Phobias Types What Is Taijin Kyofusho? A Culture-Bound Social Phobia By Lisa Fritscher Lisa Fritscher Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics. Learn about our editorial process Updated on March 24, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print visualspace / Getty Images Table of Contents View All Table of Contents Definition Symptoms Diagnosis Types Causes Impact Treatment Coping 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. People who have this phobia might be intensely fearful that their body's appearance or functioning is offensive or displeasing to others. Some 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 the mind rather than the physical body. A person with TKS might be afraid that their attitude, behaviors, beliefs, or thoughts are different than those of their 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 somewhat more common in men than women. Other anxiety disorders are significantly more prevalent in women. Symptoms of Taijin Kyofusho Taijin kyofusho and social phobia, or social anxiety disorder, have similar symptoms. Common symptoms include: A strong desire to flee the situation Blushing Difficulty speaking Gastrointestinal distress Inappropriate eye contact Shaking Sweating 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with this condition simultaneously crave and fear interpersonal interactions, and may gradually become more and more withdrawn in an effort to avoid their fearful reactions.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 of Taijin Kyofusho In order to diagnose this condition, a doctor or mental health professional will ask questions about the duration, severity, and nature of symptoms. They may also conduct a physical exam and perform lab tests in order to rule out other conditions that might be causing the symptoms. The crucial difference between taijin kyofusho and non-culturally bound social anxiety disorder is subtle. People with social anxiety disorder are afraid of experiencing embarrassment in front of others, while 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 of Taijin Kyofusho The Japanese diagnostic system divides taijin kyofusho into four specific subtypes. Each subtype is similar to a specific phobia: Sekimen-kyofu is a fear of blushing. Shubo-kyofu is a fear of a deformed body. Jiko-shisen-kyofu is a fear of one's own glance. Jiko-shu-kyofu is a fear of body odor. Severity Japanese psychology also recognizes four types of taijin kyofusho based on severity: Transient: This type is short-term, moderately severe, and most common in teens. Phobic: This type is chronic, moderate to severe, and the most common type. It often begins before the age of 30. Delusional: The individual obsesses over a particular flaw of the body or mind that may periodically change. 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 of Taijin Kyofusho 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. Behavioral inhibition is a temperament characterized by a tendency to withdraw or experience distress in response to unfamiliar people, situations, and environments. Children who have higher levels of behavioral inhibition have a higher risk of developing social anxiety disorder. Difficult or traumatic social experiences could also play a role. For example, being in a situation where a person was shamed or embarrassed socially might contribute to the development of the condition. 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. Research also suggests that the condition may be linked to less independent self-construal. Self-construal refers to how a person defines themselves with regard to their independence or interdependence with others. Greater interdependence is linked to more concerns over how people will be evaluated by others. Impact of Taijin Kyofusho Taijin kyofusho can affect a person'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. Recap Like social anxiety disorder, taijin kyofusho can create significant impairment and success. People with the condition may struggle with relationships and experience social isolation and loneliness. Treatment for Taijin Kyofusho Outside of Japan and some other Asian countries, clinicians don't recognize taijin kyofusho as a separate disorder and usually treat it the same way as social anxiety disorder. Typical treatments for the condition often involve medication and therapy. Medications Anti-anxiety medications, antidepressants, or beta blockers may be prescribed to help treat social anxiety disorders. One older study found that people with taijin kyofusho experienced improvements when taking selective serotonin reuptake inhibitors (SSRIs). 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. A type of CBT known as exposure therapy may also be helpful for treating taijin kyofusho. This approach is often used to treat specific phobias and involves gradual, progressive exposure to what a person fears. As people gain experience and tolerance toward the source of their fear, feelings of anxiety begin to gradually decrease. 