Recommended Assessment Tool for Social Anxiety Disorder with Performance Anxiety
The Mini-SPIN (3-item Social Phobia Inventory) is the recommended screening tool for social anxiety disorder with performance anxiety, using a cutoff score of ≥6 points, which demonstrates 89% sensitivity and 90% specificity in primary care populations. 1, 2
Why the Mini-SPIN is Optimal for Performance Anxiety
The Mini-SPIN specifically addresses the core features of social anxiety disorder including performance situations. The three items directly assess:
- Fear of embarrassment or looking stupid
- Avoidance of activities where one is the center of attention
- Fear of embarrassment or looking stupid (performance-related fear)
This makes it particularly well-suited for patients presenting with performance anxiety as their primary concern. 1
Practical Implementation
Scoring and Interpretation:
- Use a cutoff of ≥6 points for positive screening 1, 2
- The tool takes minimal time to administer (3 items only), making it practical for primary care settings 1
- Positive predictive value of 53% and negative predictive value of 98% means a negative screen effectively rules out social anxiety disorder 1
Alternative Assessment Tools
While the Mini-SPIN is recommended for initial screening, other validated instruments exist for more comprehensive assessment:
For broader anxiety assessment:
- The GAD-7 is validated for generalized anxiety disorder but does not specifically assess social/performance anxiety 1
- GAD-7 may miss social anxiety disorder if the patient's anxiety is primarily performance-focused rather than generalized worry 1
For detailed clinical assessment after positive screening:
- The full 24-item Liebowitz Social Anxiety Scale (LSAS) can be used for comprehensive evaluation of fear and avoidance across social and performance situations 3, 4, 5
- LSAS exists in both clinician-administered and self-report versions with similar psychometric properties 4, 6
Critical Clinical Pitfalls to Avoid
Do not use GAD-7 as your primary screening tool for suspected social anxiety disorder with performance anxiety. While GAD-7 is excellent for generalized anxiety disorder, it assesses worry across multiple life domains rather than the specific fear of social scrutiny and performance situations that characterizes social anxiety disorder. 1, 7
Do not delay proper assessment. Social anxiety disorder causes significant occupational and social impairment, and using the wrong screening tool can delay appropriate treatment with CBT and/or SSRIs. 2
Remember that approximately 24% of patients with social anxiety disorder have comorbid GAD. If the Mini-SPIN is positive, consider also administering the GAD-7 to screen for comorbidity, as this affects treatment planning and prognosis. 7