Japanese Culture-Bound Disorders: The Relationship between 'Taijin Kyofusho, Hikikomori,' and Shame

First conceptualized in the 1960s, the term culture-bound disorders refers to a classification of mental disorders or syndromes that are considered specific or closely related to cultural factors and or particular ethnocultural groups. In Japan, two culture-bound disorders, "taijin kyofusho" and "hikikomori," have seized the interest of researchers and professionals due to their prevalence in Japanese society. The first disorder, "taijin kyofusho," is a culture-bound social anxiety disorder that has been documented in Japan since the 1930s. It is characterized by the experience of anxiety in, and often avoidance of, social and interpersonal situations for fear of offending others through blushing, eye-to-eye contact, body deformity, and/or emitting body odor. The second disorder, "hikikomori," has only emerged in the last 30 years, but afflicts a substantial portion of the Japanese population. It is clinically distinguished by symptoms of social withdrawal, self-confinement in one's home, no intimate relationships with family members, and the absence of engagement in social activities. Because the symptomatology of both disorders closely resemble several of the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM-IV-TR," American Psychiatric Association, 2000) diagnoses, research on the prevalence and culture-bound specificity of the disorders are investigated, as well as the efficacy of pharmacotherapy, individual and group psychotherapy, and psychosocial rehabilitation treatments. Finally, drawing upon research describing the relationship between mental illness and shame, and shame's inextricable relationship to Japanese history and culture, it is proposed that "taijin kyofusho" and "hikikomori" are sequelae of shame in Japanese society. (Contains 1 table.)