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 therapeutic techniques such as talk therapy. Today, Japanese clinicians modify Morita therapy for outpatient or group settings, but the basic principles remain the same. Japanese doctors sometimes prescribe medications as an adjunct to therapy. Coping With Taijin Kyofusho In addition to seeking professional treatment for the conditions, people may also be able to use self-help strategies to help manage feelings of anxiety. Relaxation techniques: Strategies such as deep breathing and progressive muscle relaxation can 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: 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. Social skills practice: It can also be helpful for people with social anxiety to practice social skills with people they trust. Spending time with friends, joining a support group, or attending group therapy are good ways to get practice in safe, encouraging settings. Recap In addition to seeking professional treatment, people with taijin kyofusho can benefit from self-help strategies to help cope with symptoms. Relaxation techniques, social support, and self-care can help people manage symptoms of anxiety more effectively. 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. The Best Treatments for Social Anxiety Disorder 20 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Nakagami Y, Ii T, Russ TC, et al. Taijin kyofusho: A culture‐bound diagnosis discussed by Japanese and international early career psychiatrists. Psychiatry Clin Neurosci. 2017;71(2):146. doi:10.1111/pcn.12482 Park SC, Kim YK. Anxiety disorders in the DSM-5: Changes, controversies, and future directions. Adv Exp Med Biol. 2020;1191:187-196. doi:10.1007/978-981-32-9705-0_12 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Essau CA, Sasagawa S, Ishikawa S, Okajima I, O'Callaghan J, Bray D. A Japanese form of social anxiety (taijin kyofusho): frequency and correlates in two generations of the same family. Int J Soc Psychiatry. 2012;58(6):635-642. doi:10.1177/0020764011421099 Lim L. Taijin-Kyofu-Sho: A subtype of social anxiety. OJPsych. 2013;03(04):393-398. doi:10.4236/ojpsych.2013.34042 Tei S, Kauppi JP, Jankowski KF, et al. Brain and behavioral alterations in subjects with social anxiety dominated by empathic embarrassment. Proc Natl Acad Sci U S A. 2020;117(8):4385–4391. doi:10.1073/pnas.1918081117 Vriends N, Pfaltz MC, Novianti P, Hadiyono J. Taijin kyofusho and social anxiety and their clinical relevance in indonesia and Switzerland. Front Psychol. 2013;4:3. doi:10.3389/fpsyg.2013.00003 Arimitsu K, Hitokoto H, Kind S, Hofmann SG. Differences in compassion, well-being, and social anxiety between Japan and the USA. Mindfulness (N Y). 2019;10(5):854–862. doi:10.1007/s12671-018-1045-6 Iwata Y, Suzuki K, Takei N, et al. Jiko-shisen-kyofu (fear of one's own glance), but not taijin-kyofusho (fear of interpersonal relations), is an east Asian culture-related specific syndrome. Aust N Z J Psychiatry. 2011;45(2):148-152. doi:10.3109/00048674.2010.534068 Haibloom S. Taijin kyofusho: what clinicians need to know. Alliant International University thesis. doi:10.13140/2.1.4420.2249 Henderson H, Pine D, Fox N. Behavioral inhibition and developmental risk: A dual-processing perspective. Neuropsychopharmacol. 2015;40:207–224 (2015). doi:10.1038/npp.2014.189 Sharpless BA, Balko AL, Grom JL. Taijin kyofusho. In: Sharpless BA, ed. Unusual and Rare Psychological Disorders: A Handbook for Clinical Practice and Research. Oxford University Press. Maeda F, Nathan JH. Understanding taijin kyofusho through its treatment, Morita therapy. J Psychosom Res. 1999;46(6):525-30. doi:10.1016/s0022-3999(98)00113-5 Hofmann SG, Hinton DE. Cross-cultural aspects of anxiety disorders. Curr Psychiatry Rep. 2014;16(6):450. doi:10.1007/s11920-014-0450-3 Matsunaga H, Kiriike N, Matsui T, Iwasaki Y, Stein DJ. Taijin kyofusho: a form of social anxiety disorder that responds to serotonin reuptake inhibitors?. Int J Neuropsychopharmacol. 2001;4(3):231-7. doi:10.1017/S1461145701002474 National Institute of Mental Health. Social anxiety disorder: more than just shyness. Wu H, Yu D, He Y, Wang J, Xiao Z, Li C. Morita therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2015;(2):CD008619. doi:10.1002/14651858.CD008619.pub2 Zaccaro A, Piarulli A, Laurino M, et al. How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing. Front Hum Neurosci. 2018;12:353. doi:10.3389/fnhum.2018.00353 Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety in general practice - a systematic review and meta-analysis. BMC Health Serv Res. 2018;18(1):559. doi:10.1186/s12913-018-3313-5 Dour HJ, Wiley JF, Roy-Byrne P, et al. Perceived social support mediates anxiety and depressive symptom changes following primary care intervention. Depress Anxiety. 2014;31(5):436-42. doi:10.1002/da.22216 Editorial Process Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Phobias Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.