Culture-bound syndrome

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) which also includes a list of the most common culture-bound conditions (DSM-IV: Appendix I). Counterpart within the framework of ICD-10 (Chapter V) are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.[1]

More broadly, an epidemic that can be attributed to cultural behavior patterns or suggestion is sometimes referred to as a behavioral epidemic. As in the cases of drug or alcohol abuse or smoking, transmission can be determined by communal reinforcement as well as by person-to-person interactions. On etiological grounds, it can be difficult to distinguish the causal contribution of culture in disease from other environmental factors such as toxicity.[2]


A culture-specific syndrome is characterized by:

  1. categorization as a disease in the culture (i.e., not a voluntary behaviour or false claim);
  2. widespread familiarity in the culture;
  3. complete lack of familiarity or misunderstanding of the condition to people in other cultures;
  4. no objectively demonstrable biochemical or tissue abnormalities (signs);
  5. the condition is usually recognized and treated by the folk medicine of the culture.

Some culture-specific syndromes involve somatic symptoms (pain or disturbed function of a body part), while others are purely behavioral. Some culture-bound syndromes appear with similar features in several cultures, but with locally-specific traits, such as penis panics.

A culture-specific syndrome is not the same as a geographically localized disease with specific, identifiable, causal tissue abnormalities, such as kuru or sleeping sickness, or genetic conditions limited to certain populations. It is possible that a condition originally assumed to be a culture-bound behavioral syndrome is found to have a biological cause; from a medical perspective it would then be redefined into another nosological category.

Medical perspectives

The American Psychiatric Association states the following:[3]

The term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be "illnesses," or at least afflictions, and most have local names. Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists.[4] Anthropologists have a tendency to emphasize the relativistic and culture-specific dimensions of the syndromes, while physicians tend to emphasize the universal and neuropsychological dimensions.[5][6] Guarnaccia & Rogler (1999) have argued in favor of investigating culture-bound syndromes on their own terms, and believe that the syndromes have enough cultural integrity to be treated as independent objects of research.[7]

Some studies suggest that culture-bound syndromes represent an acceptable way within a specific culture (and cultural context) among certain vulnerable individuals (i.e. an ataque de nervios at a funeral in Puerto Rico) to express distress in the wake of a traumatic experience.[8] A similar manifestation of distress when displaced into a North American medical culture may lead to a very different, even adverse outcome for a given individual and [his or] her family.[9]

DSM-IV-TR list

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes:[10]

Name Geographical localization/populations
Running amok Malaysia, Indonesia, Philippines, Brunei, Singapore
Ataque de nervios Hispanic people as well as in the Philippines where it is known as "Nervous Breakdown"
Bilis, cólera Latinos
Bouffée délirante West Africa and Haiti
Brain fag syndrome West African students
Dhat syndrome India
Falling-out, blacking out Southern United States and Caribbean
Ghost sickness Native American
Hwabyeong Korean
Koro Chinese and Malaysian populations in southeast Asia; Assam; occasionally in West
Latah Malaysia and Indonesia
Locura Latinos in the United States and Latin America
Mal de pelea Puerto Rico[11]
Nervios Latin America, Latinos in the United States
Evil eye Mediterranean; Hispanic populations and Ethiopia
Piblokto Arctic and subarctic Inuit populations
Zou huo ru mo (Qigong psychotic reaction) Chinese
Rootwork Southern United States, Caribbean nations
Sangue dormido Portuguese populations in Cape Verde
Shenjing shuairuo Chinese
Shenkui, shen-kʼuei Chinese
Shinbyeong Korean
Spell African American, White populations in the southern United States and Ethiopia
Susto Latinos in the United States; Mexico, Central America and South America
Taijin kyofusho Japanese
Zār Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies

DSM-5 list

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes:[12]

Name Geographical localization/populations
Ataque de nervios Hispanic people as well as in the Philippines
Dhat syndrome India
Khyâl cap Cambodians in the United States and Cambodia
Ghost sickness Native American
Kufungisisa Zimbabwe
Maladi moun Haiti
Nervios Latin America, Latinos in the United States
Shenjing shuairuo Chinese
Susto Latinos in the United States; Mexico, Central America and South America
Taijin kyofusho Japanese

ICD-10 list

The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) classifies the below syndromes as culture-specific disorders:[1]

