Taijin Kyofusho and Social Phobia Symptoms in Young Adults in England and in Japan

Abstract

The main aims of the present study were to compare the frequency of social phobia and taijin kyofusho symptoms among young adults in Japan and in England and to examine the role of family environment in the development of these two conditions. A total of 927 young adults (462 in England and 465 in Japan) between the ages of 19 and 24 were investigated. They completed a set of questionnaires that were used to measure social phobia and taijin kyofusho symptoms, as well as family background. Results showed that young adults in Japan reported significantly higher levels of taijin kyofusho and social phobia symptoms than young adults in England. Family sociability had a consistent effect on both social phobia and taijin kyofusho symptoms across the two cultures, but parental rearing attitudes showed distinct patterns between the two countries. This finding suggests that cross-cultural models need to consider familial factors that may be predictive across cultures and others that may be more culturally specific.

Keywords

taijin kyofusho social phobia symptoms culture young adults classification systems

Taijin kyofusho is a culture-bound form of social phobia that is characterized by an intense fear that one’s body parts or functions displease, embarrass, or are offensive to others (American Psychiatric Association [APA], 2000). The term taijin kyofusho literally means the disorder (sho) of fear (kyofu) of interpersonal relations (taijin) (Takahashi, 1989). It was first described by Masatake Morita in the 1920s as a manifestation of “shinkeishitsu,” which was used to describe nervous character or temperament (Maeda & Nathan, 1999). Taijin kyofusho is experienced when the individuals have face-to-face contact with other people. Some common symptoms of taijin kyofusho include (a) fears of offending others by blushing, emitting offensive odors, and staring inappropriately; (b) fears of offending others by presenting an improper facial expression, a blemish, or physical defect; (c) strongly convinced of offending others; and (d) being obsessed with feelings of shame (Kirmayer, 1991; Maeda & Nathan, 1999). This fear of offending or bringing shame upon others often leads to social avoidance because it is believed that the individual’s behavior will bring shame upon his or her social or familial group or that he or she fears of disrupting group cohesiveness by making others uncomfortable.

Taijin kyofusho is included under social phobia in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders–Text Revision (DSM-IV-TR; APA, 2000) and in the 10th edition of the International Classification of Mental and Behavioral Disorders (ICD-10; World Health Organization [WHO], 1992), probably because both conditions involve fear of negative evaluation from others and avoidance of social situations (Dinnel, Kleinknecht, & Tanaka-Matsumi, 2002). In DSM-IV-TR (APA, 2000), it is included under “Specific Culture, Age, and Gender Features” section of Social Phobia, and in ICD-10 (WHO, 1992), it is included under social phobia (anthropophobia). Despite this, many professionals have considered taijin kyofusho to be separate from social phobia as they differ in relation to symptom topography and situations in which the disorder is expressed. Specifically, taijin kyofusho symptoms tend to become the most exacerbated in social situations with acquaintances, such as talking to colleagues, but less the case when interacting with strangers or intimate friends and family (Kirmayer, 1991; Maeda & Nathan, 1999). In social phobia, fear is related to being in social or performance situations in which the person is exposed to new or unfamiliar people, is speaking to authorities, or is exposed to possible scrutiny by others.

In taijin kyofusho, the symptoms are related to hypersensitivity to certain body parts but not in social phobia. Specifically, individuals with taijin kyofusho fear that they will offend or embarrass others with their “inappropriate” behavior, which may offend others and thereby bring shame upon their social or familial group (Maeda & Nathan, 1999). Individuals with social phobia fear that they will embarrass themselves (Kleinknecht, Dinnel, Kleinkecht, Hiruma, & Harada, 1997). These differences are explained from the scope of cultural background, child-rearing attitudes, norms of social interaction, and collectivistic values embedded in Asian families believed to account for the high concern in others’ thoughts and feelings (Kirmayer, Young, & Hayton, 1995). Nonetheless, there is little empirical evidence supporting such common views.

