0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Is Taijin Kyofusho a Culture-Bound Syndrome?
KATSUAKI SUZUKI, M.D., Ph.D.; NORI TAKEI, M.D., Ph.D., M.Sc.; MASAYOSHI KAWAI, M.D.; YOSHIO MINABE, M.D., Ph.D.; NORIO MORI, M.D., Ph.D.
Am J Psychiatry 2003;160:1358-1358. doi:10.1176/appi.ajp.160.7.1358

To the Editor: Taijin kyofusho is described as a "culturally distinctive phobia in Japan" in DSM-IV. However, in the indigenous Japanese diagnostic system, depending on the content of the patients’ fear that they will displease or embarrass others, taijin kyofusho is classified into four subtypes: sekimen-kyofu (the phobia of blushing), shubo-kyofu (the phobia of a deformed body), jikoshisen-kyofu (the phobia of eye-to-eye contact), and jikoshu-kyofu (the phobia of one’s own foul body odor) (1). Of these four subtypes, sekimen-kyofu can reasonably be included in the category of social phobia, according to DSM-IV, since the fear of blushing is a common symptom. Shubo-kyofu also fulfills the criteria for body dysmorphic disorder in DSM-IV. Thus, at this stage, the notion that taijin kyofusho is a culture-bound syndrome cannot be held. Furthermore, although the remaining two subtypes, jikoshisen-kyofu and jikoshu-kyofu, cannot be adequately assigned to any of the diagnoses in the DSM-IV classification system, a literature review argues against this notion.

For instance, a case has been reported in which an American woman had a fear of embarrassing others by glancing at their genital areas (2). Although the authors gave a diagnosis of taijin kyofusho to the patient, a more adequate diagnosis should have been jikoshisen-kyofu, according to Japan’s classification system. Moreover, it is likely that individuals suffering from jikoshisen-kyofu are overlooked in the West because jikoshisen-kyofu is a rare condition, and the vast majority of individuals with it do not seek psychiatric services, even in Japan.

As for jikoshu-kyofu, a similar condition exists in Western literature (olfactory reference syndrome). Pryse-Phillips (3) introduced the term, describing patients who are preoccupied with the idea that their bodies emit a foul odor that offends others, a feature identical to that of jikoshu-kyofu. Therefore, we contend that jikoshu-kyofu, as well as the other three subtypes of taijin kyofusho, are not culturally distinctive phobias in Japan.

Since there is no properly conducted population-based study of taijin kyofusho in Japan or in other countries, to our knowledge, it is difficult to make a firm conclusion as to whether all four subtypes of taijin kyofusho are culturally bound or whether some of the subtypes are virtually specific to Japan. It should be recognized, however, that there is a wide gulf between the understanding of taijin kyofusho in Japan, since it incorporates diverse clinical entities, and the current stance in DSM-IV. But is taijin kyofusho really a culturally distinctive phobia? (Other countries treat it as a specific type of phobia in Japan.) This discrepancy could be due to the erroneous introduction of the concept of taijin kyofusho to the West. In future studies, a diagnostic system specifying each subtype of taijin kyofusho should be applied, and more clinical attention should be paid to such sufferers.

Takahaski T: Social phobia syndrome in Japan. Compr Psychiatry  1989; 30:45-52
[PubMed]
[CrossRef]
 
McNally RJ, Cassiday KL, Calamari JE: Taijin-kyofu-sho in a black American woman: behavioral treatment of a "culture-bound" anxiety disorder. J Anxiety Disord  1990; 4:83-87
[CrossRef]
 
Pryse-Phillips W: An olfactory reference syndrome. Acta Psychiatr Scand  1971; 47:484-509
[PubMed]
[CrossRef]
 
+

References

Takahaski T: Social phobia syndrome in Japan. Compr Psychiatry  1989; 30:45-52
[PubMed]
[CrossRef]
 
McNally RJ, Cassiday KL, Calamari JE: Taijin-kyofu-sho in a black American woman: behavioral treatment of a "culture-bound" anxiety disorder. J Anxiety Disord  1990; 4:83-87
[CrossRef]
 
Pryse-Phillips W: An olfactory reference syndrome. Acta Psychiatr Scand  1971; 47:484-509
[PubMed]
[CrossRef]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 40.  >
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition > Chapter 0.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 40.  >
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition > Chapter 0.  >
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition > Chapter 0.  >
Topic Collections
Psychiatric News
PubMed Articles