Psych · General adult psychiatry
Culture-bound syndromes and cultural concepts of distress
Also known as Culture-bound syndrome · Culture-related syndrome · Cultural concepts of distress · Idioms of distress · Cultural Formulation Interview · Outline for Cultural Formulation · Transcultural psychiatry · Koro · Dhat syndrome · Amok · Ataque de nervios · Taijin kyofusho · Latah · Susto · Hikikomori · Shenjing shuairuo · Brain fag syndrome
Exam-exhaustive fellowship topic on culture-bound and culture-related syndromes — why DSM-IV's glossary became DSM-5-TR's cultural syndromes, idioms and explanations; koro, dhat, amok, ataque de nervios, taijin kyofusho, latah, susto, hikikomori, shenjing shuairuo and brain fag at viva depth; the Cultural Formulation Interview and Kleinman's explanatory models; belief versus delusion; the diagnostic hierarchy; migration, acculturation and cultural bereavement; eponym mastery without othering. FRANZCP-primary, globally tagged.
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Red flags
- Labelling a presentation 'cultural' and skipping the organic screen — delirium, thyroid disease, intoxication and withdrawal do not respect nosology
- Missing a treatable depression, psychosis or PTSD underneath a named cultural syndrome
- Calling a shared cultural belief a delusion because you did not check it against the person's own reference group
- Calling a delusion 'cultural' and leaving untreated psychosis in the community
- Dismissing a culturally patterned crisis as 'just an ataque' and omitting the suicide risk assessment
- Using a family member as interpreter for a disclosure-sensitive assessment
- Reciting eponyms as exotic curiosities instead of formulating the person in front of you
- Treating epidemic koro with escalating investigation and thereby amplifying the outbreak
Meet the patient
A 21-year-old engineering student, six months into a scholarship abroad, presents with burning in his scalp, aching behind the eyes, and the complaint that words "slide off the page" when he studies. He has failed two exams. He tells you a relative believes his energy is being drained.[17][18]
The registrar's note says: "?brain fag syndrome — culture-bound." The consultant's first question is one exam asks too: "And is he depressed?"[18][15]
He was. Six weeks of an antidepressant and a study-skills plan later, the words stopped sliding. The eponym was correct and almost entirely beside the point.[15][18]
[4] [1]References20ShowHide
- [1]Lewis-Fernández R, Kirmayer LJ Cultural concepts of distress and psychiatric disorders: Understanding symptom experience and expression in context Transcult Psychiatry, 2019.PMID 31347476
- [2]Lewis-Fernández R, et al. Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial Br J Psychiatry, 2017.PMID 28104738
- [3]Aggarwal NK, et al. Barriers to implementing the DSM-5 cultural formulation interview: a qualitative study Cult Med Psychiatry, 2013.PMID 23836098
- [4]Kirmayer LJ Rethinking cultural competence Transcult Psychiatry, 2012.PMID 22508634
- [5]Nichter M Idioms of distress revisited Cult Med Psychiatry, 2010.PMID 20495999
- [6]Sumathipala A, Siribaddana SH, Bhugra D Culture-bound syndromes: the story of dhat syndrome Br J Psychiatry, 2004.PMID 14990517
- [7]Grover S, et al. Phenomenology and beliefs of patients with Dhat syndrome: A nationwide multicentric study Int J Soc Psychiatry, 2016.PMID 26142412
- [8]Chowdhury AN The definition and classification of Koro Cult Med Psychiatry, 1996.PMID 8740958
- [9]Saint Martin ML Running Amok: A Modern Perspective on a Culture-Bound Syndrome Prim Care Companion J Clin Psychiatry, 1999.PMID 15014687
- [10]Guarnaccia PJ, et al. The experiences of ataques de nervios: towards an anthropology of emotions in Puerto Rico Cult Med Psychiatry, 1996.PMID 8899285
- [11]Kirmayer LJ The place of culture in psychiatric nosology: Taijin kyofusho and DSM-III-R J Nerv Ment Dis, 1991.PMID 1985144
- [12]Simons RC The resolution of the Latah paradox J Nerv Ment Dis, 1980.PMID 7365478
- [13]Weller SC, et al. Susto and nervios: expressions for stress and depression Cult Med Psychiatry, 2008.PMID 18535889
- [14]Kato TA, Kanba S, Teo AR Hikikomori : Multidimensional understanding, assessment, and future international perspectives Psychiatry Clin Neurosci, 2019.PMID 31148350
- [15]Kleinman A Neurasthenia and depression: a study of somatization and culture in China Cult Med Psychiatry, 1982.PMID 7116909
- [16]Lee S Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-mao China Cult Med Psychiatry, 1999.PMID 10572739
- [17]Prince R The "brain fag" syndrome in Nigerian students J Ment Sci, 1960.PMID 14434928
- [18]Ola BA, Morakinyo O, Adewuya AO Brain Fag Syndrome - a myth or a reality Afr J Psychiatry (Johannesbg), 2009.PMID 19582315
- [19]Bourque F, van der Ven E, Malla A A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants Psychol Med, 2011.PMID 20663257
- [20]Bhugra D, Becker MA Migration, cultural bereavement and cultural identity World Psychiatry, 2005.PMID 16633496