Objectives: Our main hypothesis in this study was that patients with social anxiety disorder (SAD) and comorbid attention deficit hyperactivity disorder (ADHD) had lower empathy levels than those without ADHD. Also, after controlling for the severity of SAD and depression, we hypothesized that ADHD symptoms contributed to lower levels of empathy in SAD patients.

Methods: 72 patients (46 females, 32 males) with SAD between the ages of 18–65 years were divided into two groups as those with (n = 32) and those without ADHD (n = 40). Participants were evaluated using the Liebowitz Social Anxiety Scale (LSAS), Turgay’s Adult Attention-Deficit/Hyperactivity Disorder, Beck Depression Inventory (BDI), and Empathy Quotient. In this study, Mann Whitney-U test, Spearman correlation test, logistic and multiple regression analysis were used.

Results: Education level (U = 371.5, p = .002) and empathy scores (U = 259.5, p < .0001) of SAD patients with ADHD were significantly lower than those without ADHD. BDI (U = 206.5, p < .0001), LSAS total (U = 454.5, p = .036), fear (U = 457.0, p = .038), and avoidance scores (U = 453.0, p = .034) were higher in SAD patients with ADHD than those without ADHD. Low levels of empathy (B = - 0.119, Exp(B) = 0.895, p = .014) and high severity of current depression (B = 0.119, Exp(B) = 1.127, p = .001) were significantly associated with comorbidity between SAD and ADHD. ADHD-inattention (β = −0.369, Exp(B) = −0.541, p = .004), and depression (β = −0.262, Exp(B) = −0.212, p = .036) negatively predicted empathy levels.

Conclusions: Our findings may provide some evidence for the contribution of ADHD-inattention and depression to poor empathy in SAD patients. Therefore, it is recommended that symptoms of ADHD-inattention and depression should be carefully evaluated in SAD patients with low empathy.