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What is Social Anxiety: 3 Ways It’s Different from Introversion

Often mistaken for introversion, social anxiety is a mental disorder that must be taken seriously. So, what is social anxiety? How to treat it? Find out here.

A woman wearing a mask and standing alone among a moving crowd

What is social anxiety? It’s a mental disorder often dismissed as shyness or unwillingness to open up. Because of these misconceptions, most people may not know a lot about social anxiety.

As it turns out, anxiety is very common. The World Health Organization (WHO) estimates 264 million people globally lived with anxiety disorders in 2015. This figure has seen a rising trend since the COVID-19 pandemic began.

In Malaysia, the Health Ministry (MOH) revealed that 85.5% of the distress calls received by government agencies from May 2020 to 2021 were related to mental health issues, including anxiety. 

No thanks to the pandemic, the number of people suffering from anxiety disorders is on the rise. While the condition is generally treated with psychotherapy, there are also different ways to manage it.

Read on as we describe these alternative methods, which are based on the principles of Traditional Chinese Medicine (TCM). This article will also help determine whether or not you have social anxiety.

So What is Social Anxiety? 

The National Institute of Mental Health (NIMH) categorises social anxiety as a mental health condition and a common type of anxiety disorder. Also known as social phobia, it is an intense, persistent fear of being watched and judged by others.

Social anxiety can hinder someone from engaging in social situations considered normal by others. Activities such as dating, attending a job interview, or even talking to a barista will cause anxiety and fear in the person. They feel afraid that people would humiliate, judge, and reject them.

In some cases, people living with the condition only experience the symptoms at public events. For example, when they’re giving a speech or performing on stage. This is called performance anxiety. 

An alternative definition: Social anxiety disorder (SAD) includes features of marked fear of one or more social situations during which the individual may or may not be under scrutiny by others. Exposure to such situations provokes anxiety in the affected individual, and they experience concerns about being judged negatively. As a result, these individuals avoid social situations which result in impairment in occupational, social or other realms important to function in society. 

Causes of Social Anxiety 

The NIMH lists some factors that may cause social anxiety: 

1. Genetics 

Although it is sometimes hereditary, the condition only affects some family members. The reason behind this is unknown. 

Many research studies done have shown genetic factors do contribute to SAD, however, it is largely dependent on environmental factors. Genetic markers have been difficult to identify. For example; parents that are overly controlling or intrusive may result in inhibited temperament in children, increasing the risks for SAD. 

2. Neurological conditions 

Studies on animals have shown that the amygdala and hippocampus play significant roles in most cases of anxiety disorders. 

3. A misreading of others’ behaviour 

A person with the disorder may falsely think they’re being watched. 

4. Underdeveloped social skills 

Lacking social skills may make someone feel discouraged to interact with people. 

Researchers have also tried to understand the root of social anxiety from TCM’s point of view. A 2020 study explains that, in TCM, anxiety is caused by Excessive Heat in the Head, Heart and Spleen Deficiency, Heart and Gall Bladder Deficiency, Liver and Kidney yin Deficiency, Excess Phlegm and Heat, as well as Blood Stasis.

Do You Have Social Anxiety? Find Out Here.

If you want to know whether or not you have the disorder, you can ask yourself these eight questions: Do you:

  1. Feel nervous when you hear the phone ringing?
  2. Fluster and start trying to come up with ways to avoid the situation, if your job requires you to contact someone? 
  3. Feel awkward and have the desire to be invisible in social settings? 
  4. Feel the need to be constantly on guard at gatherings?
  5. Hide in your rooms when your relatives come to visit? 
  6. Say no to party invites even when you’re free? 
  7. Stay indoors at home just to avoid meeting, greeting or talking to your neighbours? 
  8. Walk a longer route just to avoid meeting other people on the street? 

If your answer is yes to most of them, you might be suffering from social anxiety. As a result, you’ll notice changes in your physical state. You may blush, sweat and tremble. Your heart rate will go up and your mind will go blank. You could feel nauseous and have stomach pain.

Your body can become rigid and your voice grows soft. You make little to no eye contact. Emotionally, you feel scared, self-conscious, and embarrassed. You have low self-worth and fear of judgment. You might isolate yourself from society entirely. 

