Social Anxiety Disorder (SAD) is especially prevalent among young individuals aged 18–25 and significantly affects daily social activities and interpersonal relationships. Public Speaking Anxiety (PSA), a subtype of SAD, is a widespread concern that affects one in five individuals. The study focuses on the Public Speaking Anxiety Scale (PSAS), with the aim of assessing the factor structure and reliability of the Lithuanian version (PSAS-LT). The PSAS-LT, administered to 227 participants aged 18–25, comprises 17 Likert-scaled items, evaluating cognitive, behavioral, and physiological aspects of PSA. Three models were tested: a single-factor model, a three-factor model and a single factor model with positive and negative item wording factors model. Results indicate less than desirable fit for the single, and three-factor models, suggesting the need for alternative structures. The model that included a single factor as well as positive and negative item wording factors demonstrated a reasonably good fit. The diagnostic validity confirmed that the PSAS-LT effectively differentiated between participants with and without history of anxiety disorders. The total score of the PSAS-LT had excellent internal consistency. Despite limitations, including convenience sampling and nonrepresentative sample, the study contributes valuable insights into refining the understanding of PSA assessment features, emphasizing the importance of considering response patterns. Future research should validate these findings with larger and more diverse samples of the Lithuanian population.