There have been various theories and explanations developed for social phobia, one that has focused on the role of familial factors, particularly on parents’ child-rearing attitudes and family environments. Results of studies conducted in Western countries have generally indicated that individuals with social phobia tend to perceive their parents as having been more overprotective during childhood (Bruch & Heimberg, 1994), isolating them from social experiences, more concerned about others’ opinions, and not encouraging family sociability (Bruch, 1989; Bruch & Heimberg, 1994). These could lead to restricted social opportunities and increased social anxiety for the child. Studies have also reported that parents who are overly concerned with others’ opinions may engender a fear of negative evaluation in their children (Buss, 1980), which in turn may lead a child or adolescent to avoid being in social situations. A child’s level of social comfort and competency may also be related to the parents’ level of sociability and the encouragement of the child’s sociability (Bruch, 1989). Parents could influence young children’s social interactions by arranging social opportunities for their children (Beidel & Morris, 1995), and in the absence of adequate social opportunities, the child may not learn appropriate social interaction skills (Bruch, 1989). This lack of opportunity causes children to be unsure of how to interact properly in social situations. Another family factor that has attracted research attention is parental overcontrol. Parental overcontrol is a pattern of behavior that involves excessive regulation of children’s activities and high levels of parental vigilance and intrusion. As reported by several authors (Barlow, 2002; Dadds, 2002), parental overcontrol has been associated with children’s anxiety. In explaining this association, it has been argued that parental overcontrol may limit the development of children’s autonomy and lead to perceptions of the environment as uncontrollable and a limited sense of personal competence.

A study of similarities and differences in the etiology of social phobia and taijin kyofusho may enrich our information regarding anxiety in social situations. However, there is a dearth of research on the etiology for both social phobia and taijin kyofusho and much less cross-cultural studies. Such studies should enable us to test the universality of social phobia and taijin kyofusho. Since anxiety in social situations reflects social values and societal expectations, it is crucial that participants from different cultural backgrounds are examined to enhance our understanding of the disorders and obtain cues for clinical practice.

According to several epidemiological studies, social phobia is one of the most common anxiety disorders; up to 12% of the people in Western countries have been reported to meet the diagnostic criteria of social phobia sometime in their lifetime (e.g., Kessler et al., 1994). Epidemiological studies on the prevalence of social phobia in Japan are scant. Based on one recent epidemiological study by Tsuchiya et al. (2009), the lifetime prevalence of social phobia in Japan was 1.2%. However, studies that examined the frequency of social phobia symptoms have reported higher levels of these symptoms among participants in Japan compared to participants in some Western countries, such as the Netherlands and Belgium (Muris, Merckelbach, Ollendick, King, & Bogie, 2002; Muris, Schmidt, & Merckelbach, 2000). In almost all studies, significantly more females than males met the diagnostic criteria of a social phobia. To our knowledge, there are no data on the prevalence of taijin kyofusho in the general population in Japan and elsewhere. However, in clinical settings, up to 38% of the patients had been diagnosed with taijin kyofusho (Matsunaga, Kiriike, Matsui, Iwasaki, Nagata, & Stein, 2001). Unlike social phobia, taijin kyofusho affects significantly more males than females.

Epidemiology studies in adults have also indicated that 50% of adults in the community who suffer from social phobia report the onset of their symptoms in adolescence (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996; Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992) and many reported being socially anxious for as long as they can remember (Bourdon et al., 1988). Adolescence is a developmental period during which individuals begin to experience increased social demands and develop more complex cognitive abilities. It has been argued that the likelihood of social phobia manifesting itself during this developmental period increases because adolescents experience the anxiety of being scrutinized by people around them (Beidel & Morris, 1995). The typical age of onset for taijin kyofusho is in early adulthood (Takahashi, 1989). Thus, late adolescence to early adulthood makes for an ideal age period to investigate.

