Social Anxiety Disorder: Beyond Shyness

Neelam Hiranandani
Medically reviewed by
Last Updated:

5 min read

social anxiety disorder

Does the thought of networking, making small talk or going to a party set your pulse racing and palms sweating, with a slightly sick feeling in the pit of your stomach?


You are not alone if it does. Social anxiety disorder is so much more than being timid in social settings and is the most prevalent anxiety disorder in childhood and adolescence. In Hong Kong, the prevalence of social anxiety disorder among children between ages of 3 and 6 is currently 7.5%. The high prevalence of the disorder is definitely worthy of our attention to understand how to manage it.


What is Social Anxiety Disorder?

We all have experienced feeling uneasy, fidgety, jumpy in social settings. For instance, when giving a presentation, our heart pounds rapidly. Most people can get through the shyness, but when it comes to social anxiety, the distress caused can be much harder to bear.


Social anxiety disorder, also known as social phobia, is a mental health condition causing an intense, persistent fear of being judged or scrutinized by others. Shyness often stops after a short period of time and does not impair one’s daily functioning. However, social anxiety disorder culminates in persistent, exhausting repercussions.

Signs & Symptoms of Social Anxiety Disorder

During social interactions and social settings, individuals with social anxiety disorder may develop the following signs and symptoms:

  • Blushing, sweating, trembling or shaking
  • Rapid heart rates
  • Feeling of “mind going blank”
  • Nausea or stomachache
  • Rigid body posture, little eye contact and difficulty speaking
  • Extremely high self-consciousness in front of others, which culminates in feelings of embarrassment and awkwardness
  • Extreme fear and anxiety towards possible judgments by others
  • Feeling of uneasiness during interactions, especially with strangers
  • Tendency to stay away from places with other people

People with social anxiety disorder often panic and are on tenterhooks days or even weeks before the event. Since they are avoidant of social settings, they may miss school or work because of foreseeable anxiety.


Note that symptoms of social anxiety may not appear in all social situations. People with social anxiety disorder may experience selective anxiety under certain circumstances only.

Causes of Social Anxiety Disorder

The exact cause of social anxiety disorder is unknown. Current research suggests that the condition is caused by a combination of environmental factors and genetics. While social anxiety disorder can possibly run in families, researchers are still unraveling the effects of genetic factors and nurturing environments on the disorder. Below are some possible causes:

  1. Serotonin imbalance: An imbalance in serotonin levels will weaken the mood regulation function of the nervous system.
  2. Overactive amygdala: Amygdala is a brain structure that controls fear response and anxiety. People with an overactive amygdala are prone to a heightened fear response, experiencing increased anxiety in face of social situations.
  3. Nurturing environment: Social anxiety disorder may be acquired through social learning — individuals may develop anxiety in the wake of unpleasant social encounters. Direct or not, the effects of parenting and influences in childhood are cases in point. Children whose parents are controlling, overprotective or model anxious social behaviors, may endure social anxiety disorder consequently.

Other factors may also increase the risk of social anxiety disorder, including:

  1. Negative experiences: Children who have experiences of being teased, bullied, rejected or humiliated are more susceptible to developing the condition. Family conflict, trauma or abuse may also play a role.
  2. New social or work situations: Meeting new people, having a public speech or presentation may trigger symptoms.
  3. Having conditions that draw attention: Disfigurement, stuttering or tremors may increase the self-consciousness of an individual.
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Diagnosis of Social Anxiety Disorder

No medical tests can be used to check for social anxiety disorder. However, based on self-report of symptoms, clinicians can make a diagnosis with regards to the behavioral patterns of an individual. The diagnostic criteria include:

  1. Marked fear or anxiety about at least one social situation where one may come under the scrutiny of others.
  2. Fear of showing anxiety symptoms or acting in a way that will be negatively evaluated.
  3. Repeated sense of fear or anxiety in certain social situations.
  4. Avoidance or endurance of social situations with intense fear or anxiety.
  5. Experience out-of-proportion fear or anxiety towards threat posed by social situations or socio-cultural contexts.
  6. Significant distress over the symptoms or impairment of functioning in social, occupational or other major life areas.
  7. The above symptoms cannot be explained by the physiological effects of a substance or any other general medical conditions.

