The laboratory finding of a discrepancy between Asian-Americans' subjective reports versus their behavior was replicated in a naturalistic setting. Okazaki (2002) examined the correspondence between self-report and informant ratings of depression and social anxiety among Asian-American and white American university students. Friends and acquaintances served as independent informants. On average, Asian-Americans' levels of distress were underestimated by their informants to a greater extent than white Americans' levels of distress. Moreover, white American peers underestimated the subjective social anxiety of their Asian-American friends to a greater extent than did the Asian-American peers who rated the social anxiety of their Asian-American friends.
To summarize, studies of social anxiety in Asian-American college students suggest that there is a greater discrepancy between how socially anxious they feel and how they exhibit their anxiety to others, particularly to others of a different ethnic background. These findings have significant implications. First, chronic underestimation of distress in Asian-Americans may lead to delay in their help-seeking. Next, there is a greater potential for disagreement over the severity of distress associated with social anxiety when clinicians and clients are of different ethnic backgrounds.
Another relevant line of research on social phobia in Asian individuals revolves around the notion of the Japanese (and other East Asian) culture as a "pseudo-sociophobic culture" that promotes the sense of shame, "or one's awareness and sensitivity to the shame experienced by oneself or others" (Okano, 1994). Taijin-kyofu-sho (TKS) is a social phobia-like condition first described in the 1930s by Japanese psychiatrist Masatake Morita. In particular, the delusional subtype of TKS--in which individuals avoid interpersonal situations because they are convinced that they have a particular bodily defect that is offensive or harmful to others--has attracted much clinical and scholarly attention as exemplifying the collectivistic cultural emphasis on shame and humility. While TKS is often thought of as unique to Japan, the offensive subtype has been reported as being prevalent among Koreans (Lee and Oh, 1999), and individual cases of non-Asians with TKS in the United States have also been reported (Clarvit et al., 1996; McNally et al., 1990). A recent cross-cultural comparison showed that TKS-like symptoms (e.g., fear of offending others) were more likely to be reported by Japanese university students than by their American counterparts (Dinnel et al., 2002).
In an interesting test of the hypothesis that features of East Asian cultures promote the development of social anxiety and social phobia, Leung et al. (1994) compared social anxiety among American patients with social phobia with those of Chinese-American and non-Chinese community residents. Previously, emotionally distant and controlling attitude and behavior in child-rearing were shown to play a role in the development of social phobia in American and European patients. Leung and colleagues noted that East Asian parenting styles had also been characterized as emphasizing emotional control. The Chinese-American community residents and non-Chinese-Americans with social phobia in the study reported that their parents had discouraged sociability, used shaming tactics and were highly concerned with others' opinion. However, Chinese-Americans did not report elevated levels of social anxiety or social phobia. In fact, the association between restrictive parenting practices and the adult children's level of social anxiety was much greater for non-Chinese-Americans than for Chinese-Americans. Thus, cultural parenting styles were not strongly associated with social anxiety.
Summary and Implications
Although inconclusive, the evidence to date suggests that Asian-Americans tend to report higher social anxiety than white Americans, yet they may be no more likely to manifest dysfunctional levels of social anxiety (that meet the diagnostic criteria of social phobia) or exhibit behavior that others view as social anxiety. It is not clear if this discrepancy between subjective distress versus assessed function is due to culturally determined display rules or biased assessment by those who are culturally different, but the discrepancy may make it difficult for clinicians to accurately assess the severity of social anxiety among Asian-Americans.
It should be noted that many of these tentative conclusions are based on studies conducted largely on Asian-American college students, who tend to be more acculturated to the U.S. mainstream than the general Asian-American adult population. A significant factor that has not received scholarly attention is the possibility that subjective distress in social contexts among Asian-Americans may be heightened by their status as visible ethnic minorities, many of whom are immigrants or non-native English speakers striving to adjust to a culturally different environment and behavioral standards.