Furthermore, the two countries to be examined should be representative of Eastern and Western culture; England and Japan will provide a useful comparison for studying social phobia and taijin kyofusho symptoms due to marked cultural differences in child-rearing and socialization practice. In England, as in other Western industrialized societies, high emphasis is placed on the individual self. An important goal in child-rearing is the promotion of individualism, including self-development, independence, freedom, and autonomy (Friedlmeier & Trommsdorff, 1998; Weisz, Rothbaum, & Blackburn, 1984). To achieve these goals, children are taught to assume control over their own moral decisions and to abandon reliance on others at an early age (Atzaba-Poria & Pike, 2008; Waylen & Stewart-Brown, 2008). British parents also emphasize assertiveness as well as clear and direct verbal communication (Atzaba-Poria & Pike, 2008). In Japan, high value is placed on the socially embedded self and related values of conformity, submissiveness, and group orientation; here, socialization goals are to maintain group harmony and cooperation (Triandis, 1995). To promote group harmony, a common form of child-rearing practice in Japan involves high emphasis of the pro-empathy form of discipline. Specifically, Japanese mothers tended to use an empathy-oriented approach that describes how a child’s misbehavior could hurt other people’s feelings (Convoy, Hess, Azuma, & Kashiwagi, 1980).

Aims and Hypotheses

The main aims of the present study were to examine the frequency of social phobia and taijin kyofusho symptoms and the role of family environment in the development of these two conditions. Specifically, the following questions will be addressed:

Do young adults in England and in Japan differ significantly in the frequency of taijin kyofusho and social phobia symptoms?

What is the effect of gender on social phobia and taijin kyofusho symptoms?

Are there different childhood familial factors that lead to social phobia and taijin kyofusho symptoms in young adulthood? If so, are there distinct patterns between Eastern (Japan) and Western (England) countries?

Are there moderating effects between childhood rearing and family environment?

Three hypotheses were tested in this study. First, the frequency of social phobia and taijin kyofusho symptoms was expected to be higher among young adults in Japan than in England. This hypothesis is based on differences in socialization practices in these two cultures. Japanese socialization practices that may be associated with anxiety may include being restrictive, encouragement of self-control and emotional restraint, as well as high emphasis on other peoples’ opinions (Friedlmeier & Trommsdorff, 1998; Weisz et al., 1984). Furthermore, previous studies have reported that taijin kyofusho has a strong relationship with the collectivistic Asian culture (Dinnel et al., 2002; Kleinknecht, Dinnel, Tanouye-Wilson, & Lonner, 1994). It has been argued that people with taijin kyofusho’s worry about offending or embarrassing others is related to the value given to the group over the individual in Japanese thought (Kleinknecht et al., 1994). Socialization practices in England, by contrast, can be characterized by the promotion of individualism and independence, which may in turn contribute to high self-concept and lowering of anxiety symptoms. Some examples of behavior through which British parents promote independence include teaching children to be self-reliant and to openly express their emotional states, thoughts, and feelings (Atzaba-Poria & Pike, 2008; Waylen & Stewart-Brown, 2008). Second, in line with previous studies, females are expected to score higher on social phobia symptoms than males (Kessler et al., 1994), whereas taijin kyofusho symptoms are expected to be higher in males than females (Matsunaga et al., 2001). Third, childhood familial factors (e.g., parental rearing attitude, family sociability) are expected to play a role in the development of social anxiety and taijin kyofusho symptoms. A high level of family sociability is expected to be related to a low level of social anxiety and taijin kyofusho symptoms. As reported by Bögels, van Oostern, Muris, and Smulders (2001), lack of family sociability predicted child social anxiety in a mixed clinical and normal sample. In the present study, family sociability is defined as a frequent interaction with people outside of the family. The basic idea is that the more open the family is to people outside of the family and the more frequent the interactions, children should have more opportunity to interact with these people themselves (exposure), observe their parents being sociable (observational learning), and practice their social skills (skills acquisition). This hypothesis should apply to individuals in different cultures.

Method

Participants

The sample included 927 participants—462 in England (male = 81, female = 381) and 465 in Japan (male = 223, female = 234, 8 missing). Three hundred and eight (33.1%) of these participants were male and 615 (66.3%) were female. Participants’ age ranged from 19 to 24 years, with a mean age of 20.84 years (SD = 1.4). Participants from England were recruited from different colleges and universities in London. About 76.3% of the participants were White, 12.1% were Asian British, and 11.5% Black British. Of note is that all these participants were born and raised in England; most of them are third-generation Asian or Black British living in England. The Japanese sample was recruited from the universities in Hokkaido, Saitama, Gifu, and Okayama.