Prevention of Social Anxiety Disorder

Several practices may be helpful to cope with anxiety in social settings:

  1. Keeping a journal: A journal can serve as a record to help you observe and recognize the ebbs and flows in your personal life. It helps identify the causes of your stress and thus formulating preventive measures.
  2. Planning your schedule: Time management offers reassurance and helps reduce anxiety due to uncertainty. It will give you breathing room for idle pleasure, leisure time rather than dwelling on negativity and getting worked up over forthcoming events.
  3. Avoiding substance use: Alcohol, drugs, caffeine and nicotine use can create or aggravate anxiety. As these substances are potentially addictive, withdrawal from any of them may also trigger anxiety.

Treatments of Social Anxiety Disorder

After valid diagnosis by a clinician, people with social anxiety disorder may be advised to receive psychotherapy, medication or a combination of both as deemed suitable by a mental health professional.



Cognitive-behavioral therapy (CBT) is effective in treating social anxiety disorder. Through its clinical sessions, CBT can help the individual identify negative thought patterns, challenge and change these cognitive distortions and maladaptive behaviors. Different methods, such as coping tools, will be adopted to help them reduce anxiety and fear, whilst allowing space to practice social and communication skills.


Group CBT is also beneficial for individuals diagnosed with the disorder, where they can receive unbiased, genuine feedback from one another without judgment, so as to realize any distorted evaluation they have. Along the way, they can observe and learn from others’ approaches to overcoming anxiety in social situations.


Exposure therapy may also be delivered to encourage you to face the target anxiety source and not to avoid or escape from social situations, steadily supporting you to face them.


Several medications may be prescribed by a medical doctor to alleviate the condition:

  1. Antidepressants: By increasing serotonin levels in the brain, selective serotonin reuptake inhibitors (SSRIs) such as citalopram and paroxetine can help treat anxiety. Substitutes may be serotonin and norepinephrine reuptake inhibitor (SNRI).
  2. Anti-anxiety medications: Benzodiazepines are an effective short-term treatment for reducing anxiety. However, as your body may become accustomed to the drug and develop tolerance overtime, more doses will be needed to attain the same effect. Only short-term use of the medications is recommended as they can be habit-forming and sedating.
  3. Beta-blockers: These medications can fend off the stimulating effect of adrenaline, thus helping in mitigating physical symptoms of anxiety, such as pounding heart and tremors. They are not recommended for general treatment but only people of the “performance anxiety” type.

Please note that social anxiety disorder treatments, particularly medications, need to be conducted and prescribed by a medical doctor.

Do you need help?

If you are looking for professional advice, you may reach out to the services below:


Hospital Authority Mental Health Direct (24 hours)
Tel: 2466 7350
Available languages: English, Cantonese, Mandarin


Social Welfare Department Hotline Service
Tel: 2343 2255
Available languages: English, Cantonese, Mandarin


The Mental Health Association of Hong Kong
Tel: 2772 0047
Available languages: Cantonese, Mandarin


If you need immediate support, please do not hesitate to reach out for professional help. Below is a list of hotlines with 24-hour support:


The Samaritans
Hotline: 2896 0000
Available languages: English, Cantonese, Mandarin


Suicide Prevention
Hotline: 2382 0000
Available language: Cantonese 


The Samaritan Befrienders Hong Kong
Hotline: 2389 2222
Available language: Cantonese


When does social anxiety become a disorder?

Social anxiety disorder usually emerges during childhood or early adolescence. It may be associated with a history of bullying, abuse or negative experiences. Shy children are more prone to develop social anxiety. Children with parents who are controlling or overprotective may also be susceptible to social anxiety disorder.

Do I have social anxiety disorder, or am I just shy?
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Neelam Hiranandani
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