The place of culture in psychiatric nosology: taijin kyofusho and DSM-III-R

Article Abstract:

Effects of culture on psychiatric diagnostic criteria are discussed in terms of taijin kyofusho (TKS), a common form of social disorder in Japan. TKS patients have intense anxiety related to the way others view them, and dread offending or causing discomfort in others. Although many TKS patients fulfill the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria for social phobia, Japanese psychiatrists do not believe that social phobia includes the full TKS spectrum. There are three common TKS fears which are not among the DSM-III-R social phobia criteria: eye-to-eye contact, emitting foul odors, and blushing. Many TKS patients have the delusion that they have a malformed or defective body which offends others. Western theories of social phobias stress negative self-evaluations among patients who were criticized and humiliated in childhood. Differences in Japanese child-rearing practices illustrate how different cultural patterns can influence social anxiety. There, parents stress responsibility for the feelings of others, and children are taught that disgrace has an impact on all family members. In Western culture, steady eye contact denotes honesty and confidence. In Japan, intense eye contact is viewed as rude and aggressive. The Japanese emphasize intuiting others' thoughts and feelings. Proper conduct is dependent on awareness of others' responses. It is posited that TKS induces a feedback loop between the person with TKS and others in Japan who are discomforted by awkwardness and peculiar behavior. Although many neurobiological and psychological commonalities exist across cultures, the need for a cross-cultural perspective in general psychiatric theory is stressed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Japan, Popular culture, Terminology, Mental illness, Psychiatry, Psychiatric diagnosis, Psychiatry, Transcultural, Transcultural psychiatry

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DSM-III personality disorders among patients with major depression, anxiety disorders, and mixed conditions

Article Abstract:

The issue of which personality traits (considered permanent) are characteristic of people with different affective and anxiety disorders has long been a subject of debate in psychiatric thinking. To learn more concerning the personality characteristics of people with these psychopathological diagnoses, 298 outpatient psychiatric patients in Norway with pure anxiety or major depression, or a mixed diagnosis, underwent evaluation to determine the presence of personality disorders. Patients were diagnosed according to standardized methods, using the categories established in DSM-III (Diagnostic and Statistical Manual, edition III). Results showed that 79 percent of the patients with major depression were also diagnosed as having a personality disorder; of these 46 patients, 28 had more than one disorder. Seventy-eight percent of the patients with pure anxiety disorder also had a personality disorder; 52 had more than one disorder. Finally, among the group with mixed anxiety-depression, virtually all (95 percent) had a personality disorder, with the majority (30 out of 37) diagnosed as having more than one. Additional data are provided regarding the frequency of personality disorders for other diagnostic categories. The data indicate that people with histories of combined anxiety and disorders have a higher incidence of personality disorders, both mild (avoidant or dependent disorder) and severe (paranoid or borderline disorder). Thus, awareness of the types of personality and affective disorder a patient may exhibit is important for the institution of appropriate treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Depression, Mental, Affective disorders, Mood disorders, Personality disorders

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