Approval to conduct this study was approved by the ethic committee of each university, and the participants’ written informed consent was obtained before participation in the study. At each university, one of the authors or a research assistant distributed the questionnaires for the students to complete in the classroom. The students were informed about the voluntary nature of the study and were told that nonparticipation would not put them at any course disadvantages. All students completed a consent form assuring anonymity and confidentiality prior to responding to any of the psychometric measures.

Instruments

To allow direct comparison, the same questionnaires were used in England and Japan.

The Social Phobia Scale (SPS; Kanai, Sasagawa, Chen, Suzuki, Shimada, & Sakano, 2004; Mattick & Clarke, 1998) is a 20-item measure of fear of performance situations. Each item is rated on a 5-point scale from not at all (0) to extremely (4). The items are summed to yield a total score, with higher scores reflecting higher levels of performance anxiety symptoms. An example of an item is “I feel awkward and tense if I know people are watching me.” The Cronbach alphas in the present study were .92 in Japan and .91 in England.

The Social Interaction Anxiety Scale (SIAS; Kanai et al., 2004; Mattick & Clarke, 1998) was used to assess fear of social interaction situations. This scale is rated on a 5-point Likert-type scale from not at all (0) to extremely (4). The 0 to 4 ratings of the 19 performance anxiety items are summed to yield a total score, with higher scores reflecting higher levels of social interaction anxiety symptoms. An example item is “I find myself worrying that I won’t know what to say in social situations.” The Cronbach alphas in the present study were .93 in Japan and .92 in England.

The Taijin Kyofusho Scale (TKS; Kleinknecht et al., 1997) is a 31-item scale used to assess taijin kyofusho symptoms. It reflects the respondents’ concerns that they would do something to offend or embarrass others. Responses are made on a 7-point Likert-type rating scale, ranging from totally false (1) to exactly true (7). An example item is “I am afraid that eye-to-eye contact with other people will offend them.” Both the English and the Japanese version of the taijin kyofusho have been demonstrated to possess sound internal consistency (Kleinknecht et al., 1997), with Cronbach’s alphas of .92 and .93 for Japanese and American participants, respectively (Kleinknecht et al., 1997). In the present study, the Cronbach alphas were .96 in Japan and .96 in England.

The Brief Fear of Negative Evaluation (BFNE; Leary, 1983) was used to assess fear of negative evaluation. Watson and Friend (1969) defined fear of negative evaluation as “apprehension about others’ evaluation, distress over their negative evaluations, avoidance of evaluative situations, and the expectations that others would evaluate oneself negatively” (p. 449). It comprises 12 items rated on a 5-point Likert-type scale ranging from not at all characteristics of me (1) to extremely characteristic of me (5). Four of its items are reversed keyed. Total scores range from 12 to 60, with high scores reflecting a higher concern for others’ opinions. An example item is “I am usually worried about what kind of impression I make.” The reliability of the BFNE has been established using nonclinical samples, with a high level of internal consistency (alpha = .90), and a test-retest reliability coefficient of .75 was found over a 4-week interval (Leary, 1983).

Recently, the BFNE has been re-analyzed using item response theory (Rodebaugh et al., 2004; Sasagawa, Kanai, Muranaka, Suzuki, Shimada, & Sakano, 2004). To enable accurate measurement of this trait, we estimated the latent trait theta instead of the total score for the BFNE. Computations were done using Mathematica Version 5.2 based on location parameter and slope estimates reported in previous studies. Theta was estimated so that 0 would represent the mean value for both populations and the SD would be 1. A higher theta value indicates a higher BFNE; scores higher than 1 represent scores higher than 1 SD. A negative theta value indicates scores lower than the mean. In the present study, the Cronbach alphas were .92 in Japan and .93 in England.

The Parental Bonding Instrument (PBI; Parker, Tupling, & Brown, 1979) was used to assess parental rearing attitudes. The PBI comprises two subscales: Care and Overprotection. High scores on the Care subscale indicate warm and affectionate parenting attitudes, whereas low scores indicate rejection and indifference. High overprotection scores represent parental control and interference, while low overprotection scores represent allowance of autonomy and independence. All items are rated on a 4-point Likert-type scale ranging from very unlike (0) to very like (3). An example item is “Spoke to me with a warm and friendly voice.” The Cronbach alphas in the present study were .61 in England and .66 in Japan.

