Taijin kyofusho

Taijin kyofusho (対人恐怖症 taijin kyōfushō, TKS, for taijin kyofusho symptoms), is a Japanese culture-specific syndrome. The term taijin kyofusho literally means the disorder (sho) of fear (kyofu) of interpersonal relations (taijin). Dr. Shoma Morita described the condition as vicious cycle of self examination and reproach which can occur in people of hypochondriacal temperament.

Taijin kyofusho is commonly described as a form of social anxiety (social phobia), with the sufferer dreading and avoiding social contact. However, instead of a fear of embarrassing themselves or being harshly judged by others because of their social ineptness, sufferers of taijin kyofusho report a fear of offending or harming other people. The focus is thus on avoiding harm to others rather than to oneself.

In the official Japanese diagnostic system, taijin kyofusho is subdivided into the following categories:
 * Sekimen-kyofu, the phobia of blushing (ereuthophobia)
 * Shubo-kyofu, the phobia of a deformed body, similar to Body dysmorphic disorder
 * Jikoshisen-kyofu, the phobia of eye contact
 * Jikoshu-kyofu, the phobia of having foul body odor (osmophobia, bromidrosiphobia)

Taijin kyofusho is not detailed as distinct from social anxiety disorder in the DSM IV. This is under debate, however, as symptoms indicative of taijin kyofusho are sometimes found in patients in the United States.

Prevalence
Typically diagnosed in adolescence or early adulthood, taijin kyofusho affects 10-20% of the Japanese population. Clinical data indicates that more males have the condition than females despite the fact that females scored higher on a social phobia scale and report higher scores on proclivity towards feelings of embarrassment than their male counterparts. This differs from Western society where the prevalence of females with social phobias is to some extent greater than that of males. The lifetime prevalence of the disorder falls anywhere between 3% and 13% with changes in severity occurring throughout one's lifetime.

Diagnosis
A person may be diagnosed with Taijin Kyofusho (TKS), if they feel as if their attitudes, behavior, and physical characteristics are inadequate in social situations. As a result of these feelings, they also experience persistent suffering in the form of emotional distress through shame, embarrassment, anxiety, fear, and other tense feelings when confronted with social circumstances. In addition, individuals also worry about being unable to maintain healthy relationships with others. When it comes to socializing, TKS sufferers avoid painful social and interpersonal situations, while simultaneously being averse to doing so.

Treatment
The standard Japanese treatment for taijin kyofusho is Morita therapy, developed by Dr. Morita Masatake in the 1910s as a treatment for the Japanese mental disorders taijin kyofusho and shinkeishitsu (nervousness). The original regimen involved patient isolation, enforced bed rest, diary writing, manual labor, and lectures on the importance of self-acceptance and positive endeavor. Since the 1930s, the treatment has been modified to include out-patient and group treatments; this modified version is known as neo-Morita therapy. Medications have also gained acceptance as a treatment option for taijin kyofusho.

Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI), is currently used in the treatment of taijin kyofusho and has been shown to be efficacious for social anxiety disorder.