Social anxiety disorder is an anxiety disorder with varying degrees of severity. The central feature of social anxiety disorder (SAD) is the fear of negative evaluation by others. Previous studies suggest that there are differences in reports of social anxiety and social anxiety disorder across cultures. Taijin kyofusho has frequently been discussed as a culture-specific expression of SAD that is believed to be particularly prevalent in Japanese and Korean cultures. The aim of this study was to determine to which degree social anxiety and a culture-specific expression of SAD – taijin kyofusho are present among Taiwanese students when compared with international students. Taiwanese university students and international students studying in Taiwan were given two types of questionnaires: Liebowitz Social Anxiety Scale (LSAS) used for measuring severity of symptoms of social anxiety and taijin kyofusho Scale (TKS) used for measuring severity of symptoms of taijin kyofusho. A total of 300 participants were included for the data analysis. The results showed that there was no significant difference for international students when compared with domestic Taiwanese students. Taiwanese students scored higher on TKS questionnaires measuring taijin kyofusho than students from non-Asian cultures. Older participants scored lower on social anxiety questionnaires without regard to their country of origin.

Introduction 1
Research background 1
Problem statement 2
Purpose of study 2
Definition of terms 3
Thesis outline 4
Literature review 5
Social Anxiety 5
Diagnostic criteria for social anxiety 5
Culturally specific forms of social anxiety: taijin kyofusho 7
Diagnostic criteria for taijin kyofusho 7
Functional consequences of social anxiety disorder 9
Liebowitz Social Anxiety scale 10
Taijin kyofusho Scale 10
Cultural differences in self-reported social anxiety 11
Cultural differences in lifetime prevalence of social anxiety 11
Cultural dimensions that may impact social anxiety 12
Contributions of acculturation to social anxiety 15
Research hypotheses 16
Methodology 19
Research design 19
Research instruments 20
Socio-demographic questionnaire 20
LSAS scale 20
TKS scale 21
Sample 21
Procedure 24
Results 27
Between group (Taiwanese vs. international) differences in LSAS and TKS scores 28
Between group (Taiwanese vs. non-Asian) differences in TKS score 28
The effect of age on social anxiety (LSAS) and taijin kyofusho (TKS) 29
Discussion and Conclusion 31
Social anxiety and taijin kyofusho between international and Taiwanese students 31
Taijin kyofusho between Taiwanese and non-Asian students 32
Effect of age on social anxiety and taijin kyofusho 33
Limitations of the study 33
Suggestions for future research 34
Conclusion 35
References 37
Appendix A 43
Appendix B 44
Appendix C 45
Appendix D 47
Appendix E 49

Andrade, M. S. (2006). International students in English-speaking universities: Adjustment factors. Journal of Research in International education, 5(2), 131-154.
Association, A. P. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub.
Brockveld, K. C., Perini, S. J., & Rapee, R. M. (2014). Social anxiety and social anxiety disorder across cultures. In Social Anxiety (Third Edition) (pp. 141-158): Elsevier.
Brunello, N., Den Boer, J. A., Judd, L. L., Kasper, S., Kelsey, J. E., Lader, M., . . . Mendlewicz, J. (2000). Social phobia: diagnosis and epidemiology, neurobiology and pharmacology, comorbidity and treatment. Journal of affective disorders, 60(1), 61-74.
Burgess, K. B., Rubin, K. H., Cheah, C. S., & Nelson, L. J. (2005). Behavioral inhibition, social withdrawal, and parenting. The essential handbook of social anxiety for clinicians, 99-120.
Chen, Y.-S. (2009). Screening for Social Phobia: Psychometric Evaluation of Chinese Social Phobia Inventory (SPIN). In: Elsevier.
Crozier, W. R., & Alden, L. E. (2001). The social nature of social anxiety. International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness, 1-20.
Crozier, W. R., & Alden, L. E. (2003). International handbook of social anxiety. Concepts, research and interventions relating to the self and shyness. Tijdschrift voor Psychiatrie, 45, 12.
Damm, D. (2005). Soziale Phobie: Angeboren oder erlernt?
Essau, C. A., Sasagawa, S., Chen, J., & Sakano, Y. (2012). Taijin kyofusho and social phobia symptoms in young adults in England and in Japan. Journal of Cross-Cultural Psychology, 43(2), 219-232.
Fang, K., Friedlander, M., & Pieterse, A. L. (2016). Contributions of acculturation, enculturation, discrimination, and personality traits to social anxiety among Chinese immigrants: A context-specific assessment. Cultural Diversity and Ethnic Minority Psychology, 22(1), 58.
Fritz, M. V., Chin, D., & DeMarinis, V. (2008). Stressors, anxiety, acculturation and adjustment among international and North American students. International Journal of Intercultural Relations, 32(3), 244-259. doi:https://doi.org/10.1016/j.ijintrel.2008.01.001
Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W., . . . Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the national epidemiologic survey on alcohol and relatedconditions. Archives of general psychiatry, 61(8), 807-816.
Hasenson-Atzmon, K., Marom, S., Sofer, T., Lev-Ari, L., Youngmann, R., Hermesh, H., & Kushnir, J. (2016). Cultural Impact on SAD: Social Anxiety Disorder among Ethiopian and Former Soviet Union Immigrants to Israel, in Comparison to Native-born Israelis. Isr J Psychiatry Relat Sci, 53(3), 48-54.