Family sociability. To assess the impact of familial interaction with others, family sociability items from the Family Functioning Scale (Bloom, 1985) were used. Five items were rated on a 4-point Likert-type scale ranging from very unlike (1) to very like (4). An example item is “Our family enjoyed being around people.” In the present study, the Cronbach alphas were .80 in Japan and .85 in England.

Translation of Instruments

The English versions of all the questionnaires used in the present study (i.e., SPS, SIAS, TKS, BFNE, PBI, Family Sociability) were adapted and translated in previous studies (e.g., Kanai et al., 2004) according to guidelines that are widely accepted for the successful translation of instruments in cross-cultural research (Brislin, 1970). One bilingual translator, who was also a native speaker or culturally informed individual, blindly translated the questionnaire from the original language (English) to the second language (Japanese), and another bilingual translator translated it back to the original language (Japanese back to English). Differences in the original and the back-translated versions were discussed and resolved by joint agreement of both translators. All the above instruments have also been tested for their construct validities in several studies in Japan (e.g., Kanai et al., 2004; Kanai, Sasagawa, Chen, Shimada, & Sakano, 2009; Shirotsuki, Sasagawa, & Nomura, 2009).

Analysis

A two-way ANOVA (Culture × Gender) was used to compare the frequency of social phobia and taijin kyofusho symptoms in each group. The relationship between childhood familial environment and social phobia and taijin kyofusho symptoms were examined by means of path analysis (multiple population method) based on the model shown in Figure 1. Interaction between parental rearing attitudes and family sociability were examined using hierarchical regression analysis.

Figure 1.

Path Model Examining the Relationship Between Childhood Familial Environment and Social Phobia/Taijin Kyofusho Symptoms

Results

Table 1 shows the means of the study variables in Japan and in England. In order to examine differences in the study variables in relation to culture and gender, all the study variables were submitted to a 2 × 2 ANOVA using culture (Japan and England) and gender (male and female) as independent variables. With regards to taijin kyofusho, the ANOVAs revealed a significant main effect for culture, F(1, 881) = 52.85, p < .001, partial eta-squared = .05, a significant main effect for gender, F(1, 881) = 6.14, p < .05, partial eta-squared = .01, and a significant culture-gender interaction, F(1, 881) = 5.05, p < .05, partial eta-squared = .01. This finding indicated that taijin kyofusho scores were significantly higher in Japan than in England. Further analysis showed gender difference to be present in England, F(1, 435) = 14.97, p < .001, partial eta-squared = .03, but not in Japan.

Table 1.

Gender Differences in the Study Variables

	Total		England		Japan
	M	SD	M	SD	M	SD	Effects
Taijin Kyofusho (total)	83.18	35.6	72.51	32.1	93.45	37.8	Country, F(1, 881) = 52.85, p = .001
							Gender, F(1, 881) = 6.14, p = .013
Male	84.48	37.0	59.65	28.9	93.06	36.0
Female	82.49	35.8	75.19	32.2	94.01	35.7
Social phobia (total)	19.23	12.9	18.05	12.2	20.37	13.5	Country, F(1, 886) = 18.16, p = .001
							Gender, F(1, 886) = 13.02, p = .001
Male	18.24	13.6	13.08	11.0	20.12	13.9
Female	19.74	12.6	19.16	12.2	20.65	13.2
Social interaction anxiety (total)						14.5	Country, F(1, 883) = 36.20, p = .001
	26.41	14.5	22.39	13.5	30.22		Gender, F(1, 883) = 5.12, p = .02
Male	27.08	15.0	19.39	14.3	29.68	14.4
Female	26.09	14.3	23.02	13.2	30.96	14.7
Fear of negative evaluation (total)	−.11	0.84	−.30	0.88	.08	0.76	Country, F(1, 917) = 51.05, p = .001
							Gender, F(1, 917) = 21.46, p = .001
Male	−.23	0.88	−.86	0.86	.01	0.77
Female	−.05	0.82	−.18	0.84	.16	0.75

Note: In England, male = 81, female = 381. In Japan, male = 223, female = 234 (8 participants have missing information on gender).

