[Social phobia: east and west].
The condition corresponding to social phobia, named taijin-kyofu (taijin: in relation to people, kyofu: phobia), has been widely known since the early 1930s in Japan. As there had been few reports on social phobia in Western countries until DSM-III was introduced in 1980, taijin-kyofu had long been considered as a unique condition existing only in Japan. After DSM-III, it was realized that taijin-kyofu included two types of social phobia (SP). The first one meets the diagnostic criteria for social phobia described in DSM-IV and ICD-10 (type 1 SP). On the other hand, the clinical manifestations of the second type of social phobia (type II SP) are not covered by the same criteria. Mori et al. reported that out of 152 patients with SP, 92 were classified as type I and 60 as type II cases. In 1977, I published a small book on taijin-kyofu dealing with 100 subjects, most of whom belonged to type II SP. Reviewing the complaints of type II SP patients, we can point out 4 characteristics; 1. Firm belief in the existence of serious shortcomings (such as flushing, bodily odors). 2. Its existence is intuitively perceived by patients from the behavior, actions and gestures of other people around them. 3. These defects make others to feel unpleasant and therefore must be corrected or removed. 4. No other symptoms appear in the long follow-up period of time. Predominant targets of their phobias are as follows, flushing in 22, eye contact in 15, showing one's odd attitude in 18, body dysmorphia in 5, bodily odors in 28, multiple fears in 3 and anxiety about others' attitude in 9 cases. Out of 100 subjects, 76 were male and 24 were female. Their sufferings started often in the low teens, most frequently in the high teens, and next in the early 20s and much less afterwards. Although avoidant personality disorder is often comorbid with SP, character traits in childhood of more than half of them were active and only 13 cases were timid and introverted. Most of them were brought up in ordinary homes. Morita-oriented psychotherapy combined with anxiolytic drugs was carried out. The outcome after the average of 10.6 times interview sessions showed complete or almost complete recovery in 27 cases, considerable improvement in 55 and no apparent changes in 18 cases. It has been argued that socio-cultural tradition in Japan where more value is placed on thoughtfulness for others than on self-assertion, more on emotional intimacy than on logical explanation, more on human trust than on laws can be one factor for the development of type II SP. But Lee of Korea reported that 119 out of 315 SP cases presented type II features. It is expected that similar condition is found in countries other than Japan and Korea. In 1993, I published the English edition of my old Japanese book. In its preface, I wrote; My purpose for providing an English translation of this book is to pose a simple question to psychiatrists and clinical psychologists outside of Japan, "Do you see these kinds of patients in your country or not?".
Yamashita
Itaru
I
Hiramatsu Memorial Hospital.
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000523:psychology