Social Anxiety

Social Anxiety & Shyness

Shyness and social anxiety disorder share many characteristics. If you have spent your whole life feeling as though you are just a shy person, how do you know if it is something more serious? As a parent of a shy child, you might also wonder if the behaviour is normal or may be signs of a disorder.

CATEGORY: Anxiety Disorders


Number: #11


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An Australian Bureau of Statistics’ National Study of Mental Health and Wellbeing released in 2023, of 5,500 people aged 16 to 85 years old during 2020-2021, showed that more than two in five Australians experience a mental health issue in their lifetime and that in 2020–21 more than 3.4 million Australians sought help from a health care professional for their mental health.

The study is published at

Tthe main symptoms that distinguish shyness from SAD are the impairment of functioning that it causes in a person’s life; the intensity of the fear; the level of avoidance.


Childhood is the time when social skills develop in preparation for the challenges of adolescence and adulthood. Children who suffer from SAD often do not develop appropriate social behaviours. As children grow with the disorder, they may become accustomed to having social fears and create a life based on avoidance. Social anxiety disorder can have a devastating impact on your education, career success, financial independence, and personal relationships. Often it will lead to an isolated lifestyle and subsequent depression or substance abuse.

Unfortunately, social anxiety disorder (SAD) is often dismissed as just extreme shyness. The reason many people don’t seek help for SAD is that they don’t realise that they have a recognised psychiatric condition. Statistics show that although symptoms usually start in childhood, only about 50% of adults with the disorder receive treatment, and those who do seek treatment wait a long time to do so.

People with social anxiety disorder don’t just feel nervous before giving a speech. They may worry about the speech for weeks or months beforehand, lose sleep due to anxiety, and have intense symptoms of anxiety during the feared situation such as a racing heart, shortness of breath, sweating, or shaking.

The symptoms usually do not go away but get worse as the situation progresses. The person with SAD usually realises that their fears are unfounded but is still unable to control them.

At the same time, it is unfortunate that people wait so long or never get help when this disorder is treatable. In fact, studies show that nearly 70% of individuals suffering from SAD may be successfully treated with cognitive therapy.



Symptoms of social anxiety disorder typically fall within three different areas. While everyone’s experience is different, symptoms of the condition typically result in physical, cognitive, and behavioural symptoms.


Physical Symptoms

The physical symptoms of SAD can be extremely distressing. Common physical symptoms include:

  • Blurred vision
  • Blushing
  • Chest pain and tightness
  • Chills
  • Diarrhea
  • Dizziness
  • Dry mouth
  • Feelings of unreality (derealisation) or feelings of detachment from oneself (depersonalisation)
  • Headaches
  • Heart pounding (palpitations) and racing (tachycardia)
  • Lump in the throat
  • Muscle tension
  • Nausea
  • Paresthesias (tingling)
  • Ringing in the ears
  • Shaking
  • Shortness of breath
  • Sweating
  • Trembling voice

In some cases, these physical symptoms may become so severe that they escalate into a full-blown panic attack. However, unlike those with panic disorder, people with SAD know that their panic is provoked by fears of social and performance-related situations rather than fears about the panic attacks themselves.

Cognitive Symptoms

Social anxiety disorder also involves cognitive symptoms, which are dysfunctional thought patterns. If you have this condition, you might find that you are bothered by negative thoughts and self-doubt when it comes to social and performance-related situations.

Below are some common symptoms that you may experience:

  • Negative beliefs: Strongly held beliefs about your inadequacy in social and/or performance-related situations
  • Negative Bias: A tendency to discount positive social encounters and magnify the social abilities of others
  • Negative Thoughts: Automatic negative evaluations about yourself in social or performance-related situations

For example, imagine you start a new job or arrive on the first day of a new class. The instructor or manager asks everyone to introduce themselves to the group. If you have social anxiety disorder, you may start to have negative thoughts such as, “Everyone else looks so much more relaxed,” “What if I say something dumb?” or “What if everyone notices my voice shaking?”

These thoughts start to rapidly spiral out of control to the point that you don’t hear anything anyone else has said. When it comes to your turn, you say as little as possible and hope that no one has noticed your anxiety.

Negative thought patterns can also erode your self-esteem over time, so it’s important to seek treatment.


Behavioural Symptoms

Social anxiety disorder can also cause you to act in certain ways. In many cases, you might find yourself making choices based on fear and avoidance rather than your actual preferences, desires, or ambitions. For example, you may drop a class to avoid doing a presentation or turn down a job promotion because it meant increased social and performance demands.

Below are some common behavioral symptoms:

  • Avoidance: The things done or not done to reduce anxiety about being in social or performance-related situations
  • Safety behaviors: Actions taken to control or limit experiences of social or performance-related situations
  • Escape: Leaving or escaping from a feared social or performance situation.

People with social anxiety disorder (SAD) experience significant and chronic fear of social or performance-related situations where they might be embarrassed, rejected, or scrutinised. In these situations, people with SAD almost always experience physical anxiety symptoms.

Although they know their fear is unreasonable, they can’t seem to do anything to stop it, so they either avoid these situations altogether or get through them while feeling intense anxiety and distress. In this way, social anxiety disorder extends beyond everyday shyness and can be extremely impairing.

Therapy | Treatment


If you believe that your shyness may actually be social anxiety disorder, it is important to make an appointment with your family doctor or mental health professional.

Avoidance of social situations can make it difficult to maintain interpersonal relationships, and this can affect your ability to work, attend school, and participate in other social events. It can contribute to feelings of isolation and loneliness, which can have a detrimental impact on your health and well-being.

Social anxiety disorder can lead to serious complications in your life. It can result in panic attacks, which can be frightening and contribute to increased feelings of fear and avoidance.

In severe cases, if left untreated, social anxiety disorder can increase your risk of having a poor quality of life. You might have few or no friends, persistent depression, and no romantic relationships. It may even lead you to drop out of school or quit jobs, and use alcohol or drugs to tolerate anxiety.


On the other hand, effective treatment such as cognitive-behavioral therapy (CBT) and medication are available and have been shown to help with a social anxiety disorder.

Treatments for SAD depend on the severity of your emotional and physical symptoms and how well you function daily. The length of treatment also varies. Some people may respond well to initial treatment and not require anything further, while others may require some form of support throughout their lives.

Both medication and therapy have been shown effective in treating social anxiety disorder. Social anxiety that occurs in all situations responds best to a combination of medication and therapy, while therapy alone is often sufficient for people with anxiety specific to one type of performance or social situation. So, if you’ve been diagnosed or think you may have SAD, know that it’s possible to overcome it.

Psychotherapy can be used alone or together with prescription medications. CBT is particularly effective for anxiety disorders including SAD, and ACT, general exposure therapy and social skills training may all be helpful.


Several different types of medications are prescribed to treat SAD. Each has its advantages and disadvantages depending on your particular situation. 


SSRIs are considered the first-line pharmacotherapy treatment due to their tolerable side effects and ease of administration.


SNRIs are a class of antidepressants used in anxiety treatment that act on the neurotransmitters seretonin and norepinephrine.

Beta Blockers

Beta blockers are usually taken orally prior to an anxiety-inducing event such as a performance to reduce symptoms of anxiety such as rapid heart rate, hand tremors, and the “butterflies in the stomach” feeling.


These are mild tranquilisers that alleviate the symptoms of anxiety by slowing down the central nervous system. Although fast-acting and well-tolerated, benzodiazepines have the potential to be habit-forming and should not be prescribed for someone with a substance abuse disorder.