Culture-Bound Syndromes

The term culture-bound syndromes was first coined in 1951 to describe mental disorders unique to certain societies or culture areas. The syndromes may include dissociative, psychotic, anxiety, depressive, and somatic symptoms and do not necessarily fit into contemporary diagnostic and classification systems of Western nosology.

Although there is no consensus among mental health professionals about the extent and ways in which cultural factors influence the manifestation and diagnosis of mental disorders, the American Psychiatric Association's inclusion of a Glossary of Culture-Bound Syndromes within the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM) constitutes a significant step toward addressing the difficulties encountered in the application of DSM criteria across cultural boundaries and suggests a concerted effort to increase universal utility of diagnostic and classification systems of Western nosology by integrating a group of mental disorders long marginalized as culture-specific. The inclusion of these categories also reflects an increasing recognition of the important role of culture in assessment and treatment as well as a growing acceptance of cultural differences in the diagnostic process. It should be noted that these syndromes were compiled on the basis of decades of interdisciplinary research (i.e., anthropology, psychiatry, and psychology).

According to the DSM, culture-bound syndromes refer to “recurrent, locality-specific patterns of aberrant behavior and troubling experience that may not be linked to a particular DSM diagnostic category. Many of these patterns are indigenously considered to be ‘illness,’ or at least afflictions, and most have local names” (p. 898). The glossary included in the DSM lists more than 20 culture-specific diagnoses along with descriptive features.

These syndromes can be categorized into the following major definitional iterations:

• A mental illness that is not attributable to an identifiable organic cause, is often recognized locally as an illness, and does not correspond to a recognized Western medical category
• An illness that is not attributable to an identifiable organic cause, is recognized within local culture as an illness, and resembles a Western disease category but may lack some symptoms considered as salient in Western culture
• A discrete disease entity not yet recognized in Western culture
• A nondescript illness that may or may not have an organic cause and may correspond to a subset of a Western disease category
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• Illnesses in the idiomatic rhetoric category that represent culturally accepted explanatory mechanisms but may not correspond with Western idioms and, in Western culture, may suggest culturally inappropriate thinking and perhaps delusions or hallucinations
• Illnesses in the category of generalized culture-bound syndromes that are characterized by behaviors such as trance, hearing, seeing, or communicating with the dead or spirits, which may or may not be seen as pathological within local culture but could indicate psychosis, delusions, or hallucinations in Western culture
• Unreal syndromes that allegedly occur in a given cultural setting, which, in fact, does not exist

As an example, shenjing shaijo (“weakened nerves” or “neurasthenia”) is on the list of culture-specific diagnoses in the DSM and also is included in the Chinese Classification of Mental Disorders, Second Edition. It is characterized by a set of symptoms, including fatigue, headaches, concentration difficulties, sleep disturbance, and memory loss, and, in many cases, the symptoms would meet the criteria for DSM Mood or Anxiety Disorder. An apparent psychiatric illness with no identifiable organic cause, shenjing shaijo is recognized in the Chinese culture but has locally salient features different from Western diseases and does not typically have symptoms considered critical in Western psychiatry.

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