Diagnostic patterns of social phobia. Comparison in Tokyo and Hawaii

A comparison was made of the diagnosis of social phobia by Japanese psychiatrists in Tokyo and American psychiatrists in Hawaii. A brief segment of videotaped interviews and written case histories of four Japanese patients from Tokyo and two Japanese-American patients from Hawaii, who were clinically diagnosed with social phobia, were presented to the clinicians for their diagnosis. Japanese psychiatrists tended to diagnose social phobia congruently for the Japanese cases but not for the Japanese-American cases. American psychiatrists tended to diagnose various categories including anxiety disorder and avoidant personality disorder, in addition to social phobia, disregarding the ethnic background of the patients. This illustrates that the diagnostic pattern for social phobia varied considerably between psychiatrists of these two countries. The reasons considered are the patient's cardinal symptom manifestation, style of problems presentation, as well as the clinician's professional orientation and familiarity to this particular disorder.