Taijin-Kyofu-Sho: A subtype of social anxiety

摘要

Taijin-Kyofu-Sho (TKS) has long been considered as a Japanese culture-bound form of social anxiety disorder, although subsequent case-reports from countries outside Japan have dispelled this notion. There are subtle yet distinct differences between TKS and DSM-defined social anxiety disorder (SAD). For instance, the TKS subject fears causing offence to others, whereas the SAD subject is more fearful of causing embarrassment to him/herself. Four sub-categories of TKS have been recognised of which the Jikoshu-kyofu variety resembles the olfactory reference syndrome (ORS) known to Western psychiatrists. There are two TKS subtypes, general (or simple) and offensive (delusional). The general subtype resembles social anxiety disorder, whereas the offensive subtype is characterised by delusions. True community-wide prevalence is unknown, although clinic studies estimate between 7.8% to 45.5% patients have a diagnosis of TKS, with a slight male preponderance. Cultural and societal norms engendering guilt, shame, and embarrassment are likely etiological factors. Treatment may consist of antidepressant and/or antipsychotic medications, while some patients may also benefit from cognitive behavior therapy.