Social Anxiety Disorder: How It Differs from Shyness and How It Is Treated in Japan
Social anxiety disorder is a treatable condition, not a personality trait, and in Japan it is treated with cognitive behavioral therapy, an SSRI, or both. Care is available in English. It is easy to mistake for shyness, and many people live with it for years before seeking treatment. This article is part of our guide to mental health for foreign residents.
How is social anxiety disorder different from shyness?
The difference is how much it limits your life. Social anxiety disorder is an intense fear of being judged or embarrassed, with avoidance of the situations that bring it on. When that fear has lasted six months or more and is affecting your work, relationships, or everyday errands, it is more than shyness.
Does living in a second language make social anxiety worse?
Symptoms are often worse during times of stress or change, and moving to a new country and a new language is both. Speaking a second language also means making mistakes in front of other people many times a day, which is the kind of situation social anxiety makes hard. The disorder itself usually begins early, at a median age of 13, so anxiety you first notice in Japan may have a longer history.
Not all nervousness about speaking Japanese is social anxiety. Nervousness that is in proportion to limited Japanese, and eases as the language improves, is not a disorder. If the same fear is there when you speak your first language, in familiar settings, or in your home country, the language is not the cause. An assessment can tell the two apart.
What does social anxiety look like day to day?
Fear, and then avoidance, in ordinary situations where other people might be watching:
- Rehearsing a phone call and then not making it
- A pounding heart, sweating, or a shaky voice in meetings, introductions, or checkout lines
- Feeling watched while eating, drinking, or writing in front of others
- Turning down unstructured social events
- Replaying a conversation afterward and looking for what went wrong
Over time, social anxiety can interfere with relationships, and depression can occur alongside it. That is one reason to treat social anxiety and not only work around it.
How is social anxiety treated in Japan?
With cognitive behavioral therapy, an SSRI, or both, after an assessment by a psychiatrist. Which to use is decided with you, and your preference counts.
- Assessment. A psychiatrist distinguishes social anxiety from panic disorder, depression, and ordinary adjustment to a new country, because the emphasis of treatment differs. No referral is needed, and psychiatric consultations are covered by health insurance.
- Medication. Three SSRIs are approved for social anxiety disorder in Japan: escitalopram, paroxetine, and fluvoxamine. Japan's clinical guideline for social anxiety disorder suggests them as the first-choice medicines. An SSRI lowers the anxiety over several weeks. Our anti-anxiety medication guide covers how these medicines are used.
- Cognitive behavioral therapy (CBT). Individual CBT designed for social anxiety is the therapy that guidelines recommend. It works on the beliefs behind the fear (for example, "everyone noticed"), on the safety behaviors that keep the fear going, and on step-by-step practice in real situations. In English, this is usually done with a counselor, self-pay, alongside insured psychiatric care (your options).
Frequently asked questions
This article is general information, not medical advice for your individual situation. If you're unwell, please see a doctor.
Medically reviewed by our psychiatrist (M.D.). Updated October 12, 2026.