Clinical Diagnoses: Integrating Culture and Social Context
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Questions and Answers

What does the Cultural Formulation section primarily aim to achieve?

  • To create a standardized diagnostic tool for all cultures.
  • To prepare clinicians for interactions with diverse patients.
  • To critique existing clinical assessments.
  • To present a systematic assessment framework that is person-centered. (correct)

    • Which of the following best describes 'cultural concepts of distress'?

  • Statistical findings about healthcare disparities.
  • Expressions and interpretations of illness shaped by culture. (correct)
  • Psychiatric disorders identified by common medical terms.
  • Universal symptoms that need no cultural context.

    • Why is a person-centered cultural assessment particularly important?

  • It replaces traditional medical assessments.
  • It addresses healthcare disparities from systemic disadvantages. (correct)
  • It ignores the socio-cultural backgrounds of individuals.
  • It focuses solely on psychological diagnoses.

    • Which of these is NOT an example of a cultural idiom of distress?

    <p>Anxiety disorder</p> Signup and view all the answers

    How are symptoms communicated according to cultural concepts of distress?

    <p>Via cultural idioms and metaphors.</p> Signup and view all the answers

    What is the primary purpose of the Cultural Formulation Interview?

    <p>To operationalize cultural assessment components.</p> Signup and view all the answers

    Which of the following statements about cultural idioms of distress is most accurate?

    <p>They can indicate a broad spectrum of distress, not limited to mental health.</p> Signup and view all the answers

    Which term is essential for understanding cultural assessments according to the chapter?

    <p>Race</p> Signup and view all the answers

    What best describes the nature of culture as presented in the content?

    <p>Culture is an open, dynamic system subject to continuous change.</p> Signup and view all the answers

    What role does background knowledge play in understanding culture?

    <p>It often remains implicit and can be hard to articulate.</p> Signup and view all the answers

    How are individuals influenced by cultural contexts in interpreting illness?

    <p>Cultural contexts shape how symptoms are expressed and understood.</p> Signup and view all the answers

    What caution is essential when dealing with cultural information in clinical settings?

    <p>Understanding the fluid nature of culture is crucial to avoid misconceptions.</p> Signup and view all the answers

    In what way do cultural systems transmit knowledge across generations?

    <p>By providing varied and evolving practices and norms.</p> Signup and view all the answers

    What is the implication of being exposed to multiple cultural contexts?

    <p>It enables individuals to form unique identities shaped by various experiences.</p> Signup and view all the answers

    How can cultural context affect the interpretation of symptoms and illness?

    <p>It shapes how individuals understand and respond to their experiences.</p> Signup and view all the answers

    What characterizes culture according to the content?

    <p>Open, dynamic systems that evolve over time.</p> Signup and view all the answers

    Which of the following is a reason to avoid overgeneralizing cultural traits?

    <p>Cultural context can vary greatly among individuals.</p> Signup and view all the answers

    What is a significant factor in the meaning-making process of illness experience?

    <p>Drawing from cultural knowledge and social experiences.</p> Signup and view all the answers

    Why is background knowledge important in cultural assessments?

    <p>It may remain implicit or presumed and can affect understanding.</p> Signup and view all the answers

    In what way does culture influence identity formation?

    <p>It enables individuals to navigate multiple cultural contexts.</p> Signup and view all the answers

    Why is understanding the concept of race critical in psychiatry?

    <p>It can lead to racial ideologies and discrimination impacting mental health.</p> Signup and view all the answers

    What distinguishes ethnicity from race?

    <p>Ethnicity relies on shared cultural attributes and history.</p> Signup and view all the answers

    Which statement best reflects the impact of racism on psychiatric disorders?

    <p>Racism can exacerbate psychiatric disorders and worsen outcomes.</p> Signup and view all the answers

    What factors may contribute to the dilution of ethnic identification?

    <p>Increased globalization and cultural exchange.</p> Signup and view all the answers

    Which of the following statements about racial categories is accurate?

    <p>Racial constructs have been used to justify oppression.</p> Signup and view all the answers

    How can ethnicity be defined according to the provided content?

    <p>A culturally constructed identity based on shared characteristics.</p> Signup and view all the answers

    Which of the following accurately describes the relationship between culture, race, and health disparities?

    <p>They are linked to political, economic, and social inequities.</p> Signup and view all the answers

    How can cultural, ethnic, and racialized identities positively influence individuals?

    <p>By enhancing resilience and group support.</p> Signup and view all the answers

    What challenges may arise from cultural and racialized identities?

    <p>Interpersonal and intergenerational conflicts.</p> Signup and view all the answers

    What is a key consideration in clinical assessment related to culture and ethnicity?

    <p>Incorporating culturally informed diagnosis.</p> Signup and view all the answers

    Where can additional key terms related to racialization and racism be found?

    <p>In the DSM-5-TR Section I Introduction.</p> Signup and view all the answers

    What is a key aspect of the Outline for Cultural Formulation introduced in DSM-IV?

    <p>It provides a framework for assessing cultural features of mental health problems.</p> Signup and view all the answers

    What does the Cultural Formulation Interview (CFI) aim to provide according to DSM-5-TR?

    <p>A culturally sensitive approach to individual assessment.</p> Signup and view all the answers

    Which category is part of the systematic assessment called for in the Outline for Cultural Formulation?

    <p>Social context and illness experience.</p> Signup and view all the answers

    What is emphasized by the Cultural Formulation when assessing individuals from diverse cultural backgrounds?

    <p>Cultural background can significantly inform the assessment of mental health.</p> Signup and view all the answers

    In what way does DSM-5-TR update the Outline for Cultural Formulation from DSM-IV?

    <p>It introduces the Cultural Formulation Interview as a new assessment tool.</p> Signup and view all the answers

    Which aspect of identity is particularly significant for understanding an individual's access to resources and interpersonal relationships?

    <p>Ethnoracial background</p> Signup and view all the answers

    What term describes the overlapping and interconnected nature of various aspects of identity?

    <p>Intersectionality</p> Signup and view all the answers

    For individuals from racialized groups, what should be noted regarding their identity?

    <p>Their degree of interaction with their own group and society at large</p> Signup and view all the answers

    Which factor is important for assessing barriers to clinical communication for individuals with a migrant background?

    <p>Language abilities and preferences</p> Signup and view all the answers

    What aspect of identity can influence both health concerns and the clinical setting?

    <p>Religious affiliation and spirituality</p> Signup and view all the answers

    How does an individual's socioeconomic class impact their identity and access to care?

    <p>It influences their developmental challenges and resource accessibility.</p> Signup and view all the answers

    What factors should be considered when assessing severity and meaning of distressing experiences?

    <p>Norms of the individual's cultural background.</p> Signup and view all the answers

    Which of the following best describes cultural idioms of distress?

    <p>Expressions within a culture that convey distress.</p> Signup and view all the answers

    When assessing coping and help-seeking patterns, which aspect is NOT relevant?

    <p>The educational background of the individual.</p> Signup and view all the answers

    What is a key aspect of cultural concepts of distress in relation to stigma?

    <p>Stigma influences the anticipated outcomes of distress.</p> Signup and view all the answers

    How do cultural explanations affect an individual's understanding of their symptoms?

    <p>They offer subjective insights into the perceived causes.</p> Signup and view all the answers

    Which of the following factors is NOT considered a key stressor in the psychosocial environment?

    <p>Personal hobbies and interests</p> Signup and view all the answers

    How can interpersonal relationships contribute to an individual's resilience?

    <p>By providing emotional support and coping strategies</p> Signup and view all the answers

    Which aspect of cultural features is most likely to affect clinical communication?

    <p>Differences in educational attainment</p> Signup and view all the answers

    Which of the following effects can result from experiences of racism in clinical settings?

    <p>Difficulty in establishing trust</p> Signup and view all the answers

    What is a crucial component for understanding the treatment intervention in culturally diverse populations?

    <p>Individual cultural assessments</p> Signup and view all the answers

    Which of the following might impede effective symptom elicitation in clinical encounters?

    <p>Misunderstandings related to cultural significance of symptoms</p> Signup and view all the answers

    How should social marginalization be assessed in terms of vulnerability?

    <p>By evaluating access to material resources</p> Signup and view all the answers

    Which factor is least likely to be influential in the cultural background of the clinician-patient relationship?

    <p>Clarity of clinical procedures</p> Signup and view all the answers

    What is the primary purpose of the core CFI?

    <p>To conduct a basic clinical assessment</p> Signup and view all the answers

    Which of the following best describes the term 'culture' in the context of the CFI?

    <p>Collective norms and practices of social groups</p> Signup and view all the answers

    Which component of the CFI is specifically designed to gather collateral information?

