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Taijun Kyofusho
Ryan Macero
John Jay College of Criminal Justice
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Taijun Kyofusho
Culturally bound syndromes are typically restricted to a certain group depending on what
the disorder is, in other words, a culturally bound syndrome is a recognizable disease restricted
to a specific group (Sumathipala, 2004). Culture-bound syndromes had significant amounts of
contributions by researchers and clinicians in last five decades, and now culture is a notable part
of psychology (Alarcón, 2009). As a result, many Americans are coming to recognize and learn
about the different types of culturally bound syndromes outside of the United States, such as
eastern bound syndromes (Sumathipala, 2004). One culturally bound syndrome outside the
United States is known as Taijin Kyofusho—often abbreviated as TKS—which is recognized to
affect the people in Japan. According to the Diagnostic and Statistical Manual of Mental
disorders (DSM-V), TKS is a social anxiety disorder that occurs among the people in the
Japanese and Korean cultures, the anxiety comes from persistent and constant fear of offending
others in social situations (Vriends, Pfaltz, Novianti & Hadiyono, 2013). In other words,
according to Vriends, Pfaltz, Novianti & Hadiyono (2013), individuals with TKS disorder fear
social situations such as conversations, group gatherings, etc., because they are afraid that their
physical characteristics, such as blushing, body odor or gaze might offend others. Nagata et al.
(2006) suggests that TKS is divided into two sub-categories: offensive and delusional. This paper
will be discussing the nature of TKS, its diagnosis, treatment, and Differential Diagnoses as well
as arguments proposing that TKS is not a culturally bound symptom.
Eastern Diagnoses
As TKS is a culture-bound syndrome, the DSM-IV describes it as a culturally distinctive
phobia in Japan, many symptoms of TKS can be classified as a specific disorder in the United
States (Suzuki, Takei, Kawai, Minabe & Mori, 2003). Suzuki, Takei, Kawai, Minabe & Mori
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(2003) break TKS in to 4 parts: the phobia of a deformed body (shubo-kyofu), the phobia of
blushing (sekimen-kyofu), the phobia of one’s own foul body odor (jikoshu-kyofu) and the
phobia of eye to eye contact (jikoshisen-kyofu). According to Ruble (2014), as a result of these
symptoms, one may go into social isolation to avoid offending others with their own body. The
most common symptom of TKS is being stared at or being caught being staring at another
person, if one fails to avoid social activity one might experience the feelings of shame and
embarrassment, because they made someone else feel uncomfortable; this part of TKS makes up
the offensive subtype of the disorder (Ruble, 2014). The offensive subtype of TKS relies heavily
on what other people think of the individual, so one might avoid interpersonal situations at all
costs (Nagata et al., 2006). According to McCrann from PBS (2017), in Japan, people are greatly
influenced by what people think, therefore impacting behaviors and thoughts; shame occurs
when one has failed to live up to other people’s obligations, versus when in the United States,
guilt is a more prominent negative feeling on the self since its an individualistic society.
Therefore, those in Japan or Korea can be more prone to experience feelings of guilt if they
found themselves offending others with their own body (Ruben, 2017). Japan is extremely
concerned with what is acceptable and what is unacceptable, which leads to one’s huge concern
to the outer-self, which can be the reason why TKS is prevalent among Japanese cultures
(Ruben, 2017). The second subtype of TKS, the delusional subtype, includes the first subtype as
well (Nagata et al., 2006). Nagata et al. 2006 describe the symptoms of TKS delusional subtype
as the individual perceives a defect in his or her own body, odor, or appearance, because of this,
the individual might think that their body might give others unpleasant feelings. The individual
might develop delusions that other might be avoiding him her/her due to their body defects
(Nagata et al., 2006). Overall the first subtype of TKS is concerned with avoiding interpersonal
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relationships in order to avoid anxiety and shame, the second subtype is concerned with
delusions, one might perceive that they have bodily defects and because of that others are
avoiding them, and at the same time that individual is avoiding interpersonal relationships as
well due to their anxiety.
Western Differential Diagnosis
TKS offensive subtype can be diagnosed differently in western countries, a major
diagnosis would be Social Anxiety Disorder (SAD). The DSM-5 defines SAD as the persistent
fear of social situations, as a result the individual will try his or her best to avoid social situations
(“Social anxiety disorder”, 2017). As both disorders share common symptoms, it is clear to see
why western clinicians might diagnose SAD instead of TKS. What distinguishes both disorders
is the fact that TKS concerns with not offending another, also, symptoms of bodily delusions
