The neurotic versus delusional subtype of taijin‐kyofu‐sho: Their DSM diagnoses

Abstract

The main purpose of the present study was to investigate the diagnostic concepts of taijin-kyofu-sho (TKS) and social phobia, by comparing the clinical diagnosis of TKS and the operational diagnosis of Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised; DSM-III-R). Three evaluators conducted semistructured interview for DSM-III-R (SCID axis I and II, the Japanese version) to 88 outpatients who visited Jikei University Daisan Hospital, Japan, over a period of 1 year, requesting Morita therapy. The patients were also independently diagnosed by three psychiatrists to identify TKS. A total of 65.8% of 38 cases of TKS were diagnosed as social phobia. Among the neurotic TKS cases, the percentage was high at 81.5%, while among the delusional TKS cases it was 27.3%. A total of 42.1% of the TKS cases were diagnosed as mood disorder; 60.5% of the TKS cases presented some axis II disorders, among which avoidant personality disorder was the most prevalent (31.6%). There was no significant difference between the neurotic and delusional subtypes of TKS, regarding comorbidity with axis I diagnoses. As for axis II diagnoses, delusional TKS patients had a higher rate of comorbidity with paranoid personality disorder, although they demonstrated very similar trends in comorbidity with all other personality disorders. In the diagnostic system of DSM-III-R, it is highly likely that the neurotic and delusional subtypes of TKS will be seen to correspond to different diagnostic categories.

Features of the offensive subtype ofTaijin-Kyofu-Sho in US and Korean patients with DSM-IV social anxiety disorder

“…Studies in non-clinical samples found moderate correlations between social anxiety and features of offensive TKS in healthy volunteers of nonAsian or Japanese descent in the US [Kleinknecht et al, 1994], students in the US and Japan [Kleinknecht et al, 1997], and students in Japan reporting interpersonal difficulties [Tarumi et al, 2004]. A clinical study reported that 65.8% of Japanese outpatients with clinically diagnosed TKS also met DSM-III-R criteria for SAD [Nakamura et al, 2002], although SAD was more common among TKS patients characterized by ''neurotic'' symptoms (81.5%) than among those with ''delusional'' symptoms (27.3%). Case reports that have described seven American patients with offensive TKS challenge the disorder's cultural exclusivity, suggesting that offensive TKS does occur, at least sporadically, outside the Far East [Clarvit et al, 1996;McNally et al, 1990].…”

Social Anxiety/Taijin-Kyofu Scale (SATS): Development and Psychometric Evaluation of a New Instrument

“…TK is a concept related to SAD and BDD. The categories of fear or anxiety and avoidance behavior are components that are as important in the assessment of TK as in that of SAD [2,40]. In the BDD-YBOCS, distress, resistance, and interference are equally assessed by the 2 categories of obsession and compulsion.…”

“…Fifteen patients (1 inpatient and 14 outpatients; 9 men and 6 women, mean age 24.8 ± 6.6 years) who met the traditional diagnostic criteria for c-TK (table 1) [40] gave signed informed consent for videotaped interviews. None of the patients had other comorbid psychiatric disorders (e.g.…”

Cross-Cultural Study of Conviction Subtype Taijin Kyofu

“…TK, however, has traditionally been divided into two categories in Japan, namely tension subtype and conviction subtype (Kasahara, 2005;Nakamura et al, 2002). Conviction subtype TK is characterized by both a strong belief and fear that others will be offended by one's own inadequacies.…”