    <p>Informant version of the core CFI</p> Signup and view all the answers

    How do cultural processes influence the Clinical Formulation Interview?

    <p>They integrate both individual perspectives and their social environments.</p> Signup and view all the answers

    What aspect may affect an individual's illness experience according to cultural considerations?

    <p>The influence of family, friends, and community network</p> Signup and view all the answers

    Which statement about the cultural background of healthcare providers is accurate?

    <p>It shapes the values and practices of healthcare systems.</p> Signup and view all the answers

    In relation to the CFI, what role do supplementary modules play?

    <p>They help in expanding the evaluation as needed.</p> Signup and view all the answers

    Which factor is NOT part of the definition of culture in the CFI context?

    <p>Economic status</p> Signup and view all the answers

    What is a primary characteristic of the Cultural Formulation Interview (CFI)?

    <p>It emphasizes the individual's personal views over societal norms.</p> Signup and view all the answers

    What is an important outcome of using the person-centered approach in cultural assessments?

    <p>It facilitates better understanding by reflecting individual cultural interpretations.</p> Signup and view all the answers

    How does the CFI avoid misinterpretation of an individual's illness experience?

    <p>Through open-ended questions that solicit personal cultural insights.</p> Signup and view all the answers

    What aspect does the CFI particularly emphasize in cultural assessments?

    <p>The social contexts surrounding clinical problems and concerns.</p> Signup and view all the answers

    Which of the following statements best reflects the application of the CFI?

    <p>It recognizes the importance of individual experiences in interpreting distress.</p> Signup and view all the answers

    What is the primary format of the Cultural Formulation Interview (CFI)?

    <p>Two text columns with instructions and illustrative examples</p> Signup and view all the answers

    Which demographic information is critical to obtain before using the CFI?

    <p>Individual's income and employment history</p> Signup and view all the answers

    In what clinical settings can the CFI be effectively utilized?

    <p>In any clinical setting, regardless of cultural background</p> Signup and view all the answers

    What flexibility does the CFI provide to clinicians during interviews?

    <p>The ability to rephrase questions and explore domains further</p> Signup and view all the answers

    Which of the following is NOT a demographic domain to explore using the CFI?

    <p>Favorite food choices</p> Signup and view all the answers

    What advantage does using the CFI in clinical assessments provide?

    <p>Customization of questions based on the individual's background</p> Signup and view all the answers

    What challenge might a clinician face when assessing a patient from a different cultural background?

    <p>Understanding culturally distinctive symptom expressions</p> Signup and view all the answers

    Why might an individual with a history of trauma be hesitant to engage with mainstream healthcare services?

    <p>They may harbor mistrust towards medical institutions</p> Signup and view all the answers

    What can contribute to the difficulty in judging the severity of a patient's illness during assessment?

    <p>Differing cultural perspectives on symptoms and illness</p> Signup and view all the answers

    What might lead to disagreements between an individual and a clinician regarding treatment?

    <p>Previous experiences with different healthcare systems</p> Signup and view all the answers

    In what way can socioeconomic factors impact patient care in a clinical setting?

    <p>They restrict access to treatment and support services</p> Signup and view all the answers

    What is the primary focus of the Cultural Definition of the Problem domain in the CFI?

    <p>Identifying how culture defines distress</p> Signup and view all the answers

    Which group is NOT specifically mentioned as a target for supplementary modules?

    <p>Individuals with disabilities</p> Signup and view all the answers

    How does the CFI enhance treatment planning?

    <p>By integrating cultural information with other clinical data</p> Signup and view all the answers

    What is the purpose of the Informant version of the CFI?

    <p>To collect collateral information from family or caregivers</p> Signup and view all the answers

    Which aspect of the CFI is emphasized to promote individual engagement and satisfaction?

    <p>Thorough integration of cultural context in assessment</p> Signup and view all the answers

    Which of the following best describes the supplementary modules related to the core CFI?

    <p>They explore specific cultural domains in greater detail.</p> Signup and view all the answers

    What are cultural idioms of distress primarily concerned with?

    <p>Collective expressions of distress</p> Signup and view all the answers

    Which of the following best describes cultural syndromes?

    <p>Clusters of symptoms recognized in specific cultural groups</p> Signup and view all the answers

    What is the primary focus of cultural explanations in the context of distress?

    <p>Culturally recognized meanings for symptoms</p> Signup and view all the answers

    How do cultural concepts of distress differ from the term culture-bound syndrome?

    <p>They provide a broader understanding of distress experiences</p> Signup and view all the answers

    Which statement about cultural idioms of distress is accurate?

    <p>They may vary greatly but still communicate shared distress.</p> Signup and view all the answers

    What aspect of cultural syndromes is emphasized in their definition?

    <p>Their recognition as coherent patterns of experience locally</p> Signup and view all the answers

    What is a primary characteristic of the term 'culture bound' in the context of cultural concepts of distress?

    <p>It indicates cultural experiences of distress are unique to specific geographic areas.</p> Signup and view all the answers

    How do cultural differences impact coping strategies according to the content provided?

    <p>They are associated with variations in coping strategies and help-seeking patterns.</p> Signup and view all the answers

    Which of the following statements best reflects the concept of 'operationalized prototypes' in relation to DSM diagnoses?

    <p>They began as cultural syndromes and gained acceptance for their clinical utility.</p> Signup and view all the answers

    What influences the formation of cultural concepts of distress?

    <p>The interplay of cultural beliefs, values, and practices.</p> Signup and view all the answers

    Which aspect of cultural differences is emphasized in relation to symptoms of distress?

    <p>Culturally patterned differences exist in symptoms and expressions of distress.</p> Signup and view all the answers

    What is the relationship between DSM disorders and cultural syndromes?

    <p>Many DSM diagnoses started as cultural syndromes and evolved into recognized disorders.</p> Signup and view all the answers

    Which statement accurately reflects the relationship between cultural concepts of distress and DSM-5 diagnostic entities?

    <p>There can be multiple DSM diagnoses for a single cultural concept of distress.</p> Signup and view all the answers

    What range of presentations can cultural concepts of distress encompass?

    <p>Any level of symptom severity, meeting or not meeting DSM criteria.</p> Signup and view all the answers

    How can a single cultural term signify different concepts of distress?

    <p>It may describe both a syndrome and an individual experience simultaneously.</p> Signup and view all the answers

    What factor can influence the evolution of cultural concepts of distress over time?

    <p>Local and global cultural influences.</p> Signup and view all the answers

    What is a potential misconception regarding cultural concepts of distress?

    <p>They consistently align with DSM diagnostic categories.</p> Signup and view all the answers

    In what way are diverse presentations classified differently in cultural concepts of distress?

    <p>Cultural concepts may separate what DSM considers a single disorder.</p> Signup and view all the answers

    Which of the following examples illustrates the complexity of cultural idioms of distress?

    <p>Describing both acute grief and chronic illness under the same cultural concept.</p> Signup and view all the answers

    What is a defining characteristic of cultural concepts of distress?

    <p>They may encompass a wide range of interpretations and meanings.</p> Signup and view all the answers

    How do cultural concepts of distress enhance the detection of psychopathology?

    <p>By aligning clinical terms with cultural concepts.</p> Signup and view all the answers

    What is a potential consequence of misunderstanding cultural concepts of distress?

    <p>Misdiagnosis of certain conditions as different disorders.</p> Signup and view all the answers

    In what way can understanding cultural concepts of distress improve clinical rapport?

    <p>By engaging in meaningful discussions using culturally relevant language.</p> Signup and view all the answers

    Why is it important to explore cultural variations in symptoms?

    <p>They provide insights into factors of risk and resilience.</p> Signup and view all the answers

    How can cultural concepts influence therapeutic efficacy?

    <p>By addressing culturally specific cognitive patterns contributing to symptoms.</p> Signup and view all the answers

    What role do culture and distress concepts play in clinical research?

    <p>They can reveal new patterns of comorbidity and disorders.</p> Signup and view all the answers

    What can the exploration of cultural concepts of distress elicit in a clinical context?

    <p>Insights into specific contexts affecting symptom development.</p> Signup and view all the answers

    What is one reason for the importance of cultural concepts in psychiatric diagnosis?

    <p>They prevent misinterpretation of symptom severity.</p> Signup and view all the answers

    What is the significance of distinguishing cultural idioms of distress in the study of cultural epidemiology?

    <p>It aids in understanding the distribution of cultural features of illness.</p> Signup and view all the answers

    How do cultural explanations function in the context of cultural concepts of distress?

    <p>They offer insight into the unique meanings individuals ascribe to their experiences.</p> Signup and view all the answers

    What does the concept of cultural epidemiology primarily focus on?

    <p>The influence of cultural beliefs on health outcomes.</p> Signup and view all the answers

    What type of questions does the study of cultural features of illness suggest?

