Taijin kyofusho: the fear of offending others

The short answer

Taijin kyofusho (said “tie-jin kyo-foo-show”) means roughly “fear of interpersonal relations” in Japanese. It was first described by Japanese psychiatrists.

In the form most often described in Western social anxiety, you fear that others will think badly of you. In taijin kyofusho, you fear that you will offend or upset others: that your stare is rude, that your blushing makes people uneasy, that your body smells, or that your face looks wrong.

The focus is on the harm you might do to others, not only on the harm to yourself.

What it can look like

People with taijin kyofusho may fear that:

• their gaze is too intense, so others feel stared at and look away;
• their blushing will make others feel awkward;
• their body odour offends people nearby, even when no one can smell anything;
• their face or body is unpleasant to look at;
• their expressions (an odd smile, a twitch) upset others.

In some people the belief becomes very fixed. They are certain that others are reacting to them, even when there is no sign of it.

Is it the same as social anxiety?

Mostly, yes, with a cultural twist.

• The American DSM-5 definition of social anxiety disorder includes the fear that you will act in a way that offends others. That phrase covers the kind of fear seen in taijin kyofusho.
• A study comparing 181 US and 161 Japanese students found that the usual social fear and the fear of offending others formed two separate patterns. They were linked to different ways of seeing yourself: as an independent person, or as part of a group with duties to others.
• A review of culture and social anxiety concluded that the evidence for taijin kyofusho as a distinct condition is mixed.

Is it only Japanese?

No. The fear of offending others is most often written about in Japan and Korea. But doctors in India have described cases too, and people everywhere can have this kind of fear.

Culture and social anxiety more generally

Culture changes how social fear shows up, and maybe how common it is.

• A survey of more than 140,000 people across 28 surveys found lower rates of diagnosed social anxiety in lower-income countries, and in Africa and the Eastern Mediterranean region. Rates were higher in high-income countries.
• The review of culture found the lowest rates in Asian samples and the highest in Russian and US samples.

So the popular idea that people in group-focused cultures are “more socially anxious” does not fit the data. What differs is the form the fear takes. See how common is it?.

What helps

There are few treatment trials for taijin kyofusho itself. In practice, people are treated with the same approaches used for social anxiety:

• Cognitive therapy for social anxiety, which tests feared predictions: for example, do people really look away when you look at them? Does anyone react to your smell?
• SSRIs, prescribed by a doctor.
• In Japan, a traditional approach called Morita therapy has long been used. It teaches you to accept anxious feelings while doing what matters. It has little trial evidence.

When the belief feels certain

If you are completely sure that you smell, or that your face disgusts people, and nothing changes your mind, please talk to a doctor. Very fixed beliefs like this can overlap with other conditions, such as body dysmorphic disorder, and the right treatment may differ. See talking to your doctor. If the distress feels unbearable, see crisis lines.