Taijin kyofusho
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''Taijin kyofusho'' ( ja, 対人恐怖症, TKS, for ''taijin kyofusho symptoms'') is a Japanese
culture-specific syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
. The term taijin kyofusho translates into the disorder (sho) of fear (kyofu) of interpersonal relations (taijin). Those who have taijin kyofusho are likely to be extremely embarrassed about themselves or fearful of displeasing others when it comes to the functions of their bodies or their appearances. These bodily functions and appearances include their faces, odor, actions, or even looks. They do not want to embarrass other people with their presence. This culture-bound syndrome is a
social phobia Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects ...
based on fear and anxiety. The symptoms of this disorder include avoiding social outings and activities, rapid heartbeat, shortness of breath, panic attacks, trembling, and feelings of dread and panic when around people. The causes of this disorder are mainly from emotional trauma or psychological defense mechanism. It is more common in men than women.] Lifetime prevalence is estimated at 3–13%.


Subcategories

''Taijin kyofusho'' is commonly described as a form of
social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disord ...
(social
phobia A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...
), with the person dreading and avoiding social contact, and as a subtype of ''shinkeishitsu'' (
anxiety disorder Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
). However, instead of a fear of embarrassing themselves or being harshly judged by others because of their social ineptness, sufferers of ''taijin kyofusho'' report a fear of offending or harming other people. The focus is thus on avoiding harm to others rather than to oneself. In the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
(DSM-5) it is instead considered a sub-category of the "Other Specified Obsessive-Compulsive and Related Disorder" category 00.3 (F42) where variants of taijin kyofusho are "Shubo-kyofu ..that is similar to body dysmorphic disorder and is characterized by excessive fear of having a bodily deformity" and "Jikoshu-kyofu ..characterized by fear of having an offensive body odor". One source even breaks ''taijin kyofusho'' into two different subtypes: neurotic and offensive. The first subtype can be broken into two parts that are classical type and avoidant type. The classical type being afraid of being judged negatively because of physical signs of anxiety and feeling shame due to anxiety. The physical signs that can cause fear of being judged include sweating and tremors. The second subtype deals with people thinking something about them is offensive. Some of their fears include body odor, gas, excessive or insufficient eye contact, blushing, etc. In the official Japanese diagnostic system, ''taijin kyofusho'' is subdivided into the following categories: * Sekimen-kyofu ( ja, 赤面恐怖), the phobia of
blushing Blushing is the reddening of a person's face due to psychological reasons. It is normally involuntary and triggered by emotional stress associated with passion, embarrassment, shyness, fear, anger, or romantic stimulation. Severe blushing is ...
(ereuthophobia) * Shubo-kyofu ( ja, 醜貌恐怖), the phobia of a deformed body, similar to
body dysmorphic disorder Body dysmorphic disorder (BDD), occasionally still called dysmorphophobia, is a mental disorder characterized by the obsessive idea that some aspect of one's own body part or appearance is severely flawed and therefore warrants exceptional meas ...
* Jikoshisen-kyofu ( ja, 自己視線恐怖), the phobia of
eye contact Eye contact occurs when two people look at each other's eyes at the same time. In humans, eye contact is a form of nonverbal communication and can have a large influence on social behavior. Coined in the early to mid-1960s, the term came from t ...
* Jikoshu-kyofu ( ja, 自己臭恐怖), the phobia of having foul
body odor Body odor or body odour (BO) is present in all animals and its intensity can be influenced by many factors (behavioral patterns, survival strategies). Body odor has a strong genetic basis, but can also be strongly influenced by various diseases ...
(also termed
olfactory reference syndrome Olfactory reference syndrome (ORS) is a psychiatric condition in which there is a persistent false belief and preoccupation with the idea of emitting abnormal body odors which the patient thinks are foul and offensive to other individuals. People w ...
, osmophobia or bromidrosiphobia) Japan psychology also recognizes additional types of ''taijin kyofusho'' based on severity: * Transient: This type of ''taijin kyofusho'' is short-lived and moderately severe. It most commonly appears in teens, but may occur at any time. * Delusional: This is the most common type of ''taijin kyofusho'' and is the most similar to social phobia. It is chronic, often begins before the age of 30, and varies in severity from moderate to severe. * Phobic with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
: This is a more complicated disorder. In such cases, rather than a phobia, ''taijin kyofusho'' is a manifestation of schizophrenic symptoms.


