Taijin Kyofusho and Social Anxiety Disorder: A Cross-Cultural Analysis of Fear, Shame, and Diagnosis

Cultural frameworks profoundly shape the ways in which psychological disorders are experienced, expressed and diagnosed. This thesis examines the impact of cultural differences on psychiatric diagnosis through a comparative analysis of Social Anxiety Disorder (SAD), as defined in Western psychiatry, and Taijin Kyofusho (TKS), a Japanese culture-bound syndrome. Drawing on psychiatric literature, cultural psychology and cross-cultural psychiatry, the study explores how individualistic versus collectivistic orientations influence symptomatology, help-seeking and clinical interpretation. Starting from the cultural foundations of SAD and TKS, with particular attention to the role of individualism, collectivism and cultural constructs – the study investigates the symptomatology and diagnostic overlap between SAD and TKS, highlighting both shared features of social distress and culturally specific expressions of anxiety. It goes on to review debates of whether TKS should be considered a cultural variant of SAD or a distinct disorder. The third and final chapter turns to the clinical and sociocultural implications of this comparison, addressing challenges in cross-cultural diagnosis, adaptations in therapeutic approaches, and the broader impact of stigma and mental health literacy. The findings suggest that, while SAD and TKS share core features of social fear and avoidance, their cultural framing leads to divergent symptom expression and diagnostic interpretation. Ignoring cultural meaning risks committing a “category fallacy”, where Western diagnostic categories are inappropriately applied across contexts. The thesis concludes by emphasizing the need for greater cultural sensitivity in psychiatric practice and diagnostic systems, arguing that integrating cultural insights is essential for accurate assessment and effective treatment.