Culture-Bound Syndromes in the DSM-IV-TR

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Amok

Dissociative episode: period of brooding followed by an outburst of violent, aggressive or homicidal behavior directed at people and objects. Episode is precipitated by a perceived slight or insult. Episode is often accompanied by persecutory ideas, automatism, amnesia, exhaustion, and a return to premorbid state following the episode. Originally described in Malaysia. Similar episodes are found in Laos, Philippines, Polynesia, Papua New Guinea, Puerto Rico (mal de pelea), and among the Navajo (iich'aa)

Ataque de nervios

Among latinos. Uncontrollable shouting, crying, trembling, heat in the chest rising to the head, verbal/physical aggression. Dissociative experiences, seizure-like/fainting episodes, suicidal gestures are commonly seen. Sense of being out of control. Frequently precipitated by a stressful family event. May be amnestic for events during the episode. Differences form a Panic DISORDER: association with a precipitating event AND absence of hallmark acute fear or apprehension

bilis OR colera OR muina

Thought to be caused by strongly experienced anger or rage. This anger disturbs core body balances. Chronic fatigue may result from an acute episode.

boufée delirante

W. Africa and Haiti. Sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. Sometimes accompanied by visual and auditory hallucinations or paranoid ideation. May resemble a brief psychotic disorder.

brain ***

Initially from W. Africa among high school or university students in response to the challenges of school. Difficulty concentrating, remembering, and thinking. Somatic sx include head/neck pain, pressure/tightness, visual blurring. May 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.

Falling out or Blacking out

Primarily in southern United States and Caribbean groups. Sudden collapse, sometimes without warning but may be preceded by feelings of dizziness or "swimming" in the head. Eyes are usually open but the person claims an inability to see. Usually hears and understands what is occurring but feels powerless to move. May correspond to a diagnosis of Conversion Disorder or a Dissociative Disorder

Ghost Sickness

Preoccupation with death and the deceased (mB a/w witchcraft) usually amon AmIndian tribes. Various symptoms possible: bad dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation.

Hwa-byung

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

Malaysian origin, refers to sudden and intense anxiety that the penis (or, in females, the vulva and nipples) will recede into the body and possibly cause death. Reported in S and E 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. This diagnosis is included in the Chinese Classification of Mental Disorders, Second Edition

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.

Locura

Term used by Latinos in the US and LAmerica, a form of chronic psychosis. Attributed to an inherited vulnerability, to the multiple life difficulties, or to a combination of both factors. Symptoms include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possible violence.

Mal de Ojo

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 females) have the condition.

Nervios

Refers both to a general state of vulnerability to stressful life experiences and to a syndrome brought on by difficult life circumstances. Includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Sx may include headaches and "brain aches," irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigo-like exacerbations). Very broad syndrome that spans the range from cases free of a mental disorder to presentations resembling Adjustment, Anxiety, Depressive, Dissociative, Somatoform, or Psychotic Disorders.

Pibloktoq

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. This is observed primarily in arctic and subarctic Eskimo communities, although regional variations in name exist. The individual may be withdrawn or mildly irritable for a period of hours or days before the attack and will typically report complete amnesia for the attack. During the attack, the individual may tear off his or her clothing, break furniture, shout obscenities, eat feces, flee from protective shelters, or perform other irrational or dangerous acts.

qi-gong psychotic reaction

A term describing an acute, time-limited episode 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 individuals who become overly involved in the practice. This diagnosis is included in the Chinese Classification of Mental Disorders, Second Edition (CCMD-2).

Rootwork

Set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or the evil influence of another person. Sx include generalized anxiety and GI 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 persons, 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 bewitch 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

This syndrome is found among Portuguese Cape Verde Islanders (and immigrants from there to the United States) and includes pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, and miscarriage.

Shenjing shuairuo

("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 GI 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-IV Mood or Anxiety Disorder. This diagnosis is included in the Chinese Classification of Mental Disorders, Second Edition (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 thereby be life threatening.

Shin-byung

Korean folk syndrome: 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 individuals "communicate" with deceased relatives or with spirits. At times this state is associated with brief periods of personality change. This 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

Folk illness prevalent among some Latinos in the US and among people in Mexico, Central America, and South America. An illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Individuals 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. Sx appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, feeling of sadness, lack of motivation to do anything, and feelings of low self-worth or dirtiness. Somatic sx 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 experiences of susto may be related to Major Depressive Disorder, Posttraumatic Stress Disorder, and Somatoform Disorders. Similar etiological beliefs and symptom configurations are found in may parts of the world.

taijin kyofusho

Japanese syndrome resembling Social Phobia in DSM-IV. This syndrome refers to an individual's intense fear that his or her body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements. This syndrome is included in the official Japanese diagnostic system for mental disorders.

Zar

Applied in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies to the experience of spirits possessing an individual. Persons possessed by a spirit may experience dissociative episodes that may include shouting, laughing, hitting the head against a wall, singing, or weeping. Individuals 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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