Cultural aspects in social anxiety and social anxiety disorder

Abstract

To examine cultural aspects in social anxiety and social anxiety disorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and social anxiety disorder. This has direct relevance for the upcoming DSM-V.The defining feature of social anxiety disorder (SAD) is the fear of negative evaluation by others. Therefore, SAD is directly linked to social standards and role expectations, which are culture dependent. Recognizing the intricate interplay between culture and social anxiety, some research has focused on psychopathologic manifestations of SAD across cultures [1], while in other studies the focus has been on comparing disorder-typical symptoms across cultures [2]. It should be noted that most of the studies on cultural differences in SAD have examined Eastern (especially Japanese, Korean, and Chinese) and Western (US American and European) samples.The following is a review of the evidence pertaining to the validity of the DSM-IV-TR criteria for social anxiety disorder (SAD) as it relates to culture, race, and ethnicity. We use the term "race" when we refer to broad differentiations based on physiognomy (e.g., White), "ethnicity" when we refer to "common descent" and affiliation with a historically continuous community (e.g., Latino), and "culture" when we refer to social groups with specific or homogenous attributes. We particularly concentrate on culture as a source for the nosological revisions to explore whether certain cognitive/ behavioral elements (e.g., interpretations of illness; patterned reactions to stressors) affect the development or expression of psychiatric syndromes.The search methods for the current review entailed a thorough computer search using the Pubmed and PsychInfo databases for articles published since the publication of the DSM-IV in 1994. Specifically, key words relevant to SAD (i.e., "social phobia" or "social anxiety disorder") were combined with the terms "culture", "ethnic*", and "race". This approach

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“…Both point of view between previous study and culture showed that head injury become situation which family of patient increase their anxiety due to the condition of their relatives who are in sick. 15 In depth, the results of this study also identified that the anxiety of someone on the condition of patient suffered from pain, is affect to the level of anxiety of family. Data obtained from the results of this study revealed that respondents who identified as mother of patient experienced severe anxiety, unlike respondents as husband and father who are in moderate level of anxiety.…”

Associations between competitive anxiety, athlete characteristics and sport context: evidence from a systematic review and meta-analysis

“…The role of sports and the preference for a specific modality can reveal important characteristics of a country's culture, norms and customs. Experience and manifestation of anxiety may be influenced by ethnical and cultural factors due to beliefs on mental diseases, including social context and norms to which an individual is exposed 85 .…”

Shame: The Emotional Basis of Library Anxiety

“…In some East Asian, collectivist societies, shame is used openly to control social behavior; feeling it publicly can be a positive attribute. 20 Harmony within the community is valued more than individual accomplishments. A modern, individualistic culture views shame as a sign of failure and considers individual success to be the greatest achievement.…”