Taijin Kyofusho, A Culture-Bound Social Phobia

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).

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with this condition simultaneously crave and fear interpersonal interactions, and may gradually become more and more withdrawn in an effort to avoid their fearful reactions.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.

How Is Taijin Kyofusho Diagnosed?

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:

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 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.

What Causes 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.

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.

Treatment Options

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).

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.

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.

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.