Neurodevelopmental Disorder Traits in Taijin-Kyofu-sho and Social Anxiety Disorder: A Cross-Sectional Study among University Students

Abstract

Taijin-Kyofu-sho is an East Asian culture-bound anxiety disorder with similarities to social anxiety disorder. However, few studies have examined these two disorders from the perspective of neurodevelopmental disorders. This study is aimed at examining the association of Taijin-Kyofu-sho and social anxiety disorder with the attention-deficit/hyperactivity disorder (ADHD) trait and autism spectrum disorder (ASD) trait. The Liebowitz Social Anxiety, Taijin-Kyofu-sho, and Adult Attention-Deficit/Hyperactivity Disorder Self-Report scales and the 16-item Autism-Spectrum Quotient were administered to 818 university students. Participants were divided into four groups: control (neither Taijin-Kyofu-sho nor social anxiety disorder), pure Taijin-Kyofu-sho (Taijin-Kyofu-sho alone), pure social anxiety disorder (social anxiety disorder alone), and mixed Taijin-Kyofu-sho-social anxiety disorder (both Taijin-Kyofu-sho and social anxiety disorder). We used logistic regression analysis to examine whether the ADHD trait and ASD trait were associated with Taijin-Kyofu-sho and social anxiety disorder. ASD trait was significantly associated with pure Taijin-Kyofu-sho ( p = 0.006 , odds ratio: 3.99). Female sex and ADHD trait were significantly associated with pure social anxiety disorder (sex: p = 0.013 , odds ratio: 2.61; ADHD trait: p = 0.012 , odds ratio: 2.46). Female sex, ADHD trait, and ASD trait were significantly associated with mixed Taijin-Kyofu-sho-social anxiety disorder (sex: p = 0.043 , odds ratio: 2.16; ADHD trait: p = 0.003 , odds ratio: 2.75; ASD trait: p < 0.001 , odds ratio: 16.93). Neurodevelopmental disorder traits differed between individuals with Taijin-Kyofu-sho and those with social anxiety disorder. Overall, our study reveals that Japanese individuals with the ADHD or ASD traits are at a heightened risk of developing Taijin-Kyofu-sho or social anxiety disorder.

The Relationship Between Social Anxiety Disorder and ADHD in Adolescents and Adults: A Systematic Review

“… Kajitani et al (2019) found a moderate positive correlation between the culture-specific taijin kyofusho and subdiagnostic ADHD, and a weak positive correlation between subdiagnostic social anxiety and ADHD, in university students. In another study, the prevalence of subdiagnostic ADHD was 45.3% in university students with subdiagnostic social anxiety, compared to 32.7% for taijin kyofusho, and 18.8% for no subdiagnostic social anxiety ( Kajitani et al, 2021 ). Studies that investigated diagnostic ADHD in adults with diagnostic SAD reported prevalence rates of 1.1% ( Peyre et al, 2022 ), 3% ( Safren et al, 2001 ), 7.8% ( Mörtberg et al, 2012 ), 38.5% ( Van Ameringen et al, 2011 ), 40.1% ( Umutlu et al, 2022 ), 58.2% ( Yoldas et al, 2019 ), 62% ( Koyuncu et al, 2019 ), and 72.3% ( Koyuncu et al, 2015 ).…”

“…This can be problematic as both the prevalence of SAD and how SAD is manifested are associated with cultural factors (e.g., perceived social norms in a given cultural group; Hofmann et al, 2010 ). Additionally, three of the studies included culture-specific diagnoses of social anxiety, namely hikikomori ( Umeda et al, 2021 ) and Tajin-Kyofu-sho ( Kajitani et al, 2019 ; Kajitani et al, 2021 ). More research studies on cultural differences concerning SAD in general, and specifically comorbid SAD and ADHD, is therefore certainly warranted.…”