    <p>Questions about cultural determinants of risk and outcomes.</p> Signup and view all the answers

    Why might a uniform endorsement of cultural concepts of distress be problematic?

    <p>It can limit the ability to recognize diverse cultural expressions of distress.</p> Signup and view all the answers

    What is one role of cultural terms and explanations in clinical assessment?

    <p>They assist in clarifying symptoms and etiological attributions.</p> Signup and view all the answers

    What does DSM-5-TR provide information on regarding cultural variations?

    <p>Cultural variations in symptom expression and attributions.</p> Signup and view all the answers

    When evaluating individuals from marginalized groups, what is a risk that clinicians should consider?

    <p>Misdiagnosis due to cultural misunderstandings.</p> Signup and view all the answers

    How should treatment expectations be handled for individuals whose symptoms do not meet DSM criteria?

    <p>They may still expect and require treatment on a case-by-case basis.</p> Signup and view all the answers

    What is a key consideration when diagnosing individuals using DSM criteria and cultural concepts of distress?

    <p>Cultural variations must be integrated into the diagnostic process.</p> Signup and view all the answers

    What is the relationship between cultural concepts of distress and DSM disorders?

    <p>There is no one-to-one correspondence between them.</p> Signup and view all the answers

    What may enhance the comprehensiveness of clinical assessment in relation to cultural concepts of distress?

    <p>Incorporating cultural concepts in case formulations.</p> Signup and view all the answers

    How can cultural norms influence clinical assessments?

    <p>They may affect the threshold for pathology and perceived severity.</p> Signup and view all the answers

    What role do cultural concepts of distress play in the clinical setting?

    <p>They may coexist with psychiatric disorders and influence clinical outcomes.</p> Signup and view all the answers

    Which example best illustrates a cultural concept of distress that can co-occur with psychiatric disorders?

    <p>Ataque de nervios in U.S. Latinx communities.</p> Signup and view all the answers

    How should clinicians approach cultural concepts of distress?

    <p>By familiarizing themselves with these concepts to enhance their diagnostic skills.</p> Signup and view all the answers

    What is a key consideration when addressing cultural concepts of distress?

    <p>They may vary significantly based on individual cultural contexts.</p> Signup and view all the answers

    Which of the following statements about the Cultural Formulation Interview is accurate?

    <p>It helps identify individual cultural concepts of distress.</p> Signup and view all the answers

    What might be included in the description of cultural concepts of distress?

    <p>Related conditions in DSM-5-TR.</p> Signup and view all the answers

    Why is it important for clinicians to be aware of cultural concepts of distress?

    <p>They can lead to misdiagnosis if ignored.</p> Signup and view all the answers

    Which of the following best defines the term 'cultural concept of distress'?

    <p>A way to understand how different cultures interpret mental health issues.</p> Signup and view all the answers

    Which of the following is a common symptom of ataque de nervios?

    <p>Intense emotional upset</p> Signup and view all the answers

    What is a general feature of an ataque de nervios?

    <p>Feeling out of control</p> Signup and view all the answers

    Which of the following is NOT typically associated with ataque de nervios?

    <p>Acute happiness</p> Signup and view all the answers

    In what context do ataques de nervios typically occur?

    <p>In response to stressful family events</p> Signup and view all the answers

    What is a possible, though not universal, symptom of ataque de nervios?

    <p>Seizure-like episodes</p> Signup and view all the answers

    Which of the following best describes the relationship between ataque de nervios and psychiatric disorders?

    <p>Ataque de nervios has symptomatic overlap with several psychiatric disorders.</p> Signup and view all the answers

    What percentage of US Latinx adults report experiencing ataque?

    <p>7%-15%</p> Signup and view all the answers

    Which of the following is NOT a condition related to ataque as per DSM-5-TR?

    <p>Major depressive disorder</p> Signup and view all the answers

    What does the term ataque de nervios refer to in relation to emotionality?

    <p>Loss of control due to intense stress</p> Signup and view all the answers

    Which cultural condition is mentioned as similar to ataque?

    <p>Blacking out in Haiti</p> Signup and view all the answers

    Which statement best describes the clinical significance of ataque?

    <p>It indicates high rates of suicidal thoughts and disability.</p> Signup and view all the answers

    In what context is ataque often seen as a normative response?

    <p>At a funeral</p> Signup and view all the answers

    What is the primary concern of individuals suffering from dhat syndrome?

    <p>Anxiety and distress about semen loss</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with dhat syndrome?

    <p>Erectile dysfunction</p> Signup and view all the answers

    Which demographic is most commonly associated with dhat syndrome?

    <p>Young men from lower socioeconomic backgrounds</p> Signup and view all the answers

    How do cultural ideas about the substance dhat impact individuals' understanding of their health?

    <p>By providing a culturally relevant explanation for distress</p> Signup and view all the answers

    What physiological observation do individuals identify as related to dhat syndrome?

    <p>White discharge noted during defecation or urination</p> Signup and view all the answers

    In addition to men, which group is mentioned as experiencing related concerns to those of dhat syndrome?

    <p>Women with leukorrhea</p> Signup and view all the answers

    What is suggested about the prevalence of dhat syndrome in health care settings?

    <p>It varies significantly among populations</p> Signup and view all the answers

    Besides semen loss, what were some complaints linked to dhat syndrome?

    <p>Multiple somatic complaints and depressed mood</p> Signup and view all the answers

    What is the primary characteristic of hikikomori?

    <p>Prolonged social withdrawal</p> Signup and view all the answers

    In which cultural context is shen-k'uei, or 'kidney deficiency,' recognized?

    <p>China</p> Signup and view all the answers

    What is the minimum duration of social withdrawal required for a diagnosis of hikikomori according to Japan's health guidelines?

    <p>6 months</p> Signup and view all the answers

    Which of the following is NOT typically associated with hikikomori?

    <p>Frequent in-person social interactions</p> Signup and view all the answers

    Which DSM-5 disorder is related to protracted social withdrawal in adolescents and young adults?

    <p>Social anxiety disorder</p> Signup and view all the answers

    Hikikomori behavior is often linked to which social aspect?

    <p>Virtual social exchanges</p> Signup and view all the answers

    Which of the following regions has NOT reported hikikomori-type behaviors?

    <p>Egypt</p> Signup and view all the answers

    Which of these conditions might manifest independently of a DSM-5 disorder in the context of hikikomori?

    <p>Social withdrawal</p> Signup and view all the answers

    What is a common trigger for khyâl attacks?

    <p>Worrisome thoughts</p> Signup and view all the answers

    Which symptom is NOT typically associated with khyâl attacks?

    <p>Persistent cough</p> Signup and view all the answers

    Khyâl attacks are primarily characterized by a fear of which phenomenon?

    <p>Windlike substance rising in the body</p> Signup and view all the answers

    Which of the following is a cultural concept related to mental distress in Zimbabwe?

    <p>Kufungisisa</p> Signup and view all the answers

    Which condition is associated with considerable disability, according to the content?

    <p>Khyâl attacks</p> Signup and view all the answers

    What is the term for the Cambodian syndrome characterized by panic-like symptoms?

    <p>Khyâl cap</p> Signup and view all the answers

    Which of the following describes a symptom related to khyâl attacks?

    <p>Blurred vision</p> Signup and view all the answers

    Khyâl attacks may include catastrophic cognitions focusing on which potential outcomes?

    <p>Health deterioration</p> Signup and view all the answers

    What primary factor is believed to provoke maladi dyab in individuals?

    <p>Interpersonal envy and malice</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with maladi dyab?

    <p>Asthma</p> Signup and view all the answers

    What is a common perception regarding individuals who are economically successful in the context of maladi dyab?

    <p>They are more vulnerable to spiritual attacks</p> Signup and view all the answers

    What does the term 'sent sickness' refer to in the context of maladi dyab?

    <p>An illness attributed to supernatural causes</p> Signup and view all the answers

    Which symptom's abrupt onset is most likely to raise suspicions of maladi dyab?

    <p>Acute behavioral changes</p> Signup and view all the answers

    In the context of maladi dyab, which of the following factors is least likely to influence the assignment of a 'sent sickness' label?

    <p>Type of physical illness present</p> Signup and view all the answers

    Which term refers to illness caused by envy or social conflict, often expressed through cultural beliefs across different societies?

    <p>Evil eye</p> Signup and view all the answers

    What may cultural explanations of illness lead to in psychiatric diagnosis?

    <p>Misdiagnosis of delusional disorder</p> Signup and view all the answers

    Which of the following best describes subsyndromal affliction?

    <p>Issues related to the social environment</p> Signup and view all the answers

    In which cultural context is the term 'mal de ojo' used to express concerns about physical illness caused by envy?

