both were highest in high-income countries.
The two often occur together. In the GAD survey, 81.9% of people with lifetime GAD also had another mental disorder at some point. The NHS notes that many people with social anxiety also have depression, GAD or panic disorder. If panic attacks happen only in social situations, ICD-11 does not add a separate diagnosis of panic disorder. It uses a "with panic attacks" specifier instead.
NICE guideline CG113 (published 2011, updated June 2020) offers "the least intrusive, most effective intervention first".
For medication, NICE says to offer an SSRI, considering sertraline first as the most cost-effective. Next comes another SSRI or an SNRI, then pregabalin if those can't be tolerated. Benzodiazepines are for short-term crisis use only. If a drug works, NICE advises continuing it for at least a year, "as the likelihood of relapse is high".
In Ireland, the HSE describes a similar sequence, with pregabalin for when SSRIs and SNRIs are not suitable.
NICE guideline CG159 (published May 2013) is more directive. It says to offer adults individual CBT developed for social anxiety disorder, over about four months. Group CBT should not routinely be preferred. The Clark and Wells model it names uses video feedback to correct a distorted self-image. It also trains attention outwards and tests negative beliefs with behavioural experiments.
The order after that is:
NICE also lists what not to routinely offer for social anxiety disorder. That includes anticonvulsants, tricyclic antidepressants, benzodiazepines, antipsychotics, mindfulness-based interventions and supportive therapy. It says not to offer St John's wort or other over-the-counter anxiety preparations.
NICE also notes that alcohol or drug use is "often an attempt to reduce anxiety in social situations" and should not block treatment.
Licences differ by country, and some NICE choices are off-label. UK and US product information, checked 1 November 2026:
Pregabalin's EU licence, which covers Ireland, includes GAD. A European Medicines Agency summary of eight GAD trials reports that 52% on pregabalin improved by half or more. On placebo, 38% did.
Pregabalin carries a recognised risk of dependence. It has been a Class C controlled drug in the UK since April 2019, and is Schedule V in the US. The MHRA tells prescribers to check for a history of drug misuse. The NHS and HSE warn that stopping suddenly can cause withdrawal symptoms, including anxiety.
With SSRIs and SNRIs, NICE says to warn people under 30 about increased suicidal thinking and self-harm in a minority. US labels carry a boxed warning on this for children and young adults. Early "activation", such as more anxiety and poor sleep, can also occur. More on how they work and stopping is in what SSRIs actually do. Never change a dose without your prescriber.
Propranolol is a beta blocker. The NHS says it reduces physical signs of anxiety, such as a fast heartbeat, sweating and shaking. UK product information for propranolol tablets includes "relief of situational anxiety and generalised anxiety symptoms, particularly those of somatic type". The US Inderal LA label does not list anxiety.
The evidence for anxiety disorders is weak. A 2016 systematic review found eight trials, only one in social phobia, with 16 participants. It judged the evidence insufficient for routine use in any anxiety disorder. Canada's 2014 guidelines found no benefit from propranolol or atenolol in social anxiety trials, and do not recommend propranolol for GAD. NICE's social anxiety guideline does not include beta blockers.
For performance nerves, a 2019 review in professional musicians found CBT and beta blockers were the most studied treatments. It reported beneficial results for CBT and noted widespread methodological weaknesses.
Propranolol is prescription-only, and an overdose can be very serious. The NHS asks people to tell their doctor before starting if they have asthma, or have ever had depression or thoughts of self-harm.
Self-help is a formal NICE step for both. For GAD, it is CBT-based, and NICE's unguided version runs for at least six weeks. For social anxiety, it pairs a CBT book with about three hours of practitioner support.
A 2016 Cochrane review pooled 38 trials of therapist-supported internet CBT, including 11 in social anxiety and 5 in GAD. People improved more than on a waiting list (risk ratio 3.75, 95% CI 2.51 to 5.60), on low-quality evidence. Against face-to-face CBT it found no significant difference. That rests on four studies and 365 people, so it is not proof they are equal.
For GAD, NHS tips include gradually facing anxious situations, cutting caffeine, not using alcohol to cope, and regular exercise. For social anxiety, it suggests noting your thoughts in social situations and breaking hard situations into steps. It also suggests focusing on what people say rather than assuming the worst. For a broader ranking, see what actually works for anxiety.
The NHS advises seeing a GP if you think you might have GAD, or if treatment isn't helping. For social anxiety, it says to see a GP especially if it's having a big impact on your life.
NICE suggests GPs consider two questions for social anxiety: "Do you find yourself avoiding social situations or activities?" and "Are you fearful or embarrassed in social situations?"
You don't always need a GP. The NHS website says adults can self-refer to NHS talking therapies. In Ireland, the HSE says you can refer yourself to Primary Care Psychology.
Yes. They frequently co-occur, and the NHS lists GAD among the conditions common in people with social anxiety. NICE's GAD guideline says to treat the more severe condition first.
No. ICD-11 treats shyness as a normal personality trait. The disorder applies when fear and avoidance clearly exceed what's usual in your culture and cause real distress or impairment.
The trials don't support it. It can reduce physical signs such as shaking, but reviews have not found it effective for the disorder itself.
NICE describes 12 to 15 weekly CBT sessions for GAD, and about four months of CBT for social anxiety. If medication works, NICE advises at least a year for GAD. For social anxiety, it advises at least six more months after a good response.
This article is general information, not medical advice. It cannot diagnose an anxiety disorder or tell you which treatment is right for you. Talk to your GP or prescriber before starting, stopping or changing any medication.
Reviewed by: Proco Team
Last updated: November 2026