Clarvit S R, Schneier F R, Liebowitz M R
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.
J Clin Psychiatry. 1996 Nov;57(11):523-7. doi: 10.4088/jcp.v57n1104.
Taijin-kyofu-sho (TKS) is thought to be a common, culture-bound disorder of social anxiety in Japan and Korea. Its phenomenology has been noted to overlap with that of social phobia. The "offensive type" of TKS, which has no direct parallel in Western classification, is characterized by a fear of offending others in social situations, which leads to social avoidance. There has been only one case of offensive-type TKS reported in the United States, and this case was not regarded as a variant of social phobia.
The phenomenology and treatment of six patients who presented to New York City anxiety disorders research clinic psychiatrists with the offensive type of TKS are described. Features of TKS are compared with those of social phobia, as described in Western countries. Treatment outcomes for four patients are discussed and compared with TKS treatment experience in Japan and Korea and with treatment outcome in social phobia.
In this anxiety clinic sample, features of the offensive type of TKS showed much overlap with symptoms of social phobia. Only two of four treated patients in this TKS sample received adequate trials of medication known to be effective for social phobia, and one of the two improved significantly.
The offensive type of TKS may not be as culture-bound as previously thought. Further study is needed to determine whether such cases respond to medications and to cognitive-behavioral approaches that are effective for social phobia. How to classify the offensive type of TKS is uncertain, but social phobia should be considered in the differential diagnosis.
恐人症被认为是日本和韩国常见的、与文化相关的社交焦虑障碍。其现象学特征已被指出与社交恐惧症有重叠。恐人症的“冒犯型”在西方分类中没有直接对应的类型，其特征是在社交场合中害怕冒犯他人，进而导致社交回避。在美国仅报告过一例冒犯型恐人症病例，且该病例未被视为社交恐惧症的一种变体。
描述了六名因冒犯型恐人症到纽约市焦虑症研究诊所求诊于精神科医生的患者的现象学特征及治疗情况。将恐人症的特征与西方国家所描述的社交恐惧症的特征进行比较。讨论了四名患者的治疗结果，并与日本和韩国的恐人症治疗经验以及社交恐惧症的治疗结果进行了比较。
在这个焦虑症诊所样本中，冒犯型恐人症的特征与社交恐惧症的症状有很多重叠。在这个恐人症样本中，接受治疗的四名患者中只有两名接受了已知对社交恐惧症有效的药物的充分试验，其中两名中的一名有显著改善。
冒犯型恐人症可能不像以前认为的那样受文化限制。需要进一步研究以确定此类病例是否对治疗社交恐惧症有效的药物和认知行为方法有反应。冒犯型恐人症如何分类尚不确定，但在鉴别诊断中应考虑社交恐惧症。