On social phobia, ANOVA revealed a significant main effect for culture, F(1, 886) = 18.16, p < .001, partial eta-squared = .02, a significant main effect for gender, F(1, 886) = 13.02, p < .001, partial eta-squared = .02, and a significant culture-gender interaction, F(1, 886) = 4.24, p < .05, partial eta-squared = .01. Social phobia scores were significantly higher in Japan than in England, and females in England had significantly higher scores than males, F(1, 437) = 16.92, p < .001, partial eta-squared = .04; no gender differences were found in Japan.

On social interaction anxiety, a significant main effect was found for culture, F(1, 883) = 36.20, p < .001, partial eta-squared = .04, and for gender, F(1, 883) = 5.12, p < .05, partial eta-squared = .01; culture-gender interaction was not significant. As shown in Table 1, social interaction anxiety scores were significantly higher in Japan than in England. With respect to gender difference, females in England had significantly higher scores than males, F(1, 434) = 4.55, p < .05, partial eta-squared = .01. In Japan, no significant gender differences could be found.

Next, we examined linear effects of childhood familial environment on the development of taijin kyofusho and social phobia symptoms by means of path analysis. Pearson product-moment correlations for England and Japan data are shown in Table 2. Taijin kyofusho, SPS, SIAS, and BFNE were strongly associated with each other, as was parental care, overprotection, and family sociability; these correlations were incorporated into the model (Figure 1). Although taijin kyofusho, SPS, SIAS, and BFNE were dependent variables, it was theoretically difficult to assume that these correlations could be completely explained by the causal variables included in the present study (i.e., parental bonding, family sociability), so covariances between the error variables were introduced.

Table 2.

Correlations Between Variables Included in the Path Model

	PBI Care	PBI Overprotection	Family Sociability	SPS	SIAS	TKS
English Data
PBI overprotection	−.58**
Family sociability	.46**	−.30**
SPS	−.04	.09	−.33**
SIAS	−.15**	.15**	−.40**	.80**
TKS	−.10*	.16**	−.30**	.79**	.77**
BFNE	−.01	.06	−.23**	.71**	.58**	.74**
Japanese Data
PBI overprotection	−.51**
Family sociability	.42**	−.32**
SPS	−.18**	.25**	−.21**
SIAS	−.19**	.23**	−.27**	.77**
TKS	−.20**	.24**	−.21**	.77**	.75**
BFNE	.01	.12**	−.11*	.60**	.62**	.62**

Note: PBI = Parental Bonding Instrument; TKS = Taijin Kyofusho Scale; SPS = Social Phobia Scale; SIAS = Social Interaction Anxiety Scale; BFNE = Brief Fear of Negative Evaluation.

p < .05. **p < .01.

To ensure the same theoretical model applied across both countries, multiple population analysis procedure was utilized. The same model structure was specified and fit simultaneously to the two countries to examine the similarities and differences between these subgroups. Constraints were set to assume that all error variances as well as the covariances between error variables take the same value for English and Japanese data. High fit of this model indicate that the measures used in the present study have similar statistical characteristics between the two countries, assuring measurement invariance for each subgroup. All analyses were performed on AMOS Version 5.0 (Arbuckle, 2003). Maximum likelihood method was used for estimation.

Model fit was tested using GFI, CFI, and RMSEA. GFI and CFI values higher than .95 indicate that the model explains the variance of the data well (Jöreskog & Sörbom, 1989). RMSEA provides a fit index unaffected by the size of the model by considering degree of freedom; an RMSEA of .08 or lower is conventionally considered to be an acceptable value.

The present model showed excellent fit, with a GFI of .96, CFI of .97, and RMSEA of .08. These figures provide evidence that the model adequately fits across both the English and the Japanese data and that the translated scales effectively measured identical constructs in the two countries. Path coefficients in the two countries are shown in Figure 1.