    <p>Spanish</p> Signup and view all the answers

    Which factor could potentially cause a misdiagnosis of psychiatric conditions due to cultural beliefs?

    <p>Supernatural forces</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with nervios?

    <p>Euphoria</p> Signup and view all the answers

    What cultural context does the term 'nervios' particularly refer to?

    <p>Latinx cultural contexts</p> Signup and view all the answers

    In Puerto Rican communities, which condition is notably included under nervios?

    <p>Being nervous since childhood</p> Signup and view all the answers

    Nervios can indicate conditions that vary regionally and may resemble which of the following?

    <p>Somatic symptom disorders</p> Signup and view all the answers

    Which of the following best describes the term 'nervios'?

    <p>A cultural idiom of distress</p> Signup and view all the answers

    Which symptom is related to the feeling of 'mareos' in the context of nervios?

    <p>Dizziness</p> Signup and view all the answers

    Nervios may include symptoms that affect which aspect of functioning?

    <p>Emotional and social functioning</p> Signup and view all the answers

    What is a common emotional symptom attributed to nervios?

    <p>Easy tearfulness</p> Signup and view all the answers

    Which cultural idiom is associated with South Asian populations as a causal explanation?

    <p>Tension</p> Signup and view all the answers

    Which term is commonly used among Whites in Appalachia and Newfoundland to describe distress?

    <p>Nerves</p> Signup and view all the answers

    Which of the following conditions is NOT classified in the DSM-5-TR?

    <p>Cultural distress syndrome</p> Signup and view all the answers

    Which of the following disorders focuses primarily on chronic sadness and low mood?

    <p>Persistent depressive disorder</p> Signup and view all the answers

    Which cultural idiom denotes a condition recognized among Greeks in North America?

    <p>Nevra</p> Signup and view all the answers

    What is the meaning of 'Shenjing Shuairuo' in Mandarin?

    <p>Weakness of the nervous system</p> Signup and view all the answers

    Which of the following is NOT a symptom cluster associated with 'Shenjing Shuairuo'?

    <p>Physical strength</p> Signup and view all the answers

    How has the usage of 'Shenjing Shuairuo' changed in recent years?

    <p>It has largely been replaced by terms related to depression and anxiety.</p> Signup and view all the answers

    'Fan nao' is best characterized as which of the following?

    <p>A form of irritability mixed with worry and distress</p> Signup and view all the answers

    Which edition of the CCMD retained 'Shenjing Shuairuo' as a somatoform diagnosis?

    <p>Third edition</p> Signup and view all the answers

    What has replaced the CCMD in China for mental health classification?

    <p>ICD-10</p> Signup and view all the answers

    What are common precipitants of shenjing shuairuo?

    <p>Family-related stressors</p> Signup and view all the answers

    Which traditional concept is associated with shenjing shuairuo?

    <p>Depletion of qi</p> Signup and view all the answers

    What percentage of patients with shenjing shuairuo do not meet DSM-IV criteria for any disorder?

    <p>45%</p> Signup and view all the answers

    Which psychiatric disorders are primarily associated with shenjing shuairuo?

    <p>Mood and anxiety disorders</p> Signup and view all the answers

    Neurasthenia-spectrum disorders are recognized in which of the following cultural contexts?

    <p>India</p> Signup and view all the answers

    What other condition is closely related to shenjing shuairuo?

    <p>Burnout syndrome</p> Signup and view all the answers

    What primarily causes susto according to cultural beliefs?

    <p>A frightening event</p> Signup and view all the answers

    Which symptom is NOT commonly associated with susto?

    <p>Excessive happiness</p> Signup and view all the answers

    Interpersonal susto is most closely related to which type of psychiatric diagnosis?

    <p>Major depressive disorder</p> Signup and view all the answers

    Which of the following is a potential outcome of untreated susto?

    <p>Death</p> Signup and view all the answers

    Which type of susto is thought to resemble somatic symptom disorder?

    <p>Susto with recurrent somatic symptoms</p> Signup and view all the answers

    What is a common precipitating event for susto?

    <p>Natural phenomena</p> Signup and view all the answers

    Which of the following best describes 'susto resulting from a traumatic event'?

    <p>Closely related to posttraumatic stress disorder</p> Signup and view all the answers

    Susto is primarily recognized in which cultural contexts?

    <p>Latinx cultures</p> Signup and view all the answers

    What is the primary psychological impact of soul loss as described in the context?

    <p>It results in vulnerability to physical and psychological distress.</p> Signup and view all the answers

    Which form of Taijin Kyofusho is characterized by extreme social sensitivity and anxiety?

    <p>Sensitive type</p> Signup and view all the answers

    Which condition is NOT directly related to Taijin Kyofusho?

    <p>Posttraumatic stress disorder</p> Signup and view all the answers

    What aspect of culture does Taijin Kyofusho predominantly emphasize?

    <p>Self-conscious maintenance of appropriate social behavior</p> Signup and view all the answers

    Which characteristic is a variant of the 'offensive type' of Taijin Kyofusho?

    <p>Facial blushing</p> Signup and view all the answers

    What does delusional disorder refer to in relation to Taijin Kyofusho?

    <p>Concerns that present delusional qualities and do not improve with reassurance</p> Signup and view all the answers

    Which term best describes the interdependent self-construal emphasized in cultures related to Taijin Kyofusho?

    <p>Collective identity</p> Signup and view all the answers

    What is one of the related conditions to soul loss as described?

    <p>Somatic symptom disorder</p> Signup and view all the answers

    What risk factor for Taijin Kyofusho symptoms is identified in relation to social roles and relationships?

    <p>Identification of self</p> Signup and view all the answers

    Which disorder is specifically related to the jikoshu-kyofu variant of Taijin Kyofusho?

    <p>Olfactory reference syndrome</p> Signup and view all the answers

    In which countries has the concern with offending others through inappropriate social behavior been described?

    <p>United States, Australia, Indonesia, New Zealand</p> Signup and view all the answers

    Which of the following disorders is NOT listed as related to DSM-5-TR conditions?

    <p>Post-traumatic stress disorder</p> Signup and view all the answers

    What is the primary characteristic of the offensive-type Taijin Kyofusho?

    <p>Concern about offending others</p> Signup and view all the answers

    Study Notes

    Integrating Culture and Social Context in Clinical Diagnoses

    • The chapter provides basic information on integrating culture and social context in clinical diagnoses, defining essential terms such as culture, race, and ethnicity.

    Cultural Formulation

    • The Cultural Formulation section presents a systematic person-centered cultural assessment outline for clinicians to use in any care setting.
    • The Cultural Formulation Interview is an operationalized protocol for this assessment.
    • Symptom presentations, interpretations of illness, and help-seeking expectations are influenced by individuals' cultural backgrounds and sociocultural contexts.
    • A person-centered cultural assessment can improve care for every individual, regardless of background.
    • Cultural formulation is especially helpful for individuals affected by healthcare disparities driven by systemic disadvantage and discrimination.

    Cultural Concepts of Distress

    • Cultural concepts of distress include idioms, explanations, perceived causes, and syndromes.
    • Symptoms are expressed and communicated using cultural idioms of distress, such as behaviors, linguistic terms, metaphors, phrases, or ways of talking about symptoms.
    • Idioms of distress are used to convey a wide range of concerns and may not indicate a psychiatric disorder.
    • Common contemporary idioms in the United States include "burnout", "feeling stressed", "nervous breakdown", and "feeling depressed" (in a sense of dissatisfaction or discouragement, not meeting psychiatric disorder criteria).
    • Culturally specific explanations and syndromes are common and distributed widely across populations.
    • Examples of idioms, explanations, and syndromes from diverse geographic regions are provided, chosen for their familiarity and well-studied nature.

    Culture and Illness Experience

    • Culture is a complex system of knowledge, concepts, values, norms, and practices that are learned and transmitted across generations.
    • Cultural systems include language, religion, spirituality, family structures, life-cycle stages, ceremonial rituals, customs, and ways of understanding health and illness.
    • Culture also encompasses moral, political, economic, and legal systems that shape individuals' experiences and perceptions.
    • Cultures are dynamic and constantly evolving over time, influenced by various factors and contexts.
    • In today's world, individuals are often exposed to multiple cultural contexts, which they use to form their identities and make sense of their experiences.

    Cultural Influence on Health and Illness

    • Culture plays a crucial role in shaping how individuals perceive and respond to symptoms and illness.
    • Cultural contexts influence how individuals fashion their identities, including their understanding of health and illness.
    • Cultural background and values can remain implicit or presumed, making it challenging for individuals to articulate them explicitly.
    • It is essential to recognize that all forms of illness and distress, including DSM disorders, are shaped by cultural contexts.

