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Cross-Cultural Study of Conviction Subtype Taijin Kyofu: Proposal and Reliability of Nagoya-Osaka Diagnostic Criteria for Social Anxiety Disorder

Kinoshita, Yoshihiro MD*†; Chen, Junwen PhD†‡; Rapee, Ronald M. PhD§; Bögels, Susan PhD; Schneier, Franklin R. MD; Choy, Yujuan MD; Kwon, Jung-Hye PhD#; Liu, Xinghua PhD**; Schramm, Elisabeth PhD††; Chavira, Denise A. PhD‡‡; Nakano, Yumi MD, PhD; Watanabe, Norio MD, MSc; Ietzugu, Tetsuji MSc†§§; Ogawa, Sei MD; Emmelkamp, Paul PhD∥∥; Zhang, Jianxue MD¶¶; Kingdon, David MD, FRCPsych*; Nagata, Toshihiko MD, PhD##; Furukawa, Toshi A. MD, PhD

The Journal of Nervous and Mental Disease: April 2008 - Volume 196 - Issue 4 - p 307-313
doi: 10.1097/NMD.0b013e31816a4952
Original Article

Conviction subtype Taijin-Kyofu (c-TK) is a subgroup of mental disorder characterized by conviction and strong fear of offending others in social situations. Although the concept of c-TK overlaps with that of social anxiety disorder (SAD), patients with c-TK often may not be diagnosed as such within the current Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. We propose the Nagoya-Osaka criteria to amend this situation. This study examined the cross-cultural interrater reliability of the proposed criteria. Eighteen case vignettes of patients with a variety of complaints focused around social anxieties were collected from 6 different countries, and diagnosed by 13 independent raters from various nationalities according to the original DSM-IV and the expanded criteria. The average agreement ratio for the most frequent diagnostic category in each case was 61.5% with DSM-IV and 87.6% with the modified DSM-IV with Nagoya-Osaka criteria (p < 0.001). These findings indicate that the Nagoya-Osaka criteria for SAD can improve interrater reliability of SAD.

*Department of Psychiatry, University of Southampton, Southampton, United Kingdom; †Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; ‡Department of Psychology, Faculty of Human Relations, Tokai Gakuin University, Gifu, Japan; §Department of Psychology, Macquarie University, Sydney, NSW, Australia; ∥Department of Education, University of Amsterdam, Amsterdam, The Netherlands; ¶Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, New York; #Department of Psychology, Korea University, Seoul, Korea; **Learning & Cognition Laboratory, Capital Normal University, Beijing, Peoples Republic of China; ††Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany; ‡‡Department of Psychiatry, University of California San Diego, La Jolla, California; §§Department of Human Life Science, Nagoya Keizai University Junior College, Inuyama, Japan; ∥∥Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; ¶¶Department of Psychiatry, Peking University Shougang Hospital, Beijing, Peoples Republic of China; and ##Department of Neuropsychiatry, Osaka City University Medical School, Osaka, Japan.

Y.K. is currently awarded with the GlaxoSmithKline international scholarship and funded by the Nitto Foundation.

Send reprint requests to Yoshihiro Kinoshita, MD, Department of Psychiatry, University of Southampton, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG, UK. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.