Diagnosis

A person may be diagnosed with taijin kyofusho if they feel as if their attitudes, behavior, and physical characteristics are inadequate in social situations. As a result of these feelings, they also experience persistent suffering in the form of emotional distress through
shame Shame is an unpleasant self-conscious emotion often associated with negative self-evaluation; motivation to quit; and feelings of pain, exposure, distrust, powerlessness, and worthlessness. Definition Shame is a discrete, basic emotion, d ...
, embarrassment, anxiety, fear, and other tense feelings that occur when confronted with social circumstances. In addition, individuals also worry about being unable to maintain healthy relationships with others. When it comes to socializing, taijin kyofusho sufferers avoid painful social and interpersonal situations, while simultaneously being averse to doing so. Those likely to develop taijin kyofusho have more of a temperamental characteristic of being hypochondriacal. The balance between introversion and extroversion in hypochondriacal temperament is geared more towards introversion. The introversion causes sufferers to focus on themself and problems they have, and by fixating on their weaknesses they become more anxious and depressed.


Treatment

The standard Japanese treatment for taijin kyofusho is
Morita therapy Morita therapy is a therapy developed by Shoma Morita. The goal of Morita therapy is to have the patient accept life as it is and places an emphasis on letting nature take its course. Morita therapy views feeling emotions as part of the laws of ...
, developed by
Shoma Morita , also read as Shōma Morita, was a contemporary of Sigmund Freud and the founder of Morita therapy, a branch of clinical psychology strongly influenced by Zen Buddhism. In his capacity as the head of psychiatry for a large Tokyo hospital, Morita ...
in the 1910s as a treatment for the Japanese mental disorders taijin kyofusho and shinkeishitsu (
nervousness Nervous may refer to: * nervousness * Nervous system, a network of cells in an animal's body that coordinates movement and the senses ** Nervous tissue, the cells of the nervous system that work in aggregate to transmit signals Music * "Nervous" ...
). The original regimen involved patient isolation, enforced
bed rest Bed rest, also referred to as the rest-cure, is a medical treatment in which a person lies in bed for most of the time to try to cure an illness. Bed rest refers to voluntarily lying in bed as a treatment and not being confined to bed because of ...
, diary writing, manual labor, and lectures on the importance of self-acceptance and positive endeavor. Since the 1930s, the treatment has been modified to include out-patient and group treatments. This modified version is known as neo-Morita therapy. Medications have also gained acceptance as a treatment option for taijin kyofusho. Other treatments include
systematic desensitization Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both c ...
, which includes slowly exposing one self to the fear, and learning relaxation skills, to extinguish fear and anxiety.
Milnacipran Milnacipran (trade names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia. It is not approved for the clinical treatment of major depressive disorder in ...
, a
serotonin–norepinephrine reuptake inhibitor Serotonin–norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant drugs used to treat major depressive disorder (MDD), anxiety disorders, obsessive–compulsive disorder (OCD), social phobia, attention-deficit hyperactivity dis ...
(SNRI), is currently used in the treatment of taijin kyofusho and has been shown to be efficacious for the related
social anxiety disorder Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects ...
. The primary aspect of treating this disorder is getting patients to focus their attention on their body parts and sensations.


Prevalence

Typically, this disease is presaged by a childhood history of social inhibition and
shyness Shyness (also called diffidence) is the feeling of apprehension, lack of comfort, or awkwardness especially when a person is around other people. This commonly occurs in new situations or with unfamiliar people; a shy person may simply opt t ...
. It is possible that it could result from a humiliating traumatic experience, or it could emerge from a lifelong onset of the illness that only comes to the surface after time. Clinical data indicates that more males have the condition than females, despite the fact that females scored higher on a
social phobia Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects ...
scale than men, and report higher scores on proclivity towards feelings of embarrassment. This differs from Western society where the prevalence of females with social phobias is to some extent greater than that of males. The lifetime prevalence of the disorder falls anywhere between 3% and 13% with changes in severity occurring throughout one's lifetime. It is estimated that about 17% of individuals with taijin kyofusho have fears of releasing foul body odor.


See also

*
Anthropophobia Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects o ...
*
Avoidant personality disorder Avoidant personality disorder (AvPD) is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy (despite an intense desire for it), severe feelings of inadequacy and inferiority, and an overrelia ...
*
Hikikomori , also known as acute social withdrawal, is total withdrawal from society and seeking extreme degrees of social isolation and confinement. ''Hikikomori'' refers to both the phenomenon in general and the recluses themselves. ''Hikikomori'' ha ...
*
NEET NEET, an acronym for "Not in Education, Employment, or Training", refers to a person who is unemployed and not receiving an education or vocational training. The classification originated in the United Kingdom in the late 1990s, and its use has ...
*
Obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...


References


Further reading

* * * *


External links

* * http://www.japanpowered.com/japan-culture/taijin-kyofusho-the-disorder-of-fear * http://anthropology.msu.edu/anp204-us12/2012/07/20/taijin-kyofusho-in-japan-and-south-korea/ * * http://www.stolaf.edu/depts/ciswp/khughes/papers/psychopathology.pdf * http://jcc.sagepub.com/content/43/2/219.abstract {{DEFAULTSORT:Taijin Kyofusho Anxiety disorders Culture-bound syndromes Society of Japan Japanese words and phrases Phobias