    Importance of Cultural Awareness in Diagnosis

    • Overgeneralizing cultural information or stereotyping groups based on fixed cultural traits must be avoided.
    • Culture influences how individuals interpret and respond to symptoms and illness, making cultural awareness crucial in diagnostic assessment and clinical management.
    • Effective diagnosis and clinical management require an understanding of the cultural context of illness experience.

    Culture and Illness Experience

    • Culture is a complex system of knowledge, concepts, values, norms, and practices that are learned and transmitted across generations.
    • Cultural systems include language, religion, spirituality, family structures, life-cycle stages, ceremonial rituals, customs, and ways of understanding health and illness.
    • Culture also encompasses moral, political, economic, and legal systems that shape individuals' experiences and perceptions.
    • Cultures are dynamic and constantly evolving over time, influenced by various factors and contexts.
    • In today's world, individuals are often exposed to multiple cultural contexts, which they use to form their identities and make sense of their experiences.

    Cultural Influence on Health and Illness

    • Culture plays a crucial role in shaping how individuals perceive and respond to symptoms and illness.
    • Cultural contexts influence how individuals fashion their identities, including their understanding of health and illness.
    • Cultural background and values can remain implicit or presumed, making it challenging for individuals to articulate them explicitly.
    • It is essential to recognize that all forms of illness and distress, including DSM disorders, are shaped by cultural contexts.

    Importance of Cultural Awareness in Diagnosis

    • Overgeneralizing cultural information or stereotyping groups based on fixed cultural traits must be avoided.
    • Culture influences how individuals interpret and respond to symptoms and illness, making cultural awareness crucial in diagnostic assessment and clinical management.
    • Effective diagnosis and clinical management require an understanding of the cultural context of illness experience.

    Race

    • A social construct that divides humans into groups based on superficial physical traits like skin color, which are falsely seen as indicating attributes and capacities inherent to the group.
    • Racial categories and constructs have varied across history and societies, and have been used to justify systems of oppression, slavery, and genocide.
    • The construct of race contributes to racial ideologies, racism, discrimination, and social oppression and exclusion, which negatively impact mental health.
    • Racism can exacerbate many psychiatric disorders, contributing to poor outcomes, and racial biases can affect diagnostic assessment.

    Ethnicity

    • A culturally constructed group identity used to define peoples and communities based on shared characteristics like history, ancestry, geography, language, religion, or other commonalities.
    • Ethnicity may be self-assigned or attributed by outsiders, and can be rooted in common characteristics that distinguish one group from others.
    • Increasing mobility, intermarriage, and cultural intermixing have led to the emergence of new mixed, multiple, or hybrid ethnic identities.
    • These processes can also lead to the dilution of ethnic identification.

    Culture, Race, and Ethnicity

    • Culture, race, and ethnicity are linked to political, economic, and social structural inequities that contribute to racism, discrimination, and health disparities.
    • These identities can be sources of strength, group support, and enhanced resilience.
    • They can also lead to psychological, interpersonal, and intergenerational conflict or difficulties in adaptation.
    • Clinical assessment and diagnosis must be socially and culturally informed to address these complexities.

    Key Terms

    • The DSM-5-TR Section I Introduction defines additional key terms related to racialization and racism under "Cultural and Social Structural Issues."
    • The subsection "Impact of Racism and Discrimination on Psychiatric Diagnosis" provides further context on these terms.

    Outline for Cultural Formulation

    • Introduced in DSM-IV, provides a framework for assessing cultural features of an individual's mental health problem and its relation to social and cultural context and history.
    • Useful for assessing social context and illness experience relevant to every individual, not just those with unfamiliar cultural backgrounds.

    Updates in DSM-5, DSM-5-TR

    • Includes an expanded version of the Outline.
    • Introduces the Cultural Formulation Interview (CFI) approach to assessment.
    • CFI has been field-tested among clinicians, patients, and relatives, and found to be:
      • Feasible
      • Acceptable
      • Useful cultural assessment tool

    Categories for Systematic Assessment

    • The Outline for Cultural Formulation calls for assessment of the following categories: (Note: categories not specified in the provided text)

    Cultural Identity of the Individual

    • Demographic characteristics of an individual include age, gender, and ethnoracial background, influencing interpersonal relationships, resources, and challenges.
    • Socially and culturally defined characteristics affecting identity include religious affiliation, spirituality, socioeconomic class, caste, personal and family places of birth and growing up, migrant status, occupation, and sexual orientation.
    • Clinically relevant aspects of identity involve which aspects are prioritized by the individual and how they intersect (intersectionality).
    • Clinical setting and health concerns can influence prioritization of identity aspects.
    • For migrants, involvement with both cultural contexts of origin and new cultural contexts should be noted.
    • For individuals identifying with racialized and ethnic groups, interaction and identification with their own group and other segments of society should be noted.

    Language and Communication

    • Language abilities, preferences, and patterns of use are significant for identifying difficulties with: • Access to care • Social integration • Clinical communication • Need for an interpreter

    Cultural Concepts of Distress

    • Cultural constructs influence how individuals experience, understand, and communicate symptoms or problems to others.
    • Three key cultural constructs: • Cultural idioms of distress • Cultural explanations or perceived causes • Cultural syndromes
    • Assessing distress severity and meaning should consider the individual's cultural background norms.
    • Relevant factors to consider: • Priority symptoms • Perceived seriousness of the illness • Level of associated stigma • Anticipated outcomes
    • Elicit individual's and family's/friends' help-seeking expectations and plans.
    • Consider: • Past help-seeking experiences • Patterns of self-coping • Connection to cultural concepts of distress
    • Assessment of coping and help-seeking patterns should account for: • Professional sources of care • Traditional, alternative, or complementary sources of care

    Psychosocial Stressors and Cultural Features of Vulnerability and Resilience

    • Key stressors in an individual's social environment include local and distant events, social determinants, and exposure to racism, discrimination, and systemic institutional stigmatization.
    • Social marginalization or exclusion can also be a significant stressor.
    • Assess the role of interpersonal relationships and social networks, including religion, family, and friends, in causing stress or providing emotional, instrumental, and informational support.
    • Social stressors and social supports vary with social context, family structure, developmental tasks, and cultural meaning of events.

    Cultural Features of the Relationship Between the Individual and the Clinician, Treatment Team, and Institution

    • Identify differences in cultural background, language, education, and social status between the individual and clinician or treatment team.
    • These differences can cause difficulties in communication and may influence diagnosis and treatment.
    • Consider how individuals and clinicians are positioned socially and perceive each other in terms of social categories, influencing the assessment process.
    • Experiences of racism and discrimination in society can impede establishing trust and safety in the clinical diagnostic encounter.
    • Potential effects include problems eliciting symptoms, misunderstanding of symptoms and behaviors, and difficulty establishing or maintaining rapport.

    Overall Cultural Assessment

    • Summarize the implications of cultural formulation components for differential diagnosis of mental disorders and other clinically relevant issues or problems.
    • Identify appropriate management and treatment interventions based on cultural assessment.

    The Cultural Formulation Interview (CFI)

    • A set of protocols used in mental health assessments to understand the impact of culture on an individual's clinical presentation and care.

    Components of CFI

    • Core CFI: 16 questions for initial assessment
    • Informant version of core CFI: For obtaining collateral information
    • Supplementary modules: To expand evaluation as needed

    Definition of Culture

    • Includes processes by which individuals assign meaning to experiences based on values, orientations, knowledge, and practices of diverse social groups
    • Encompasses aspects of individuals' background, developmental experiences, and current social contexts that affect their perspective, such as:
      • Age, gender, social class, geographic origin, migration, language, religion, sexual orientation, disability, or ethnic/racialized background
    • Includes influence of family, friends, and community members on the individual's illness experience
    • Includes cultural background of healthcare providers and values/assumptions embedded in healthcare systems and institutions

    Cultural Processes

    • Involve interactions between individuals and local/larger social contexts
    • Cultural assessment evaluates processes within the individual and in the social world, assessing context as much as the person

    The Cultural Formulation Interview (CFI)

    • A brief, semistructured interview for assessing cultural factors relevant to an individual's care
    • Focuses on the individual's experience and social contexts of the clinical problem, symptoms, or concerns
    • Person-centered approach to cultural assessment, eliciting information from the individual about their own views and those of others in their social network

    Key Features of the CFI

    • Designed to avoid stereotyping, recognizing that each individual's cultural knowledge affects their interpretation of illness experience and help-seeking behavior
    • No right or wrong answers to the questions, as it concerns the individual's personal views

    Availability of the CFI

    • The core CFI (and informant version) is available online at www.psychiatry.org/dsm5
    • Supplementary modules are also available online

    CFI Structure

    • The CFI has a two-column format
    • Left-hand column contains instructions for administering the CFI and describes the goals of each interview domain
    • Right-hand column illustrates how to explore these domains, and questions can be rephrased and followed up as needed

    CFI Purpose and Flexibility

    • The CFI is a guide to cultural assessment
    • It is used flexibly to maintain rapport with the interviewee
    • It is best used in conjunction with demographic information obtained before the interview

    Demographic Domains

    • Place of birth
    • Age
    • Gender
    • Ethnic or racialized background
    • Marital status
    • Family composition
    • Education
    • Language fluencies
    • Sexual orientation
    • Religious or spiritual affiliation
    • Occupation
    • Employment
    • Income
    • Migration history

    CFI Applicability

    • Can be used in the initial assessment of individuals at any age
    • Can be used in any clinical setting, regardless of the cultural background of the individual or clinician
    • Especially helpful when individuals and clinicians share the same cultural background but differ in ways relevant to care
    • Can be used in its entirety or incorporated into a clinical evaluation as needed

    Cultural Barriers in Diagnostic Assessment

    • Significant differences in cultural, religious, or socioeconomic backgrounds between clinicians and individuals can hinder accurate diagnosis.
    • Uncertainty arises when culturally distinctive symptoms don't fit traditional diagnostic criteria.
    • Assessing illness severity or impairment becomes challenging due to varying cultural perspectives.

