What Is Taijin Kyofusho?

A Culture-Bound Social Phobia

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What Is Taijin Kyofusho?

Translated as "the disorder of fear," taijin kyofusho, or TKS, is a specific, culturally bound, Japanese form of social phobia anxiety disorder. Japanese culture stresses the good of the group over the desires of the individual. Therefore, if you have this phobia, you might be intensely fearful that your body's appearance or functioning is offensive or displeasing to others.

Some Japanese people with taijin kyofusho particularly focus on odors, others on the way that they move, and still others on their body shape or aesthetics. The fear can also be of aspects of your mind rather than your physical body. You might be afraid that your attitude, behaviors, beliefs, or thoughts are different than those of your peers.

Taijin kyofusho is listed in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) as a culture-related diagnostic issue under the diagnostic information for social anxiety disorder (social phobia).

This fear occurs in about 10 to 20% of Japanese people. It is also more somewhat more common in men than women. By contrast, anxiety disorders are significantly more prevalent in women than men.

Symptoms

Taijin kyofusho and social phobia, or social anxiety disorder, have similar symptoms. Common symptoms include:

People with this condition simultaneously crave and fear interpersonal interactions, and may gradually become more and more withdrawn in an effort to avoid their fearful reactions. In some cases, people may experience panic attacks in response to social situations that trigger their fear response.

While usually associated with Japan and Korea, research suggests that the condition is also present in other regions including Indonesia and Switzerland.

Diagnosis

In order to diagnose this condition, a doctor or mental health professional will ask questions about the duration, severity, and nature of an individual's symptoms. They may also conduct a physical exam and perform lab tests in order to rule out other conditions that might be causing these symptoms.

The crucial difference between taijin kyofusho and non-culturally bound social anxiety disorder is subtle. Commonly in the West, people with social anxiety disorder are afraid of experiencing embarrassment in front of others, while Japanese people with taijin kyofusho are afraid of embarrassing others by being in their presence.

In keeping with cultural expectations, the basis of social anxiety disorder is on the individual's reactions, while the basis of taijin kyofusho is on the individual's perception of the reactions of the group.

Types

The Japanese diagnostic system divides taijin kyofusho into four specific subtypes. Each subtype is similar to a specific phobia:

  1. Sekimen-kyofu is a fear of blushing.
  2. Shubo-kyofu is a fear of a deformed body.
  3. Jiko-shisen-kyofu is a fear of one's own glance.
  4. Jiko-shu-kyofu is a fear of body odor.

Severity

Japanese psychology also recognizes four types of taijin kyofusho based on severity:

  1. Transient: This type is short-term, moderately severe, and most common in teens.
  2. Phobic: This type is chronic, moderate to severe, and the most common type. It often begins before the age of 30.
  3. Delusional: The individual obsesses over a particular personal flaw of the body or mind that may periodically change.
  4. Phobic with schizophrenia: This is a separate and more complicated disorder. In this case, taijin kyofusho is part of the individual's schizophrenic reactions, not a simple phobia.

Causes

While the exact causes of taijin kyofusho are not known, there are a few different factors that may play a role. As with social anxiety disorder, the condition may be more likely to occur in adults who have a history of shyness and behavioral inhibition. Difficult or traumatic social experiences could also play a role.

Because some researchers believe the condition is culturally bound to Japanese and Korean cultures, some have suggested that the collectivist culture of these regions may also play a role.

Impact of Taijin Kyofusho

Taijin kyofusho can affect an individual's life in a number of different ways. It may create significant emotional distress and lead to feelings of fear and shame.

While people with the condition may want to be around others, they tend to avoid social or interpersonal situations where they might feel embarrassed, ashamed, or inadequate. This can make it difficult to maintain healthy relationships and can lead to feelings of isolation and loneliness.

Research suggests that people with the condition tend to be more introverted. Because of this, they tend to focus their attention inward on their own perceived weaknesses and failures, which then exacerbates feelings of anxiety and depression.

Treatment

In the Western world, clinicians don't recognize taijin kyofusho as a separate disorder and usually treat it the same way as social anxiety disorder. Typical Western treatments for the condition would typically involve:

Medications

Anti-anxiety medications, antidepressants, or beta blockers may be prescribed to help treat social anxiety disorders. Such medications are often most effective when combined with some type of psychotherapy.

Psychotherapy

Cognitive-behavioral therapy (CBT) is a type of psychotherapy that is often used to treat social anxiety. It focuses on helping people identify and change negative thoughts that contribute to anxiety. It also helps people find other ways of coping with fear and practice social skills that can be helpful for reducing social fears.

Morita Therapy

Japanese clinicians frequently use Morita therapy. Developed in the 1910s, traditional Morita therapy is a highly regimented progression that helps the patient learn to accept and redirect his thoughts. Stage one is bed rest in total isolation, stages two and three focus on work, and only stage four includes what Westerners think of as therapeutic techniques such as talk therapy.

Today, Japanese clinicians modify Morita therapy for outpatient or group settings, but the basic principles remain the same. Like Western psychiatrists, Japanese doctors sometimes prescribe medications as an adjunct to therapy.

Coping

In addition to seeking professional treatment for the conditions, people may also be able to utilize self-help strategies to help manage feelings of anxiety. Some things that people may find helpful include:

  • Relaxation techniques: Strategies such as deep breathing and progressive muscle relaxation are tools that people can use to help reduce feelings of anxiety in social situations. Research suggests that deep breathing, for example, can help lower symptoms of arousal, anxiety, and depression.
  • Self-care: Taking care of physical well-being is another tactic that can help people manage feelings of anxiety. Getting enough sleep, eating a healthy diet, and getting regular exercise are all important for feeling good and keeping anxiety at bay. Avoiding excessive caffeine can also be helpful.
  • Practice social skills: It can also be helpful for people with social anxiety to practice their social skills with people that they trust. Asking friends, joining a support group, or attending group therapy are good ways to get practice in settings that are safe and encouraging.

A Word From Verywell

While taijin kyofusho can create significant distress, effective treatments are available. If you are experiencing symptoms of anxiety that are keeping you from fulfilling everyday needs including your work, relationships, school, or daily living, you should contact a mental health professional.

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