Social Anxiety Questionnaire 

Interpretation of the results

0 – 20 NONE 
21 – 30 MILD 
31 – 40 MODERATE 
41 – 50 SEVERE 
51 – 68 VERY SEVERE 
A woman sitting at a working desk while staring at her mobile phone in one hand and leaning her head on the other hand
Feeling nervous about an incoming call might be a sign of social anxiety

Social Anxiety vs. Introversion 

Introverts have more or less similar traits to people with social anxiety. That’s why some people might mistake one for another. Significant characteristics differentiate these two conditions. Here are the three key distinctions between social anxiety and introversion.

Psychological conflict 

Socially anxious people: Experience mental self-conflict and negativity; triviality consumes them; they suffer from great psychological pain and feelings of inadequacy. 

Introverts: Channel their conflict into artistic creations or other things that can be done individually. 

Mental conflict 

Socially anxious people: Experience a great fear that triggers shivers, cold sweats, heart palpitations and panic attacks.

Introverts: Can usually overcome their issues on their own. 

Length of time 

Socially anxious people: Experience persistent embarrassment and fear, despite being alone. They try to avoid people altogether. 

Introverts: Feel embarrassed in front of strangers but eventually return to the sense of self when alone. 

Treatment For Social Anxiety Disorder 

Typically, treatments of social anxiety include: 

  1. A type of psychotherapy named cognitive behavioural therapy (CBT)
  2. Support groups
  3. Medications such as anti-anxiety pills, antidepressants, or beta-blockers
Two women smiling and embracing each other while other people in the group look on in the background
Support groups might help overcome social anxiety

Beyond Western medicine, TCM also provides ways to manage symptoms of social anxiety. These methods have even been referenced in the ancient Chinese medical text, the Fundamental Questions of the Yellow Emperor’s Inner Classic (Huang Di Nei Jing Su Wen, 黄帝内经素問)

TCM treatments focus on restoring balance through acupuncture. This practice works by redistributing energy, allowing it to move more efficiently. A study says that acupuncture drives the production of painkilling chemicals by the nervous system, stimulating the part of the brain that governs emotions and reduces anxiety. Moreover, acupuncture reduces the production of stress hormones. 

The same study also discusses the acupoints used in the treatment. They are: si shen cong (EX-HN-1, 四神冲), shen ting (DU24, 神庭), yao yang guan (DU3, 腰阳关), ji zhong (DU6, 脊中), zhong shu (DU7, 中樞), yin tang (HN3, 印堂), tai yang (EX-HN-5, 太阳), yi ming (EX-HN-14, 翳明), tian shu (ST25, 天樞), iian li (RN11, 建裏), guan yuan (RN4, 關原), he gu (LI4, 合谷), san yin jiao (SP6, 三陰交), zu san li (ST36,足三里) and san jian (LI3, 三間). 

TCM also suggests cutting your caffeine intake, as caffeine is thought to generate toxic Heat in the Liver. In TCM, the Liver system governs emotions. Too much Heat in the Liver can further promote anxiety, along with frustration. You can try combatting the excess Heat with ”cold” clearing tea

Multiple kinds of research have provided evidence that acupuncture treats social anxiety disorders effectively. A 2013 study, also showed that acupuncture works well when combined with Western medicine approaches, like hypnosis.

Learning more about the disorder helps to answer the question of what social anxiety is and how it differs from introversion. With any luck, the near future will provide us with an increased awareness of the illness and its variety of treatments.


  1. Malay Mail. 2021. Covid-19: 85.5pc of distress calls involved mental health issues, says Health Ministry  [Accessed 5 January 2022]
  2. World Health Organization. 2017. Depression and Other Common Mental Disorders: Global Health Estimates [Accessed 5 January 2022] 
  3. National Institute of Mental Health. 2014. Social Anxiety Disorder: More Than Just Shyness  [Accessed 5 January 2022] 
  4. National Center for Biotechnology Information. 2013. Traditional Chinese Medicine as a Basis for Treating Psychiatric Disorders: A Review of Theory with Illustrative Cases  [Accessed 5 January 2022] 
  5. National Center for Biotechnology Information. 2014. Scalp Acupuncture Treatment Protocol for Anxiety Disorders: A Case Report  [Accessed 5 January 2021] 
  6. Research Gate. 2020. Acupuncture treatment in anxiety [Accessed 5 January 2021] 
  7. National Library of Medicine. 2022. Social Anxiety Disorder [Accessed 5 January 2021]

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