Syndromes related to a cultural emphasis on presenting a physical appearance pleasing to otherstaijinkyofu reactions

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In contrast to the condition commonly diagnosed in Western psychiatry as social phobia (ICD-10, F40.1; DSM-IV, 300.23), with which it has some features in common, the Japanese form of anthropophobia taijin-kyôfu ('fear in relation to others') is not a phobic avoidance of social contacts in order to avoid unpleasant feelings for oneself, rather it is the fear that one's external appearance and behaviour may be disturbing or offending to the other, who as a rule is neither a stranger nor a close relation but a respected acquaintance. Symptoms of taijin-kyôfu were mentioned in the eleventh-century Genji saga by Lady Murasaki Shikibu, and detailed clinical descriptions of this condition suggest it to be typical of Japanese culture (3 33> and as paradigmatic for a culturally related syndrome;(34) that it is also not uncommon in Korea(35> may only indicate a cultural relationship. The clinical syndrome taijin-kyôfu was introduced into psychiatric literature in the 1920s by Morita as a subtype of the shinkeishitsu nervous temperament that he considered to be the main indication for his 'Morita psychotherapy'. The group of taijin-kyôfu symptoms include fears of inconveniencing, disturbing, offending, or even insulting the other by blushing, by one's body odour, by staring into the other's face (therefore avoiding eye contact), by one's assumedly defective facial or body features, or by other negative attributes of one's person. As in other delusion-near phobias, the differential diagnostic exclusion of paranoid schizophrenia and persecutory delusional disorder is of prognostic and therapeutic importance. Private clinics in Japan have numerous admissions with taijin-kyôfu symptoms that were in the past mostly manifested by young males, but more recently also by young females and older persons, which has been attributed to sociocultural changes associated with an increasingly competitive economic climate.

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