How Do Different Cultures Experience Social Anxiety Disorder?

Cultural Differences in Social Anxiety Disorder

Different cultures have different reflections of social anxiety.
Social anxiety can vary by culture. Getty / Moment / Shui Ta Shan

Cultural differences in social anxiety are known to exist. Research tells us that how social anxiety disorder (SAD) presents itself can vary depending on where you live and the culture in which you are raised.

This makes sense because different cultures have different social rules and expectations. What is considered "okay" behavior in the United States might be frowned upon in Japan, and vice versa.

In addition, research shows that there are differences in the prevalence of SAD in different cultures.

Prevalence Rates

Results from the National Comorbidity Survey and the National Comorbidity Survey Replication (NCS-R) show that different cultural groups have different rates of social anxiety. In general, social anxiety is less common in East Asian countries.

  • Findings from the surveys indicated 12-month prevalence rates of 7.1 to 7.9% in the United States versus 0.4% in Taiwan.
  • South American countries had prevalence rates similar to the United States, while Korea, China, and Japan showed rates of 0.6%, 0.2% and 0.8%.
  • Results from epidemiological surveys have also indicated high prevalence rates in Russia

Cultures at Increased Risk

A 2001-2002 national epidemiologic survey of over 40,000 people indicated that there was increased risk of social anxiety disorder for native americans, younger people, and those with low incomes.

On the other hand, the following groups were at reduced risk for SAD: males, Asians, Hispanics, Blacks, and those living in urban areas.

How Culture Influences Diagnosis

In addition to differences in social anxiety that come about directly from varying cultures, research has shown that mental health professionals may differ in how they diagnose social anxiety disorder depending on their culture. In certain cultures, there are even specific types of disorders that are similar to social anxiety disorder.

For example, in Japan and Korea, there is Taijin Kyofusho (TKS), which refers to worry about being observed or offending other people. Those with TKS generally avoid a wide range of social situations.

Whereas those with SAD fear embarrassing themselves, those with TKS fear embarrassing others (also known as an allocentric focus).

For example, you might fear giving off bad odors (jikoshu-kyofu), blushing (sekimen-kyofu), having an improper facial expression, or staring inappropriately if you have TKS. Some also fear eye contact (jikoshisen-kyofu).

There tend to be more males than females with TKS and those with the problem generally suffer from only one fear. While this might sound unusual to people from North America, this is because of cultural differences.

Differences in Responding to Treatment 

There is no research evidence to support a difference in how people respond to treatment for SAD among different cultures. However, research has shown that Asians in North America tend to delay treatment more than those of other cultures. 

Social Anxiety Expression by Culture 

In general, there are a number of aspects of culture that may affect the expression of social anxiety.

For example, the degree of individualism (idocentric focus) versus collectivist orientation (allocentric focus) can be important.

Collectivist societies tend to be more accepting of socially reticent behaviors; which makes sense in terms of the lower rates of SAD in Asian countries. In addition, those living in individualistic cultures will express social anxiety in terms of self-blame while those in collectivistic cultures will experience more shame.

A study of social anxiety in Chinese people indicated a unique symptom: fear of making others uncomfortable or influencing them in an way that is not beneficial.

A Word From Verywell

Overall, social fears are dependent on the cultural context in which you live. If you are being evaluated for social anxiety disorder, it is important that your mental health professional makes a diagnosis that takes into account your cultural and social context.

What might be considered socially appropriate behavior in Japan will not be in the United States. Social anxiety should always be evaluated taking your culture into consideration.

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View Article Sources
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