    Divergent Views on Symptoms and Care

    • Individuals from diverse cultural backgrounds may have different views on symptoms and expectations of care based on prior experiences with alternative healing systems.
    • Disagreements can occur between individuals and clinicians regarding the course of treatment.

    Mistrust and Limited Engagement

    • Individuals with collective histories of trauma and oppression may distrust mainstream services and institutions, leading to:
      • Limited engagement in treatment
      • Poor adherence to treatment plans

    The Core CFI

    • Emphasizes four domains of assessment:
      • Cultural Definition of the Problem (questions 1-3)
      • Cultural Perceptions of Cause, Context, and Support (questions 4-10)
      • Cultural Factors Affecting Self-Coping and Past Help Seeking (questions 11-13)
      • Cultural Factors Affecting Current Help Seeking (questions 14-16)
    • Aims to enhance cultural validity of diagnostic assessment, facilitate treatment planning, and promote individual's engagement and satisfaction
    • Requires integration of CFI information with other clinical material for comprehensive clinical and contextual evaluation

    Informant Version

    • Collects collateral information on CFI domains from family members or caregivers
    • Provides additional perspective on the individual's cultural background and experiences

    Supplementary Modules

    • Expand on each domain of the core CFI for in-depth exploration
    • Developed for specific populations, including:
      • Children and adolescents
      • Elderly individuals
      • Caregivers
      • Immigrants and refugees
    • Available online at www.psychiatry.org/dsm5

    Cultural Concepts of Distress

    • Cultural concepts of distress refer to ways individuals experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions.

    Types of Cultural Concepts of Distress

    • Cultural idioms of distress: ways of expressing distress that may not involve specific symptoms or syndromes, but provide collective, shared ways of experiencing and talking about personal or social concerns.
    • Cultural explanations: labels, attributions, or features of an explanatory model that indicate culturally recognized meaning or etiology for symptoms, illness, or distress.
    • Cultural syndromes: clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts and are recognized locally as coherent patterns of experience.

    Relevance in Clinical Practice

    • Cultural concepts of distress are more relevant to clinical practice than the older formulation culture-bound syndrome.
    • The term culture-bound syndrome ignores the fact that clinically important cultural concepts of distress are not bound to specific cultures.

    Cultural Differences and Distress

    • Cultural differences involve explanations or experiences of distress, rather than culturally distinct configurations of symptoms.
    • The term "culture bound" overemphasizes the uniqueness of cultural concepts of distress to specific geographic regions.
    • All forms of distress, including DSM disorders, are locally shaped by cultural influences.
    • Many DSM diagnoses originated as cultural syndromes and became widely accepted due to their clinical and research utility.

    Cultural Concepts of Distress

    • Cultural concepts of distress emerge from local "folk" or professional diagnostic systems for mental and emotional distress.
    • These concepts are influenced by cultural:
      • Beliefs
      • Values
      • Practices

    Cultural Concepts of Distress

    • Cultural concepts of distress often do not have a one-to-one correspondence with DSM-5 diagnostic entities.
    • Instead, they may correspond to multiple DSM-5 disorders or encompass diverse presentations that the DSM-5 would classify as variants of a single disorder.
    • A single cultural concept of distress may include symptoms or behaviors spread across multiple DSM-5 disorders.
    • Cultural concepts of distress can apply to a wide range of symptom severity, including presentations that do not meet DSM criteria for any mental disorder.
    • Individuals with acute grief or social predicaments may use the same idiom of distress as those with more severe psychopathology.
    • A single cultural term may denote multiple types of cultural concepts of distress, such as the term "depression" being used to describe a syndrome, an idiom of distress, or an explanation or perceived cause.
    • Cultural concepts of distress are not static and may change over time due to local and global influences.

    Importance of Cultural Concepts in Psychiatric Diagnosis

    • Cultural concepts of distress are crucial for identifying patients' concerns and detecting psychopathology, as individuals are more familiar with these concepts than professional terminology.

    Avoiding Misdiagnosis

    • Culturally variant symptoms and explanatory models can lead to misdiagnosis, e.g., socially warranted suspicion being mistaken for paranoia, and unfamiliar symptom presentations being misdiagnosed as psychosis.

    Gathering Clinical Information

    • Cultural variations in symptoms and attributions provide valuable insights into risk, resilience, and outcome, and can inform on the role of specific contexts in symptom development and response to coping strategies.

    Improving Clinical Rapport and Engagement

    • Using patients' dominant cultural concepts of distress and metaphors can improve communication, satisfaction, treatment negotiation, and retention, thereby enhancing clinical rapport and engagement.

    Enhancing Therapeutic Efficacy

    • Culture influences the psychological mechanisms of a disorder, and understanding these cultural factors is essential to improve clinical efficacy, e.g., addressing culturally specific catastrophic cognitions that contribute to symptom escalation into panic attacks.

    Guiding Clinical Research

    • Locally perceived connections between cultural concepts of distress can identify patterns of comorbidity and underlying biological substrates, and may reveal previously unrecognized disorders or variants that can be included in future research.

    Cultural Epidemiology

    • Cultural concepts of distress are not universally accepted within a cultural context, implying variability in endorsement across individuals.
    • Distinguishing between three key aspects of cultural influences on illness is essential:
      • Cultural idioms of distress (expressions of distress within a culture)
      • Cultural explanations (attributions of causes or meanings of illness within a culture)
      • Cultural syndromes (patterns of symptoms and behaviors within a culture)
    • This approach enables the study of cultural features of illness across:
      • Different settings (clinical, community, etc.)
      • Regions (geographical locations)
      • Time (historical periods)
    • The study of cultural epidemiology raises important questions about:
      • Cultural determinants of risk (factors that increase susceptibility to illness)
      • Course (development and progression of illness)
      • Outcome (consequences of illness) in both clinical and community contexts
    • Answering these questions can enhance the evidence base for cultural research, ultimately informing more effective interventions and treatments.

    DSM-5 Cultural Concepts of Distress

    • Improves accuracy of diagnosis by determining if a patient's presentation meets DSM-5 criteria or should be classified as an "other specified diagnosis"
    • Enhances comprehensiveness of clinical assessment by considering cultural concepts of distress when evaluating individuals

    Key Concepts

    • Cultural terms and explanations should be included in case formulations to clarify symptoms and etiological attributions
    • Individuals whose symptoms do not meet DSM criteria may still require treatment, assessed on a case-by-case basis

    DSM-5-TR Text for Specific Disorders

    • Provides information on cultural variations in symptom expression
    • Provides information on attributions for disorder causes or precipitants
    • Provides information on factors associated with differential prevalence across demographic groups
    • Provides information on cultural norms that may affect the threshold for pathology and perceived severity of the condition
    • Provides information on risk for misdiagnosis when evaluating individuals from socially oppressed ethnoracial or marginalized groups
    • Provides information on associated cultural concepts of distress
    • Provides other material relevant to culturally informed diagnosis

    Important Note

    • There is no one-to-one correspondence between DSM disorders and cultural concepts of distress
    • Differential diagnosis for individuals must incorporate information on cultural variation with information elicited by the CFI

    Other Conditions That May Be a Focus of Clinical Attention

    • CFI may identify clinical concerns that correspond to conditions or problems listed in the "Other Conditions That May Be a Focus of Clinical Attention" section of the DSM-5, along with their associated ICD-10-CM codes.

