Assessing Social Anxiety in Japanese and Japanese-Americans in the United States

Abstract

A Social Anxiety Scale designed to assess culture-specific symptoms in Japanese clients was assessed for face validity data. Taijin-Kyofusho is a culture-bound syndrome specific to Japanese culture in the DSM-5. A Social Anxiety Scale (SAS) was designed by the first author from existing Western social anxiety scales and a Taijin-Kyofusho scale. A demographic form yielded information about culturally- knowledgeable clinician respondents, and a questionnaire was used to get feedback on the SAS. Responses were obtained from 27 mental health professionals who worked clinically with Japanese legal residents in the United States and Japanese Americans, regarding culturally appropriate social anxiety assessment. Participants perceived the SAS as comprehensive and applicable to Japanese residents and Japanese Americans. Regarding Taijin-Kyofusho, most agreed that it should be assessed in Japanese residents but were undecided about its clarity and applicability to Japanese Americans. Several concerns were expressed about the validity of Western social anxiety scales for these populations. Most stressed the need for contextualization of social anxiety scales, differences in stigma against mental disorders across ethnicities, and the need for sensitivity of mental health professions to LGBTQ members in these populations. This is the first study on the views of clinicians working with these populations about Taijin-Kyofusho and how to assess anxiety. Nuances between Japanese residents and Japanese Americans were noted. We urge incorporation of cultural differences in manifestations of distress and specifically on Taijin-Kyofusho in training for mental health professionals. The purpose of this paper is to report on the first step in development of a culturally appropriate social anxiety scale for Japanese and Japanese-Americans living in the United States (U.S.). We first review the literature on differences in anxiety presentation across U.S. and Japanese cultures. We then report on feedback from culturally knowledgeable clinicians of the new scale, and specifically on the question of whether Taijin-Kyofusho symptoms should be included.