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Taijin Kyofusho

Taijin-Kyofusho syndrome(TKS) is a fear of interpersonal relationships. TKS became a legitimate mental health disorder in 1994. This is the year that the DSM-IV first included TKS. TKS is widely thought to be a culture bound form of anxiety. This theory has been called into question as cases are now being reported and published in Europe and America. For the most part however, TKS is mainly found in Japan and Korea. The earliest reported cases of TKS were reported in Japan and Korea. The first reported case was in Kasahara, Korea in 1991. The next diagnosis of TKS took place in Kinmacer, Japan in 1998.

In the official Japanese Diagnostic System Manaul, Taijin Kyofusho is broken down to four different catagories: 1. Sekimen-Kyofo, the fear of blushing 2. Jikoshu-Kyofu, the fear of an unpleasant body odor 3. Jikshisen-Kyfy, the fear of direct eye contact 4. Shubo-Kyofu,the fear of deformed body parts This syndrome is believed to affect 10-20% of the population(JAPAN OR KOREAN POP?). It is most often diagnosed and discovered in adolescence and early adulthood which supports the research on pressure put on individuals while in school. For some unknown reason, this syndrome tends to affect males more often than females, except in the Western countries where females show a greater percent of suffering from social phobia.

TKS is closely related to Social Phobia. The DSM-IV lists the offensive form of TKS. TKS is thought to be a cultural bound syndrome due to the lack of reported cases in other parts of the world. The DSM-IV defines TKS as "a culturally distinctive phobia in Japan, in some ways resembling Social Phobia in DSM-IV. This syndrome refers to an individual's intense fear that his or her body, its parts or its functions, displeases, embarasses or are offensive to other people in appearance, odor, facial expression, or movements. This syndrome is included in the official Japanese diagnostic system for mental disorders."

Taijin-Kyofusho syndrome has two subtypes underneath the heading of TKS. These two subtypes became subtypes in 1987 and are widely accepted. The two subtypes are, General(simple) and Offensive or Delusional. The two share the same features with the only difference being that the Offensive or Delusional has additional features. General TKS is characterized by blushing, stiff facial expressions, fear of being negatively judged by other individuals, and frequent avoidance behaviors. TKS Offensive or Delusional adds the following features: a delusional belief that he or she has a defect in body odor or a specific body part such as a hand, a delusional belief that someone may be harmed by their physical traits, a delusional belief of embarrassing or offending other individuals, a delusional fear that individuals try to avoid them, and a delusional fear of facial expressions and movements.

The original treatment for Taijin-Kyofusho was developed in 1910 by Dr. Morita Massatake. Not surprisingly, the treatment is referred to as the Morita Therapy. This therapy included patient isolation, bed rest, manual labor, journal writing, and group therapy that stressed the need for self-acceptance and maintaining a positive view of oneself. This therapy was all done as an inpatient and may have taken up to thirty days until the patient was healthy enough to enter society once again. Since then, there have been developments that allow this syndrome to be treated by outpatient care. This therapy includes group therapy and the use of some new and modern medicine that has shown promise in decreasing the symptoms of Taijin-Kyofusho.

There have been studies conducted on TKS. One study was conducted using 133 participants. Ninety-four of the participants met the criteria for Social Phobia according the DSM-IV. The remaining participants had no symptoms for any mental health disorder. All participants resided in Australia and were born in the Western states. The findings indicated that the level of offensive worry rose in participants who had Social Phobia. These same participants also showed a decrease in offensive worry after treatment for Social Phobia. This study indicated that there is indeed a close relationship between TKS and Social Phobia. Though the two mental health disorders are similar, they appear to have different constructs(WHAT ARE THOSE CONSTRUCTS?).

There are some medications currently on the market that are indicating some promising results. Milnaipran and Paroxentine are two pharmaceutical drugs that have indicated to decrease the symptoms for TKS Offensive and general social fears in Japan. There has been some promising results using Cognitive Behavioral therapy in Korea. This therapy has produced positive results in decreasing the symptoms for TKS. In the Korean study, it was noted that the therapy produced better results than the pharmaceutical drugs. These findings have been used to reinforce the idea of culture playing a part int the treatment of TKS.

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1) Iwaso, M., Nakao, K., Takaishi, J., Yorifuji, K., Ikezawa, K., & Takeda, M. (2000). An empirical classification of social anxiety: Performance, interpersonal and offensive. Psychiatry and Clinical Neurosciences, 54(1), 67-76. doi:10.1046/j.1440-1819.2000.00639.x

2) http://www.brainphysics.com/taijin-kuofisjp.php

3) Nagata, T., Wada, A., Yamada, H., Iketani, T., & Kiriike, O. (2005). Effect of milnacipran on insight and stress coping strategy in patients with Taijin Kyofusho. International Journal of Psychiatry in Clinical Practice, 9(3), 193-198. doi:10.1080/13651500510029228

4) American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington, DC: Author.

5) Iwaso, M., Nakao, K., Takaishi, J., Yorifuji, K., Ikezawa, K., & Takeda, M. (2000). An empirical classification of social anxiety: Performance, interpersonal and offensive. Psychiatry and Clinical Neurosciences, 54(1), 67-76. doi:10.1046/j.1440-1819.2000.00639.x

6) American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington, DC: Author.

7) Iwaso, M., Nakao, K., Takaishi, J., Yorifuji, K., Ikezawa, K., & Takeda, M. (2000). An empirical classification of social anxiety: Performance, interpersonal and offensive. Psychiatry and Clinical Neurosciences, 54(1), 67-76. doi:10.1046/j.1440-1819.2000.00639.x7

8) American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington, DC: Author.

9) Nagata, T., van Vliet, I., Yamada, H., Kataoka, K., Iketani, T., & Kiriike, N. (2006). An Open Trial of Paroxetine for the 'Offensive Subtype' of Taijin Kyofusho and Social Anxiety Disorder. Depression and Anxiety, 23(3), 168-174. doi:10.1002/da.20153.

10) Iwaso, M., Nakao, K., Takaishi, J., Yorifuji, K., Ikezawa, K., & Takeda, M. (2000). An empirical classification of social anxiety: Performance, interpersonal and offensive. Psychiatry and Clinical Neurosciences, 54(1), 67-76. doi:10.1046/j.1440-1819.2000.00639.x

11) Iwaso, M., Nakao, K., Takaishi, J., Yorifuji, K., Ikezawa, K., & Takeda, M. (2000). An empirical classification of social anxiety: Performance, interpersonal and offensive. Psychiatry and Clinical Neurosciences, 54(1), 67-76. doi:10.1046/j.1440-1819.2000.00639.x

Kim, J., Rapee, R., & Gaston, J. (2008). Symptoms of offensive type Taijin-Kyomsho among Australian social phobics. Depression and Anxiety, 25(7), 601-608. doi:10.1002/da.20345.

Nuckolls, C. (2006). Ambivalence and Anxiety in the Psychiatric Systems of the United States and Japan. Anthropology & Medicine, 13(2), 173-186. doi:10.1080/13648470600738492. Bold text