    Cultural Concepts of Distress

    • Cultural concepts of distress need to be understood by clinicians to facilitate accurate diagnostic assessment, and the Cultural Formulation Interview can aid in this process.
    • There are numerous cultural concepts of distress that can affect the diagnostic process, and 10 examples are provided to illustrate this.
    • The same term can be used for multiple types of cultural concepts of distress and clinical presentations, depending on the context.
    • Cultural concepts of distress can occur independently or coexist with any psychiatric disorder, influencing clinical presentation, course, and outcome.
    • Ataque de nervios, a cultural concept of distress in U.S. Latinx communities, can be comorbid with nearly all psychiatric disorders.
    • Each cultural concept of distress includes a description of related conditions in DSM-5-TR, highlighting:
      • DSM-5 disorders that overlap phenomenologically with the cultural concept of distress (e.g., panic disorder and ataque de nervios).
      • DSM-5 disorders that are frequently attributed to the causal explanation or idiom (e.g., PTSD and kufungisisa).

    Ataque de Nervios

    • Ataque de nervios, or "attack of nerves," is a syndrome found in Latinx cultural contexts.

    Symptoms

    • Intense emotional upset, including acute anxiety, anger, or grief
    • Screaming and shouting uncontrollably
    • Attacks of crying
    • Trembling
    • Heat in the chest rising into the head
    • Becoming verbally and physically aggressive

    Dissociative Experiences

    • Depersonalization
    • Derealization
    • Amnesia

    Additional Features

    • Seizure-like or fainting episodes (not universal symptoms)
    • Suicidal behavior (not universal symptoms)
    • Sense of being out of control

    Triggers

    • Stressful events relating to the family, such as:
      • News of the death of a close relative
      • Conflicts with a spouse or children
      • Witnessing an accident involving a family member
    • Accumulated experience of suffering (for a minority of individuals)

    Relationship to Psychiatric Disorders

    • No one-to-one relationship with a specific psychiatric disorder
    • Symptomatic overlap with:
      • Panic disorder
      • Other specified or unspecified dissociative disorder
      • Functional neurological symptom disorder (conversion disorder)

    Ataque

    • Reported among US Latinx by 7%-15% of adults and 4%-9% of youth, depending on region and Latinx subgroup.
    • Associated with suicidal thoughts, disability, and outpatient psychiatric utilization, after adjustment for psychiatric diagnoses, traumatic exposure, and other covariates.
    • Can represent normative expressions of acute distress (e.g., at a funeral) without clinical sequelae.
    • Indisposition in Haiti
    • Blacking out in several West Indies and Caribbean countries
    • Falling out in the Southern United States
    • Note: These terms should not be confused with alcohol or other substance-induced blackouts or amnesia.
    • Panic attack
    • Panic disorder
    • Other specified or unspecified dissociative disorder
    • Functional neurological symptom disorder
    • Intermittent explosive disorder
    • Other specified or unspecified anxiety disorder
    • Other specified or unspecified trauma- and stressor-related disorder

    Dhat Syndrome

    • A term coined in South Asia to describe clinical presentations of young men attributing various symptoms to semen loss
    • Not a discrete syndrome, but a cultural explanation of distress
    • Characterized by anxiety and distress about loss of dhat (a white discharge) despite no physiological dysfunction
    • Dhat is believed to be a white discharge noted on defecation or urination

    Dhat in Ayurveda

    • Related to dhatu (semen), one of seven essential bodily fluids in Ayurveda
    • Balance of dhatu necessary to maintain health in Ayurveda

    Prevalence of Dhat Syndrome

    • Estimated to affect 64% of men attending psychiatric clinics in India for sexual complaints
    • Estimated to affect 30% of men attending general medical clinics in Pakistan
    • Most commonly identified in young men from lower socioeconomic backgrounds
    • Middle-age men may also be affected

    Variants of Dhat Syndrome

    • Concerns about white vaginal discharge (leukorrhea) associated with a variant for women
    • Dhat may be used as an idiom and causal explanation for sexually transmitted infections (STIs) without psychological distress
    • Koro in Southeast Asia, particularly Singapore
    • Shen-k'uei ("kidney deficiency") in China
    • Major depressive disorder
    • Persistent depressive disorder
    • Generalized anxiety disorder
    • Somatic symptom disorder
    • Illness anxiety disorder
    • Erectile disorder
    • Early (premature) ejaculation
    • Other specified or unspecified sexual dysfunction
    • Educational problems

    Hikikomori

    • A syndrome of protracted and severe social withdrawal observed in Japan
    • May result in complete cessation of in-person interactions with others
    • Typical picture: adolescent or young adult male who does not leave his room within his parents' home and has no in-person social interactions
    • Often associated with high intensity of Internet use and virtual social exchanges
    • No interest or willingness to attend school or work
    • Diagnosis requires 6 months of social withdrawal according to the 2010 Japan Ministry of Health, Labor, and Welfare guideline
    • Can occur in the context of an established DSM-5 disorder ("secondary") or manifest independently ("primary")

    Hikikomori Worldwide

    • Protracted social withdrawal among adolescents and young adults reported in various countries, including:
      • Australia
      • Bangladesh
      • Brazil
      • China
      • France
      • India
      • Iran
      • Italy
      • Oman
      • South Korea
      • Spain
      • Taiwan
      • Thailand
      • United States
    • Individuals with hikikomori-type behaviors tend to display high levels of loneliness, limited social networks, and moderate functional impairment
    • Social anxiety disorder
    • Major depressive disorder
    • Generalized anxiety disorder
    • Posttraumatic stress disorder
    • Autism spectrum disorder
    • Schizoid personality disorder
    • Avoidant personality disorder
    • Schizophrenia or other psychotic disorder

    Khyâl cap (Khyâl Attacks or Wind Attacks)

    • Found in Cambodian cultural contexts
    • Symptoms include:
      • Panic attack symptoms: dizziness, palpitations, shortness of breath, and cold extremities
      • Anxiety and autonomic arousal symptoms: tinnitus, neck soreness, and others
    • Catastrophic cognitions centered on the concern that khyal (a windlike substance) may rise in the body and cause serious effects, such as:
      • Compressing the lungs to cause shortness of breath and asphyxia
      • Entering the cranium to cause tinnitus, dizziness, blurry vision, and fatal syncope
    • Triggers:
      • Worrisome thoughts
      • Standing up (orthostasis)
      • Specific odors with negative associations
      • Agoraphobic-type cues: going to crowded spaces or riding in a car
    • Meets panic attack criteria and may shape the experience of other anxiety and trauma- and stressor-related disorders
    • Associated with considerable disability
    • Pen lom in Laos
    • Srog rlung gi nad in Tibet
    • Vata in Sri Lanka
    • Hwa byung in Korea
    • Panic attack
    • Panic disorder
    • Generalized anxiety disorder
    • Agoraphobia
    • Posttraumatic stress disorder
    • Illness anxiety disorder

    Kufungisisa

    • Idiom of distress and cultural explanation among the Shona of Zimbabwe
    • Considered causative of:
      • Anxiety
      • Depression
      • Somatic problems (e.g., "My heart is painful because I think too much")
    • Means "thinking too much" in Shona

    Maladi Dyab: Cultural Explanation for Illnesses in Haitian Communities

    • Maladi dyab, also known as "devil/Satan illness" or "sent sickness," is a cultural explanation for various medical and psychiatric disorders in Haitian communities.

    Causes of Maladi Dyab

    • Interpersonal envy and malice are believed to cause people to harm their enemies by having sorcerers send illnesses.
    • Economic success, such as a new job or expensive purchase, can provoke envy and hatred, making an individual vulnerable to attack.

    Types of Maladi Dyab

    • Ekspedisyon, movè zespri, and kout poud are different types of "sent sicknesses" based on how they are believed to be sent.

    Characteristics of Maladi Dyab

    • The label of "sent sickness" is assigned based on the mode of onset, social status, and successful treatment, rather than presenting symptoms.
    • Acute onset of new symptoms or an abrupt behavioral change raises suspicions of a spiritual attack.
    • Vulnerable individuals include those who are attractive, intelligent, or wealthy, as well as young, healthy children.

    Psychiatric Disorders Attributed to Maladi Dyab

    • A wide range of psychiatric disorders can be attributed to this cultural explanation, including psychosis, depression, social or academic failure, and inability to perform activities of daily living.

    Cross-Cultural Perspectives on Illness

    • Concerns about physical illness caused by envy or social conflict are prevalent across cultures.

    The Evil Eye Concept

    • The "evil eye" belief is a common expression of this concern across cultures.
    • The concept is referred to as "mal de ojo" in Spanish and "mal'occhiu" in Italian.
    • Subsyndromal afflictions, including social and educational problems, may be misdiagnosed.
    • Psychiatric disorders with a cultural explanation of supernatural forces may be misdiagnosed as delusional disorder, persecutory type, or schizophrenia.

