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Social Anxiety or Just Plain Shy?

Dr. Nusrat Habib Rana

2 min read

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As the second most globally diagnosed anxiety disorder after specific phobias, Social Anxiety Disorder (SAD) or ‘Social Phobia’ is defined as a persistent, intense fear of unfamiliar situations, judgement or being watched by others, causing major hindrances in daily activities and often leading to complete social avoidance.

Like most mental health conditions, psychiatrists say that SAD sufferers recognize the irrationality of their behaviour and beliefs yet are powerless to stop them. The disorder usually appears during childhood or young adulthood; mostly in people with an extremely shy disposition.

How It Differs from Shyness:

While it is true that most people diagnosed with social anxiety were extremely shy as children, Social Anxiety Disorder (SAD) takes the occasional nervousness, jitters, shyness, and self-consciousness associated with social situations and morphs it into an extremely stressful, often physically painful experience when one so much as thinks of social events and venturing out of their comfort zone.  Medically, Social Anxiety Disorder (SAD) symptoms have to be consistently present for at least 6 months prior to diagnosis.


Social Anxiety Disorder (SAD) alters numerous physical, emotional, and behavioural patterns. However, it manifests differently in different people, with symptoms changing over time and amplifying with increased stress.


  • Intense worry spanning days, weeks, and even months prior to an upcoming social event.
  • Excessive self-consciousness in mundane, everyday situations.
  • Fear of accidentally acting in embarrassing and self-humiliating ways.
  • Fear that others will notice their nervousness through their behaviour like stammering, blushing, etc.
  • Worrying about being viewed as stupid, boring, or awkward
  • Low self-esteem
  • Fear of criticism and rejection
  • Dysmorphia (viewing certain body parts as abnormal or disfigured, usually the face)


  • Avoiding social situations where one might have to do something ‘embarrassing’, or where one might be continuously scrutinized by others, e.g. using public restrooms, eating in public, etc.
  • Evading others’ notice by staying quiet or blending in the background
  • A need to be accompanied by at least one familiar person at all times
  • Complete isolation; like resigning from a job or quitting school
  • Over-analyzing one’s performance and pinpointing their interactional flaws following a social situation.
  • Dreading daily activities (phone calls, starting conversations, shopping, etc.), new encounters, and change.
  • Avoiding eye contact
  • A rigid body posture and speaking very softly.
  • Avoiding populated places like buses, malls, parks, etc.


  • Palpitations (pounding or racing heartbeat) and/or chest tightness
  • Nausea
  • Sweating
  • Hot flashes
  • Blushing
  • Shortness of breath
  • Trembling or shaking, including voice
  • Dizziness
  • Muscle twitches around the face and neck
  • Mental blanks
  • Full-blown panic attacks (usually including hyperventilation)

4-SAD in Children:

In addition to the above symptoms, socially anxious children also display the following signs:

  • Crying more than usual
  • Frequent tantrums
  • Avoiding interactions with other children and adults
  • Fear of taking part in school-related activities like performances and classroom interactions; some may even fear going to school altogether.
  • Not asking for help at school
  • Over-reliance on parents or siblings  

Performance Anxiety:

While Social Anxiety Disorder (SAD) often manifests in its generalized state, i.e. fear and distress in all social situations, some individuals may only exhibit symptoms of anxiety in situations where they are expected to perform in front of large gatherings, like giving speeches, playing team sports, dancing, or going on stage.


While the exact cause is as yet unrecognized, the following factors are commonly observed in most people with Social Anxiety Disorder (SAD):

  • Genetics: The fact that siblings and parents often share in the condition makes it possible that SAD is an inheritable condition.
  • Brain Structure: In addition to an overactive amygdala, the part of the brain responsible for controlling fear response, an imbalance in the mood-regulating neurotransmitter serotonin may contribute towards increased anxiety and fear in social situations.
  • Environment: Some children may learn to be socially anxious from their SAD-diagnosed parents or may develop SAD as a result of a controlling and overprotective home environment.
  • Underdeveloped Social Skills: Discouragement following a bad social experience leads to excess worrying and care over how one acts in similar future situations, eventually resulting in a full-blown anxiety disorder.
  • An Attention-Grabbing Appearance or Condition: People with a physical deformity, or stuttering, stammering, and tremors due to Parkinson’s or other neural disorders often develop Social Anxiety Disorder (SAD).

Social anxiety disorder can interfere with one’s relationships, career advancement, and daily life in general, but, with a little effort, can be treated easily and effectively. So, if you observe any signs of SAD in yourself or a loved one, don’t hesitate in reaching out to a specialist. You can also book an appointment with a top Psychologist or Psychiatrist in Islamabad, Karachi and  Lahore through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your mental health concerns.

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Dr. Nusrat Habib Rana - Author Dr. Nusrat Habib Rana is among the Best Psychiatrists in Lahore. Dr. Nusrat Habib Rana is a Psychiatrist practicing in Lahore. She is Ph.D from Spain, MD from China and MCPS from Pakistan.
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