Name Geographical localization/populations
Amok Indonesia; Malaysia
Dhat syndrome (dhātu), shen-kʼuei, jiryan India; Taiwan
Koro, suk yeong, jinjin bemar South-east Asia, India, China
Latah Indonesia; Malaysia
Nervios, nerfiza, nerves, nevra Egypt; Greece; northern Europe; Mexico, Central and South America
Pa-leng (frigophobia) Taiwan; south-east Asia
Pibloktoq (Arctic hysteria) Inuit living within the Arctic Circle
Susto, espanto Mexico, Central and South America
Taijin kyofusho, shinkeishitsu (anthropophobia) Japan
Ufufuyane, saka Kenya; southern Africa (among Bantu, Zulu, and affiliated groups)
Uqamairineq Inuit living within the Arctic Circle
Windigo Indigenous people of north-east America

Other examples

Within the contiguous United States, the consumption of kaolin has been proposed as a culture bound syndrome observed in African Americans in the rural south, particularly in areas in which the mining of kaolin is common.[13] In South Africa, among the Xhosa people, the syndrome amafufunyana is commonly used to describe those believed to be possessed by demons or other malevolent spirits. Traditional healers in the culture usually perform exorcisms in order to drive off these spirits. Upon investigating the phenomenon, researchers found that many of the people claimed to be affected by the syndrome exhibited the traits and characteristics of schizophrenia.[14]

Vegetative-vascular dystonia can be considered an example of somatic condition formally recognised by local medical community in former Soviet Union countries, but not in Western classification systems. Its umbrella term nature as neurological condition also results in diagnosing neurotic patients as neurological ones,[15][16] in effect sybstituting possible psychiatric stigma with culture-bound syndrome disguised as a neurological condition.

See also


  1. 1 2 Diagnostic criteria for research, p. 213–225 (WHO 1993)
  2. Porta, Miquel, ed. (2008). "Behavioral epidemic". A Dictionary of Epidemiology (5th ed.). Oxford University Press. p. 48. ISBN 978-0-19-157844-1. Retrieved 25 August 2013.
  3. American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, American Psychiatric Pub, p. 898, ISBN 978-0-89042-025-6
  4. Perry, S. (2012, 13 January). The controversy over 'culture-bound' mental illnesses. Retrieved 27 January 2013 from MinnPost.
  5. Prince, Raymond H. (2000) In Review. Transcultural Psychiatry: Personal Experiences and Canadian Perspectives. Canadian Journal of Psychiatry, 45: 431–437
  6. Jilek W.G (2001) Psychiatric Disorders: Culture-specific. International Encyclopedia of the Social and Behavioral Sciences. Elsevier Science Ltd.
  7. Guarnaccia, Peter J. & Rogler, Lloyd H. (1999) Research on Culture-Bound Syndromes: New Directions. American Journal of Psychiatry 156:1322–1327, September
  8. Schechter DS, Marshall RD, Salman E, Goetz D, Davies SO, Liebowitz MR (2000). Ataque de nervios and childhood trauma history: An association? Journal of Traumatic Stress, 13:3, 529–534.
  9. Schechter DS, Kaminer, T, Grienenberger JF, Amat J (2003). Fits and starts: A mother-infant case study involving pseudoseizures across three generations in the context of violent trauma history (with Commentaries by RD Marshall, CH Zeanah, T Gaensbauer). Infant Mental Health Journal. 24(5), 510–28.
  10. American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, American Psychiatric Pub, pp. 898–901, ISBN 978-0-89042-025-6
  11. What is MAL DE PELEA? Psychology Dictionary, Accessed 19 December 2014.
  12. American Psychiatric Association (2013), Diagnostic and statistical manual of mental disorders, 5th ed., pp. 833–837, ISBN 978-0-89042-554-1
  13. South Med J. 1999;Feb 92 (2): 190-192. Chalk Eating in Middle Georgia: A Culture-Bound Syndrome of Pica? Grigsby, RK, Thyer, BA, Waller, RJ, Johnston, GA Jr
  14. Niehaus DJ, Oosthuizen P, Lochner C, Emsley RA, Jordaan E, Mbanga NI, Keyter N, Laurent C, Deleuze JF, Stein DJ (March–April 2004). "A culture-bound syndrome 'amafufunyana' and a culture-specific event 'ukuthwasa': differentiated by a family history of schizophrenia and other psychiatric disorders". Psychopathology. Karger Publishers. 37 (2): 59–63. doi:10.1159/000077579. PMID 15057028.]]
  15. Mikhaylov, B (2010). "P02-34 -Statistical issues of the psychiatric care in Ukraine". European Psychiatry. 25: 652. doi:10.1016/S0924-9338(10)70647-7. Retrieved October 2, 2016.
  16. EPA-1025 - Integrative psychotherapy model of anxiety disorders Mykhaylov, B. et al. European Psychiatry , Volume 29 , 1

Further reading

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