How Do Different Cultures Experience Social Anxiety Disorder?

Cultural Differences in Social Anxiety Disorder

Different cultures have different reflections of social anxiety.
Social anxiety can vary by culture.. Getty / Moment / Shui Ta Shan

Cultural differences in social anxiety are known to exist. In other words, research tells us that there can be differences in social anxiety disorder (SAD) based on culture.

If different cultures have different social rules and expectations this makes sense; what is considered "okay" behavior in one culture might be viewed differently in another.

In addition, research shows that there are differences in the prevalence of SAD in different cultures.

Prevalence Rates

Results from the National Comorbidity Survey and the National Comorbidity Survey Replication (NCS-R) indicate that different cultural groups have different prevalence rates. In general, rates are lower in East Asian countries.

  • Findings from the surveys indicated 12-month prevalence rates of 7.1 to 7.9% in the United States versus 0.4% in Taiwan.
  • South American countries had prevalence rates similar to the United States, while Korea, China, and Japan showed rates of 0.6%, 0.2% and 0.8%.
  • Results from epidemiological surveys have also indicated high prevalence rates in Russia

Cultures at Increased Risk

A 2001-2002 national epidemiologic survey of over 40,000 people indicated that there was increased risk of SAD for the following groups:

  • native americans
  • younger people
  • those with low incomes

The following groups were at reduced risk for SAD:

  • Males
  • Asians
  • Hispanics
  • Blacks
  • those living in urban areas

    How Culture Influences Diagnosis

    In addition to differences in social anxiety that arise directly from varying cultures, research has shown that mental health professionals may differ in how they diagnose social anxiety disorder depending on their culture.

    Diagnoses Based on Culture

    In certain cultures, there are even specific types of disorders that parallel SAD.

    For example, in Japan and Korea, there is Taijin Kyofusho (TKS), which refers to the concern about being observed or offending other people. Those with TKS generally avoid a wide range of social situations. Whereas those with SAD fear embarrassing themselves, those with TKS fear embarrassing others (also known as an allocentric focus). For example, they might fear giving off bad odours (jikoshu-kyofu), blushing (sekimen-kyofu), having an improper facial expression or staring inappropriately.

    There are also those with a fear of eye contact (jikoshisen-kyofu). There tend to be more males than females with TKS and those with the problem generally suffer from only one fear.

    Treatment Response

    There is no research evidence to support a difference in treatment response for SAD among different cultures. However, research has shown that Asians in North America tend to delay treatment more than those of other cultures.

    Expression of Social Anxiety

    In general, there are a number of aspects of culture that may affect the expression of social anxiety.

    For example, the degree of individualism (idocentric focus) versus collectivist orientation (allocentric focus) can be important.

    Collectivist societies tend to be more accepting of socially reticent behaviors; which makes sense in terms of the lower rates of SAD in Asian countries. In addition, those living in individualistic cultures will express social anxiety in terms of self-blame while those in collectivistic cultures will experience more shame.

    In addition, a study of social anxiety in Chinese people indicated a unique aspect: fear of making others uncomfortable or influencing them in an unbeneficial way.

    Putting it All Together

    Overall, social fears are dependent on the cultural context in which you live.

    If you are being evaluated for social anxiety disorder, it is important that the mental health professional makes a diagnosis that takes into context your culture and social norms.

    What might be considered socially appropriate behavior in Japan will not in the United States. Social anxiety should always be evaluated taking your culture into consideration.

    Read Next: 50 Things to Do to Get Yourself Out of a Social Anxiety Rut


    Hoffman SG, Asnaani A. Cultural Aspects in Social Anxiety and Social Anxiety Disorder. Depression and Anxiety. 2010;27(12):1117-1127.

    Fan Q, Chang WC. Social Anxiety among Chinese People. The Scientific World Journal. 2015;2015:743147. doi:10.1155/2015/743147.

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