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DSM-IV - Culture-Bound Syndromes

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[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  • amok A dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at persons and objects. The episode tends to be precipitated by a perceived slight or insult and seems to be prevalent only among men. The episode is often accompanied by persecutory idea; automatism, amnesia, exhaustion, and a return to premorbid state following the episode. Some instances of amok may occur during a brief psychotic episode or constitute the onset or an exacerbation of a chronic psychotic process. The original reports that used this term were from Malaysia. A similar behavior pattern is found in Laos, Philippines, Polynesia (cafard or cathard), Papua New Guinea, and Puerto Rico (mal de pelea), and among the Navajo (iich'aa).

  • ataque de nervios An idiom of distress principally reported among Latinos from the Caribbean, but recognized among many Latin American and Latin Mediterranean groups. Commonly reported symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. Dissociative experiences, seizurelike or fainting episodes, and suicidal gestures are prominent in some attacks but absent in others. A general feature of an ataque de nervios is a sense of being out of control. Ataques de nervios frequently occur as a direct result of a stressful event relating to the family (e.g., death of a close relative, separation or divorce from a spouse, conflicts with a spouse or children, or witnessing an accident involving a family member). Persons may experience amnesia for what occurred during the ataque de nervios, but they otherwise return rapidly to their usual level of functioning. Although descriptions of some ataques de nervios most closely fit the DSM description of panic attacks, the association of most ataques with a precipitating event and the frequent absence of the hallmark symptoms of acute fear or apprehension distinguish them from panic disorder. Ataques span the range from normal expressions of distress not associated with a mental disorder to symptom presentations associated with anxiety, mood, dissociative, or somatoform disorders.

  • bilis and colera (also referred to as muina) The underlying cause is thought to be strongly experienced anger or rage. Anger is viewed among many Latino groups as a particularly powerful emotion that can have direct effects on the body and exacerbate existing symptoms. The major effect of anger is to disturb core body balances (which are understood as a balance between hot and cold valences in the body and between the material and spiritual aspects of the body). Symptoms can include acute nervous tension, headache, trembling, screaming, stomach disturbances, and, in more severe cases, loss of consciousness. Chronic fatigue may result from an acute episode.

  • bouffée délirante A syndrome observed in West Africa and Haiti. The French term refers to a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It may sometimes be accompanied by visual and auditory hallucinations or paranoid ideation. The episodes may resemble an episode of brief psychotic disorder.

  • brain fag A term initially used in West Africa to refer to a condition experienced by high school or university students in response to the challenges of schooling. Symptoms include difficulties in concentrating, remembering, and thinking. Students often state that their brains are “fatigued.” Additional somatic symptoms are usually centered around the head and neck and include pain, pressure or tightness, blurring of vision, heat, or burning. “Brain tiredness” or fatigue from “too much thinking” is an idiom of distress in many cultures, and resulting syndromes can resemble certain anxiety, depressive, and somatoform disorders.

  • dhat A folk diagnostic term used in India to refer to severe anxiety and hypochondriacal concerns associated with the discharge of semen, whitish discoloration of the urine, and feelings of weakness and exhaustion. Similar to jiryan (India), sukra prameha (Sri Lanka), and shen-k'uei (China).

  • falling-out or blackout Episodes that occur primarily in southern United States and Caribbean groups. They are characterized by a sudden collapse, which sometimes occurs without warming but is sometimes preceded by feelings of dizziness or “swimming” in the head. The person's eyes are usually open, but the person claims an inability to see. Those affected usually hear and understand what is occurring around them but feel powerless to move. This may correspond to a diagnosis of conversion disorder or a dissociative disorder.

  • ghost sickness A preoccupation with death and the deceased (sometimes associated with witchcraft), frequently observed among members of many American Indian tribes. Various symptoms can be attributed to ghost sickness, including bad dreams, weakness, feeling of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation.

  • hwa-byung (also known as wool-hwa-byung) A Korean folk syndrome literally translated into English as “anger syndrome” and attributed to the suppression of anger. The symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and a feeling of a mass in the epigastrium.

  • koro A term probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or, in women, the vulva and nipples) will recede into the body and possibly cause death. The syndrome is reported in South and East Asia, where it is known by a variety of local terms, such as shuk yang, shook yong, and suo yang (Chinese); jinjinia bemar (Assam); or rok-joo (Thailand). It is occasionally found in the West. Koro at times occurs in localized epidemic form in East Asian areas. The diagnosis is included in the second edition of Chinese Classification of Mental Disorders (CCMD-2).

  • latah Hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. The term latah is of Malaysian or Indonesian origin, but the syndrome has been found in many parts of the world. Other terms for the condition are amurakh, irkunil, ikota, olan, myriachit, and menkeiti (Siberian groups); bah tschi, bah-tsi, baah-ji (Thailand); imu (Ainu, Sakhalin, Japan); and mali-mali and silok (Philippines). In Malaysia it is more frequent in middle-aged women.

  • locura A term used by Latinos in the United States and Latin America to refer to a severe form of chronic psychosis. The condition is attributed to an inherited vulnerability, to the effect of multiple life difficulties, or to a combination of both factors. Symptoms exhibited by persons with locura include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possibly violence.