Finally, moderating effects between parental rearing attitudes (i.e., care and overprotection) and family sociability were examined using hierarchical regression analysis using taijin kyofusho, SPS, SIAS, and BFNE as dependent variables. The results are shown in Table 3. The only moderating effects found were that in the English data, with SIAS and taijin kyofusho as dependent variables. No moderating effect was found in any of the Japanese data or the analysis with SPS and BFNE.

Table 3.

Moderating Effects of Parental Rearing Attitudes and Family Sociability

	Beta	R-Squared	Delta R-Squared	F
SPS
Step 1		.13 (.08)		21.41* (12.81*)
PBI care	.19** (−.01)
PBI overprotection	.08 (.20***)
Family sociability	−.40* (−.14)
Step 2		.14 (.08)	.01 (.01)	2.66 (1.17)
PBI care	.24*** (−.01)
PBI overprotection	.12* (.21***)
Family sociability	−.40* (−.14)
Care × Family Sociability	.13* (.03)
Overprotection × Family Sociability	.12* (.09)
SIAS
Step 1		.17 (.10)		27.67* (15.74*)
PBI care	.08 (−.02)
PBI overprotection	.07 (.16**)
Family sociability	−.42* (−.21*)
Step 2		.19 (.10)	.03 (.01)	6.72** (1.16)
PBI care	.15* (−.02)
PBI overprotection	.15* (.16**)
Family sociability	−.42* (−.20*)
Care × Family Sociability	.15* (.03)
Overprotection × Family Sociability	.22*** (.08)
TKS
Step 1		.10 (.08)		14.86* (12.75*)
PBI care	.11 (−.06)
PBI overprotection	.13* (.17**)
Family sociability	−.31*** (−.13*)
Step 2		.12 (.09)	.02 (.01)	5.05** (1.85)
PBI care	.19** (−.07)
PBI overprotection	.19 (.18)
Family sociability	−.30*** (−.12*)
Care × Family Sociability	.20** (.01)
Overprotection × Family Sociability	.14* (.09)
BFNE
Step 1		.07 (.03)		10.69* (4.99)
PBI care	.17** (.13*)
PBI overprotection	.07 (.15**)
Family sociability	−.28*** (−.12*)
Step 2		.07 (.04)	.01 (.00)	1.19 (.93)
PBI care	.21*** (.11)
PBI overprotection	.10 (.15**)
Family sociability	−.28*** (−.11*)
Care × Family Sociability	.10 (−.05)
Overprotection × Family Sociability	.07 (.03)

Note: Values outside parentheses are English data, and values inside parentheses are Japanese data. PBI = Parental Bonding Instrument; TKS = Taijin Kyofusho Scale; SPS = Social Phobia Scale; SIAS = Social Interaction Anxiety Scale; BFNE = Brief Fear of Negative Evaluation.

p < .05. **p < .01. ***p < .001.

Discussion

The main aims of the present study were to compare the frequency of social phobia and taijin kyofusho symptoms and the role of family environment in the development of these two conditions. To our knowledge, this is the first study that has compared the frequency and correlates (i.e., family factors) of social phobia and taijin kyofusho in two contracting cultures. As hypothesized, young adults in Japan reported significantly more taijin kyofusho symptoms than young adults in England. The mean taijin kyofusho scores for the young adults were 93.45 in Japan and 72.51 in England. The finding was in line with those reported in previous studies (e.g., Kleinknecht et al., 1997). Our hypothesis that the frequency of social phobia symptoms was higher among participants in Japan than in England was also supported. It is tempting to interpret the higher levels of social phobia and taijin kyofusho symptoms in Japan in terms of culturally determined child-rearing practices and early childhood environment. As discussed by Weisz et al. (1984), “Japanese patterns of child-rearing and socialization seem to foster self-discipline, politeness, attentiveness to others, a strong sense of personal and group identity” (p. 965). It has furthermore been argued that the Japanese’ intense ability for accommodation makes them overly sensitive to disapproval. Japanese mothers have also been reported to generally teach their children to accommodate to social expectations (Friedlmeier & Trommsdorff, 1998; Weisz et al., 1984). British ideology of child training has emphasized individualism, autonomy, independence, and freedom. Given these child-rearing practices and cultural values (Friedlmeier & Trommsdorff, 1998; Weisz et al., 1984), it was not surprising that Japanese young adults, in comparison to young adults in England, had significantly higher scores on taijin kyofusho and social phobia.