Heimberg, R. G., Horner, K., Juster, H., Safren, S., Brown, E., Schneier, F., & Liebowitz, M. (1999). Psychometric properties of the Liebowitz social anxiety scale. Psychological medicine, 29(1), 199-212.
Heinrichs, N., Rapee, R. M., Alden, L. A., Bogels, S., Hofmann, S. G., Oh, K. J., & Sakano, Y. (2006). Cultural differences in perceived social norms and social anxiety. Behav Res Ther, 44(8), 1187-1197. doi:10.1016/j.brat.2005.09.006
Hjörleifsdottir Steiner, K., Johansson, S.-E., Sundquist, J., & Wändell, P. E. (2007). Self-Reported Anxiety, Sleeping Problems and Pain Among Turkish-Born Immigrants in Sweden. Ethnicity & Health, 12(4), 363-379. doi:10.1080/13557850701300673
Hofmann, S. G., Anu Asnaani, M. A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depress Anxiety, 27(12), 1117-1127. doi:10.1002/da.20759
Hong, J. J., & Woody, S. R. (2007). Cultural mediators of self-reported social anxiety. Behaviour Research and Therapy, 45(8), 1779-1789. doi:https://doi.org/10.1016/j.brat.2007.01.011
Hsu, L., & Alden, L. (2007). Social anxiety in Chinese-and European-heritage students: The effect of assessment format and judgments of impairment. Behavior Therapy, 38(2), 120-131.
Hsu, L., Woody, S. R., Lee, H. J., Peng, Y., Zhou, X., & Ryder, A. G. (2012). Social anxiety among East Asians in North America: East Asian socialization or the challenge of acculturation? Cultur Divers Ethnic Minor Psychol, 18(2), 181-191. doi:10.1037/a0027690
Kasahara, Y. (1986). Fear of eye to eye confrontation among neurotic patients in Japan. Japanese culture and behavior, 379-387.
Kasahara, Y., Fujinawa, A., Sekiguchi, H., & Matsumoto, M. (1972). Fear of eye-to-eye confrontation and fear of emitting bad odors. Tokyo: Igaku Shoin, 74-80.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593-602.
Kirmayer, L. J. (1991). The place of culture in psychiatric nosology: taijin kyofusho and DSM-III-R. J Nerv Ment Dis, 179(1), 19-28.
Kleinknecht, R. A., Dinnel, D. L., Kleinknecht, E. E., Hiruma, N., & Harada, N. (1997). Cultural factors in social anxiety: a comparison of social phobia symptoms and taijin kyofusho. J Anxiety Disord, 11(2), 157-177.
Li, A., & Gasser, M. B. (2005). Predicting Asian international students’ sociocultural adjustment: A test of two mediation models. International Journal of Intercultural Relations, 29(5), 561-576.
Liebowitz, M. R. (1987). Social phobia. In Anxiety (Vol. 22, pp. 141-173): Karger Publishers.
Lim, L. (2013). Taijin-Kyofu-Sho: A subtype of social anxiety. Open Journal of Psychiatry, 3(04), 393.
McNeil, D. W. (2010). Evolution of terminology and constructs in social anxiety and its disorders. In Social Anxiety (Second Edition) (pp. 3-21): Elsevier.
Mori, S. C. (2000). Addressing the Mental Health Concerns of International Students. Journal of Counseling & Development, 78(2), 137-144. doi:doi:10.1002/j.1556-6676.2000.tb02571.x
Okazaki, S. (1997). Sources of ethnic differences between Asian American and White American college students on measures of depression and social anxiety. Journal of Abnormal Psychology, 106(1), 52.
Okazaki, S. (2000). Asian American and White American differences on affective distress symptoms: do symptom reports differ across reporting methods? Journal of Cross-Cultural Psychology, 31(5), 603-625.
Sam, D. L., & Eide, R. (1991). Survey of mental health of foreign students. Scand J Psychol, 32(1), 22-30.
Schönbauer, D. (2012). Vergleich der sozialen Ängstlichkeit zwischen europäischen Studenten und ostasiatischen Migranten. uniwien.
Smith, R. A., & Khawaja, N. G. (2011). A review of the acculturation experiences of international students. International Journal of Intercultural Relations, 35(6), 699-713.
Sue, D., Ino, S., & Sue, D. M. (1983). Nonassertiveness of Asian Americans: an inaccurate assumption? Journal of Counseling Psychology, 30(4), 581.
Takahashi, T. (1989). Social phobia syndrome in Japan. Comprehensive Psychiatry, 30(1), 45-52.
Tanaka-Matsumi, J. (1979). Taijin kyofusho: diagnostic and cultural issues in Japanese psychiatry. Culture, Medicine and Psychiatry, 3(3), 231-245.
Tarumi, S., Ichimiya, A., Yamada, S., Umesue, M., & Kuroki, T. (2004). Taijin kyofusho in university students: patterns of fear and predispositions to the offensive variant. Transcult Psychiatry, 41(4), 533-546. doi:10.1177/1363461504047933
Vriends, N., Pfaltz, M. C., Novianti, P., & Hadiyono, J. (2013). Taijin kyofusho and social anxiety and their clinical relevance in indonesia and Switzerland. Front Psychol, 4, 3. doi:10.3389/fpsyg.2013.00003
Wittchen, H.-U., & Fehm, L. (2001). Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatric Clinics, 24(4), 617-641.
Wittchen, H.-U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychological medicine, 29(2), 309-323.