  • mal de ojo A concept widely found in Mediterranean cultures and elsewhere in the world. Mal de ojo is a Spanish phrase translated into English as “evil eye.” Children are especially at risk. Symptoms include fitful sleep, crying without apparent cause, diarrhea, vomiting and fever in a child or infant. Sometimes adults (especially women) have the condition.

  • nervios A common idiom of distress among Latinos in the United States and Latin America. A number of other ethnic groups have related, though often somewhat distinctive, ideas of nerves (such as nerva among Greeks in North America). Nervios refers both to a general state of vulnerability to stressful life experiences and to a syndrome brought on by difficult life circumstances. The term nervios includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Common symptoms include headaches and brain aches, irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigolike exacerbations). Nervios tends to be an ongoing problem, although variable in the degree of disability that is manifest. Nervios is a very broad syndrome that spans the range from patients free of a mental disorder to presentations resembling adjustment, anxiety, depressive, dissociative, somatoform, or psychotic disorders. Differential diagnosis depends on the constellation of symptoms experienced, the kinds of social events that are associated with the onset and progress of nervios, and the level of disability experienced.

  • piblokto An abrupt dissociative episode accompanied by extreme excitement of up to 30 minutes' duration and frequently followed by convulsive seizures and coma lasting up to 12 hours. It is observed primarily in Arctic and subarctic Eskimo communities, although regional variations in name exist. The person may be withdrawn or mildly irritable for a period of hours or days before the attack and typically reports complete amnesia for the attack. During the attack persons may tear off their clothing, break furniture, shout obscenities, eat feces, flee from protective shelters, or perform other irrational or dangerous acts.

  • qi-gong psychotic reactions Acute, time-limited episodes characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms that may occur after participation in the Chinese folk health-enhancing practice of qi-gong (exercise of vital energy). Especially vulnerable are persons who become overly involved in the practice. This diagnosis is included in CCMD-2.

  • rootwork A set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or evil influence of another person. Symptoms may include generalized anxiety and gastrointestinal complaints (e.g., nausea, vomiting, diarrhea), weakness, dizziness, the fear of being poisoned, and sometimes fear of being killed (voodoo death). Roots, spells, or hexes can be put or placed on other person, causing a variety of emotional and psychological problems. The hexed person may even fear death until the root has been taken off (eliminated), usually through the work of a root doctor (a healer in this tradition), who can also be called on to bewitched an enemy. Rootwork is found in the southern United States among both African-American and European-American populations and in Caribbean societies. It is also known as mal puesto or brujeria in Latino societies.

  • sangue dormido (“sleeping blood”) A syndrome found among Portuguese Cape Verde Islanders (and immigrants from there to the United States). It includes pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, and miscarriages.

  • Shenjing shuariuo (“neurasthenia”) In China a condition characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and various signs suggesting disturbance of the autonomic nervous system. In many cases the symptoms would meet the criteria for a DSM mood or anxiety disorder. The diagnosis is included in CCMD-2.

  • shen-k'uei (Taiwan); shenkui (China) A Chinese folk label describing marked anxiety or panic symptoms with accompanying somatic complaints for which no physical cause can be demonstrated. Symptoms include dizziness, backache, fatigability, general weakness, insomnia, frequent dreams, and complaints of sexual dysfunction, such as premature ejaculation and impotence. Symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of white turbid urine believed to contain semen. Excessive semen loss is feared because of the belief that it represents the loss of one's vital essence and can therefore be life threatening.

  • shin-byung A Korean folk label for a syndrome in which initial phases are characterized by anxiety and somatic complaints (general weakness, dizziness, fear, anorexia, insomnia, gastrointestinal problems), with subsequent dissociation and possession by ancestral spirits.

  • spell A trance state in which persons “communicate” with deceased relatives or spirits. At times the state is associated with brief periods of personality change. The culture-specific syndrome is seen among African-Americans and European-Americans from the southern United States. Spells are not considered to be medical events in the folk tradition but may be misconstrued as psychotic episodes in clinical settings.

  • susto (frigh or “soul loss”) A folk illness prevalent among some Latinos in the United States and among people in Mexico, Central America, and South America. Susto is also referred to as espanto, pasmo, tripa ida, perdida del alma, or chibih. Susto is an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Persons with susto also experience significant strains in key social roles. Symptoms may appear any time from days to years after the fright is experienced. It is believed that in extreme cases, susto may result in death. Typical symptoms include appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, feelings of sadness, lack of motivation to do anything, and feelings of low self-worth or dirtiness. Somatic symptoms accompanying susto include muscle aches and pains, headache, stomachache, and diarrhea. Ritual healings are focused on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance. Different experience of susto may be related to major depressive disorder, posttraumatic stress disorders, and somatoform disorders. Similar etiological beliefs and symptom configurations are found in many parts of the world.

  • taijin kyofu sho A culturally distinctive phobia in Japan, in some ways resembling social phobia in DSM. The syndrome refers to an intense fear that one's body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements. The syndrome is included in the official Japanese diagnostic system for mental disorders.

  • zar A general term applied in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies to the experience of spirits possessing a person. Persons possessed by a spirit may experience dissociative episodes that may include shouting, laughing, hitting the head against a wall, singing, or weeping. They may show apathy and withdrawal, refusing to eat or carry out daily tasks or may develop a long-term relationship with the possessing spirit. Such behavior is not considered pathological locally.



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