However, the role of family in social phobia and taijin kyofusho in the present study is less than clear. Specifically, we found no concrete evidence that taijin kyofusho has a distinct etiological background; rather, it seemed that taijin kyofusho may be a variant of social interaction anxiety. We also found parental rearing to have distinct effects on social phobia and taijin kyofusho symptoms in Japan and in the United Kingdom. Specifically, in the English data, parental care predicted SPS and BFNE scores but failed to have an effect on SIAS and taijin kyofusho scores. On the other hand, parental overprotection predicted SIAS and taijin kyofusho scores but not SPS and BFNE scores. The difference between the SPS/BFNE and SIAS/taijin kyofusho is that the former represents fear of negative evaluation in performance situations such as public speaking and writing, whereas the latter represents anxiety in interaction situations, such as speaking to an unfamiliar person or authorities. The present results can be interpreted that less parental care is associated with a harsher view of the world in terms of performance, whereas more parental overprotection lead to less experience and more fear of social interactions.

In contrast, care had no effect on any of the scales in the Japanese data, but overprotection had an effect on all of the scales. Thus, the distinction between the different social anxiety situations was less outstanding in Japan. This may represent the fact that the Japanese are more sensitive to the observer/audience’s reaction even in performance situations (as represented by the SPS and the BFNE), thereby strengthening the interactional nature of the situation and diluting the distinction between performance and interaction situations. Within the Japanese culture, one needs to be sensitive and emphatic to the responses of others and to “read the atmosphere” in order for the social performance to be successful, whereas in Western cultures, the emphasis is placed more on getting one’s ideas across in a clear and effective way. The fact that parental overprotection was a prime factor to increase fear in all of these situations suggests less exposure and possibly that behavioral modeling plays an important role in the heightening of social anxiety regardless of situation.

Family sociability had a consistent effect on all of the scales across both cultures. The finding that parental rearing has a different effect on social phobia and taijin kyofusho in England and in Japan seemed to suggest that the function of family may be different depending on cultural background. Future studies need to replicate the present study by involving numerous cultures. As our data seem to suggest that taijin kyofusho may be a variant of social interaction anxiety, one aspect to consider in future studies may be to compare interaction communication rules across cultures.

There are several limitations to the present study, which need to be taken into consideration when interpreting our results. First, participants between the ages of 19 and 24 who have been recruited from higher education institutes, while convenient, may have implications for the generalizability of our findings to other populations and age groups. However, findings from clinical settings may be biased due to selection processes. Furthermore, differences in health systems in Japan and in England may make it difficult to compare and interpret findings. Nevertheless, it would be useful to replicate and extend this study in clinical settings because symptoms presented in clinical settings may be different that those presented in community/academic settings. These patients should be free of other comorbid disorders but at a comparable level of distress/disability serving as controls. Second, the data were based on self-report, so the correlations found could have been inflated due to shared method variance. Also, because of this methodology, we cannot rule out that some of the cultural differences across the study measures may have been due to cultural differences in young adults’ willingness to report on social anxiety problems and family environment. Third, the cross-sectional nature of the study does not allow us to make statements about the causal linkage between variables. Fourth, in this study, we did not measure whether there were any subgroups with clinical diagnosis, nor did we ask the participants whether they are in treatment for social phobia or taijin kyofusho.

In summary, the current study provided some important information on cultural differences in the frequency of social phobia and taijin kyofusho symptoms among young adults and on the role of family environment in these two conditions. Specifically, the scores of both social phobia and taijin kyofusho symptoms were significantly higher in Japan than in England. Furthermore, our findings seemed to suggest that taijin kyofusho may be a variant of social interaction anxiety and that the function of family on taijin kyofusho and social phobia may be different depending on cultural background. Thus, this finding suggests that cross-cultural models need to consider factors that may be predictive across cultures and others that may be more culturally specific.

Footnotes

The authors declared that they had no conflicts of interests with respect to their authorship or the publication of this article.

This study was funded by the British Academy and the Japan Society for the Promotion of Science (awarded to Cecilia A. Essau and Yuji Sakano).

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