Question

17. Cultural factors are recognized to contribute to how psychological disorders present themselves (e.g., Koro, dhat, susto, ataque). Using examples from class and the textbook provide 3 examples of disorders that present with culturally specific symptoms (symptoms typically not shown by individuals in other cultures with the same disorder). Identify a disorder with a symptom set that is similar across almost all cultures (prevalence, gender breakdown, diagnostic criteria, etc.)

Answer 1

• Culture-Bound Syndromes
• A culture-bound syndrome is a collection of signs and symptoms that is restricted to a limited number of cultures by reason of certain psychosocial features. Culture-bound syndromes are usually restricted to a specific setting, and they have a special relationship to that setting. Because culture-bound syndromes are classified on the basis of common etiology (e.g., magic, evil spells, angry ancestors), clinical pictures may vary.
• Projection is a common ego defense mechanism in many non-Western cultures. Guilt and shame are often projected into cultural beliefs and ceremonies. Guilt and shame are attributed to other individuals, groups, or objects and may involve acting out, blaming others, and needing to punish others. Projection is also seen in magic and supernatural perspectives of existence. This leads to projective ceremonies and may lead to illness when the ceremonies are not performed.
• Cultural psychoses are difficult to define. In cultural syndromes hallucinations may be viewed as normal variants. Delusions and thought disorder must be re-evaluated within a particular cultural setting. A culture may interpret abnormal behavior as relating to some kind of voodoo or anger and may regard the symptoms as normal even though symptoms are consistent with schizophrenia. Table 47-1 lists a number of culture-bound syndromes and the countries or regions where they have been described.
• In the past it was believed that culture-bound syndromes occurred only in the country or region of origin.
• However, with significant population movements and the tendency for immigrants to remain within their culture (despite having moved to a new country), culture-bound syndromes have been observed in other parts of the world. One common culture-bound syndrome is ataque de nervios, which is commonly known and observed in Hispanic populations.
• As with many culture-bound syndromes, there may be significant overlap with DSM-IV psychiatric diagnoses. In one study 36% of Dominican and Puerto Rican subjects diagnosed with ataque de nervios also met the criteria for panic attacks, although the features did not necessarily present together during the ataque episode.