    Nervios: A Cultural Idiom of Distress

    • Nervios is a common cultural idiom of distress and causal explanation in Latinx cultural contexts in the US and Latin America.
    • It refers to a general state of vulnerability to stressful life experiences and difficult life circumstances.
    • The term encompasses a wide range of symptoms of emotional distress, somatic disturbance, and inability to function.

    Symptoms of Nervios

    • Headaches and "brain aches" (occipital neck tension)
    • Irritability
    • Gastrointestinal disturbances
    • Sleep difficulties
    • Nervousness
    • Easy tearfulness
    • Inability to concentrate
    • Trembling
    • Tingling sensations
    • Mareos (dizziness with occasional vertigo-like exacerbations)

    Severity and Variations of Nervios

    • Spans the range of severity from cases with no mental disorder to presentations resembling adjustment, anxiety, depressive, dissociative, somatic symptom, or psychotic disorders.
    • Can refer to a cultural explanation for multiple forms of psychological distress, especially those involving weakness, enervation, and anxiety.
    • Shows regional variation, related to the nervous system (literally, the anatomical nerves).

    Regional Variations of Nervios

    • In Puerto Rican communities, nervios includes conditions such as:
      • "Being nervous since childhood," which appears to be more of a trait and may precede social anxiety disorder.
      • "Being ill with nerves," which is more related to psychiatric problems, especially dissociation and depression.

    Cross-Cultural Contexts

    • Nevra is a condition similar to nerves found among Greeks in North America
    • Nierbi is a related condition found among Sicilians in North America
    • "Nerves" is a condition found among Whites in Appalachia and Newfoundland
    • In South Asian populations, "tension" is an idiomatic expression and causal explanation for similar conditions

    Mood Disorders

    • Major depressive disorder is a related condition
    • Persistent depressive disorder is a related condition

    Anxiety Disorders

    • Generalized anxiety disorder is a related condition
    • Social anxiety disorder is a related condition

    Dissociative Disorders

    • Other specified or unspecified dissociative disorder is a related condition
    • Somatic symptom disorder is a related condition

    Psychotic Disorders

    • Schizophrenia is a related condition

    Shenjing Shuairuo: A Cultural Syndrome

    • Shenjing Shuairuo, or "weakness of the nervous system", is a cultural syndrome that combines Traditional Chinese Medicine with the Western concept of neurasthenia.

    Definition and Symptoms

    • Defined in the Chinese Classification of Mental Disorders (CCMD-2-R) as a syndrome consisting of three out of five symptom clusters:
      • Weakness (e.g., mental fatigue)
      • Emotions (e.g., feeling vexed)
      • Excitement (e.g., increased recollections)
      • Nervous pain (e.g., headache)
      • Sleep (e.g., insomnia)

    Concept of "Fan Nao"

    • "Fan nao" refers to a form of irritability mixed with worry and distress over conflicting thoughts and unfulfilled desires.

    Classification and Evolution

    • Shenjing Shuairuo was retained as a somatoform diagnosis of exclusion in the CCMD-3.
    • China adopted the ICD-10 as its official classification system in 2011, replacing the CCMD.
    • ICD-10 included neurasthenia as a diagnostic category, but ICD-11 does not.
    • The use of Shenjing Shuairuo has decreased substantially in recent years, replaced by idioms of depression and anxiety in urban areas.

    Clinical Significance

    • Shenjing Shuairuo may still be used by mental health clinicians in interactions with traditional patients to facilitate communication and limit stigma associated with psychiatric diagnoses.

    Salient Precipitants of Shenjing Shuairuo

    • Shenjing shuairuo is triggered by work or family-related stressors, loss of face (mianzi, lianzi), and a sense of failure (e.g., in academic performance)
    • It is related to traditional concepts of weakness (xu) and health imbalances related to deficiencies of a vital essence (e.g., depletion of qi [vital energy])
    • Shenjing shuairuo occurs when bodily channels (jing) conveying vital forces (shen) become dysregulated due to social and interpersonal stressors

    Associated Psychiatric Disorders

    • Shenjing shuairuo is associated with various psychiatric disorders, including mood, anxiety, and somatic symptom disorders
    • However, up to 45% of patients with shenjing shuairuo do not have symptoms that meet criteria for any DSM-IV disorder
    • Neurasthenia-spectrum idioms and syndromes are present in many cultural contexts, including India (ashaktapanna), Mongolia (yadargaa), and Japan (shinkei-suijaku)
    • Other conditions, such as brain fag syndrome, burnout syndrome, and chronic fatigue syndrome, are also closely related
    • Shenjing shuairuo is related to conditions listed in the DSM-5-TR

    What is Susto?

    • Susto is a cultural explanation for distress and misfortune prevalent in some Latinx cultural contexts in North, Central, and South America.
    • It is not recognized as an illness category among Latinx from the Caribbean.

    Causes and Symptoms

    • Susto is attributed to a frightening event that causes the soul to leave the body, leading to unhappiness, sickness, and difficulties in key social roles.
    • Symptoms may appear days to years after the frightening event.
    • Symptoms often reported by individuals with susto include:
    • Appetite disturbances
    • Inadequate or excessive sleep
    • Troubled sleep or dreams
    • Feelings of sadness, low self-worth, or dirtiness
    • Interpersonal sensitivity
    • Lack of motivation
    • Somatic symptoms may include:
    • Muscle aches and pains
    • Cold in the extremities
    • Pallor
    • Headache
    • Stomachache
    • Diarrhea
    • Precipitating events are diverse and include natural phenomena, animals, interpersonal situations, and supernatural agents.

    Syndromic Types

    • Three syndromic types of susto have been identified:
    • Interpersonal susto: characterized by feelings of loss, abandonment, and not being loved by family, with symptoms similar to major depressive disorder.
    • Susto resulting from a traumatic event: closely related to posttraumatic stress disorder.
    • Susto characterized by various recurrent somatic symptoms: resembles a somatic symptom disorder.
    • Similar etiological concepts and symptom configurations are found globally.
    • In the Andean region, susto is a recognized concept.

    Soul Loss and Psychological Distress

    • Soul loss, or espanto and susto, are conditions associated with South Asia and Southeast Asia, where a person may lose their soul or a piece of soul due to a fright, making them vulnerable to physical and psychological distress.
    • Related conditions include major depressive disorder, posttraumatic stress disorder, and somatic symptom disorder.

    Taijin Kyofusho

    • Taijin Kyofusho is a syndrome occurring in Japanese cultural contexts, characterized by anxiety and avoidance of social situations due to individuals believing that their appearance and actions are inadequate or offensive.
    • It has two related forms:
      • Sensitive type: Extreme social sensitivity and anxiety.
      • Offensive type: Concern is offending others.
    • Variants of Taijin Kyofusho include:
      • Facial blushing (sekimen-kyofusho)
      • Offensive body odor (jiko-shu-kyofusho)
      • Inappropriate gaze (jiko-shisen-kyofusho)
      • Stiff or awkward facial expression or bodily movements (stiffening, trembling) or body deformity (shubo-kyofusho)
    • Taijin Kyofusho is broader than social anxiety disorder and can include syndromes with features of body dysmorphic disorder, olfactory reference syndrome, and delusional disorder.
    • Delusional disorder should be considered when concerns exhibit delusional qualities and do not respond to reassurance or counterexamples.
    • Taijin Kyofusho occurs in specific contexts and has aspects that are present across cultures, with similar syndromes found in Korea (taein kong po).
    • These syndromes are present in societies that place a strong emphasis on self-conscious maintenance of appropriate social behavior in hierarchical interpersonal relationships.
    • An interdependent self-construal emphasizes relatedness of self to a collective and the community.

    Identification of Self and Taijin Kyofusho

    • The identification of self through social roles and relationships is a potential risk factor for Taijin Kyofusho symptoms across diverse cultures.

    Taijin Kyofusho Symptoms Across Cultures

    • The fear of offending others through inappropriate social behavior, characteristic of offensive-type Taijin Kyofusho, has been reported in multiple societies, including:
      • The United States
      • Australia
      • Indonesia
      • New Zealand

    DSM-5-TR Classification

    • Taijin Kyofusho is related to:
      • Social anxiety disorder
      • Body dysmorphic disorder
      • Delusional disorder
      • Obsessive-compulsive disorder
      • Olfactory reference syndrome (a type of other specified obsessive-compulsive and related disorder)

    Jikoshu-Kyofu Variant

    • Olfactory reference syndrome is specifically related to the jikoshu-kyofu variant of Taijin Kyofusho.
    • This presentation is observed in various cultures outside Japan.

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    This chapter covers the importance of considering culture and social context in clinical diagnoses, including definitions of key terms and a systematic approach to cultural assessment.

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