Summary: Taijin-kyofusho, a form of social anxiety disorder characterized by a fear of causing others discomfort as a result of the sufferer’s behavioral reactions, is linked to hypersensitivity of the emotional states of others and an inability to identify emotional context.

Source: Neuroscience News

Have you ever felt embarrassed for someone in your social group when they do something cringe-worthy? Maybe it was a bad rendition of a hit song during Karaoke night or making a social faux par while at a big event.

Those feelings of embarrassment may be linked to social anxiety disorder. You worry about how the behavior of others may affect other people’s opinions of you. This often leads to feeling distressed at the prospect of social events and gatherings.

Social anxiety disorder is a phenomenon that affects as many as one in ten Americans. Governed by feelings of extreme anxiety during social interactions and events, many with social anxiety disorder take pains to avoid gatherings. Additionally, those who dread the prospect of others embarrassing themselves, and thus reflecting badly on the sufferer, can turn their perceived embarrassment and frustration on the perpetrator of the offense. This can ultimately lead to social isolation.

However, there is another form of social anxiety that often gets overlooked. Dubbed taijin-kyofusho, people with this form of social anxiety fear making others uncomfortable with their own behavioral or physical responses to embarrassing situations.

Both social anxiety disorder (SAD) and taijin-kyofusho (TKS) have one thing in common. Those who suffer from the conditions excessively focus on the perspectives and views of others.

Those with SAD obsess over a fear of being scrutinized and criticized by others, often influencing how they experience their own emotions. By contrast, those with taijin-kyofusho fear causing others unnecessary discomfort as a result of their behavioral reactions, leading to them ruminating on the feelings of others over their own. Those with TKS generally have enhanced affective and reduced cognitive empathy.

A recent neuroimaging study in PNAS revealed during cognitive empathy tests, those with TKS had increased activity within the posterior superior temporal sulcus/temporoparietal junction, and increased activity within the amygdala during tests for affective empathy. The disruptions of functional brain connectivity, and the imbalance between both affective and cognitive empathy, could explain the deterioration of cognitive processes during embarrassing situations.

Ultimately, the findings suggest that not only do people with TKS feel the emotions of others more strongly, they often misinterpret the emotional context. This means those with TKS are inappropriately sensitive to the emotions of others, either perceived or otherwise.

The data suggests TKS is likely characterized by hypersensitivity to the feelings of others, and a less than accurate ability to recognize emotional context.

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Original Research: Open access

“Brain and behavioral alterations in subjects with social anxiety dominated by empathic embarrassment”. Shisei Tei, Jukka-Pekka Kauppi, Kathryn F. Jankowski, Junya Fujino, Ricardo P. Monti, Jussi Tohka, Nobuhito Abe, Toshiya Murai, Hidehiko Takahashi, and Riitta Hari.

PNAS doi:10.1073/pnas.1918081117.

Abstract

Brain and behavioral alterations in subjects with social anxiety dominated by empathic embarrassment

Social-anxiety disorder involves a fear of embarrassing oneself in the presence of others. Taijin-kyofusho (TKS), a subtype common in East Asia, additionally includes a fear of embarrassing others. TKS individuals are hypersensitive to others’ feelings and worry that their physical or behavioral defects humiliate others. To explore the underlying neurocognitive mechanisms, we compared TKS ratings with questionnaire-based empathic disposition, cognitive flexibility (set-shifting), and empathy-associated brain activity in 23 Japanese adults. During 3-tesla functional MRI, subjects watched video clips of badly singing people who expressed either authentic embarrassment (EMBAR) or hubristic pride (PRIDE). We expected the EMBAR singers to embarrass the viewers via emotion-sharing involving affective empathy (affEMP), and the PRIDE singers to embarrass via perspective-taking involving cognitive empathy (cogEMP). During affEMP (EMBAR > PRIDE), TKS scores correlated positively with dispositional affEMP (personal-distress dimension) and with amygdala activity. During cogEMP (EMBAR < PRIDE), TKS scores correlated negatively with cognitive flexibility and with activity of the posterior superior temporal sulcus/temporoparietal junction (pSTS/TPJ). Intersubject correlation analysis implied stronger involvement of the anterior insula, inferior frontal gyrus, and premotor cortex during affEMP than cogEMP and stronger involvement of the medial prefrontal cortex, posterior cingulate cortex, and pSTS/TPJ during cogEMP than affEMP. During cogEMP, the whole-brain functional connectivity was weaker the higher the TKS scores. The observed imbalance between affEMP and cogEMP, and the disruption of functional brain connectivity, likely deteriorate cognitive processing during embarrassing situations in persons who suffer from other-oriented social anxiety dominated by empathic embarrassment.

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