CULTURAL BOUND SYNDROME

Cultural bound syndromes
Presenter-Dr.Vivek Sharma[JR2]
Chairperson-Dr.Tapas kumar Aich [Professor and HOD]
Dept. of Psychiatry ,BRD MEDICAL COLLEGE GORAKHPUR

WHAT IS CULTURE??
 Culture refers to systems of knowledge, concepts, rules,
and practices that are learned and transmitted across
generations.
 Culture includes language, religion and spirituality, family
structures, life-cycle stages, ceremonial rituals, and
customs, as well as moral and legal systems.
 Cultures are open, dynamic systems that undergo
continuous change over time; in the contemporary world,
most individuals and groups are exposed to multiple
cultures, which they use to fashion their own identities
and make sense of experience.

CULTURE BOUND SYNDROME
 Definition given by Prince in 1985.
 Collection of signs and symptoms which is restricted to
a limited number of cultures primarily by reasons of
certain of their psychosocial features.
 Denotes specific arrays of behavioral and experiential
phenomena that tend to present themselves
preferentially in particular socio-cultural contexts and
that are readily recognized as illness behavior by most
participants in that culture.

DSM -V
 Cultural concepts of distress refers to ways that
cultural groups experience understood and
communicate suffering, behavioral problems or
troubling thoughts or emotions.
 Three concepts
1. Syndromes
2. Idioms
3. Explanations

SYNDROMES
 Cluster of symptoms and attributions that tend to
co-occur among individuals in specific cultural
groups, communities or contexts and that are
recognized locally as coherent patterns of
experience.
 Ways of experiencing distress that may not
involve specific symptoms/ syndromes but that
provide collective, shared ways of experiencing
and talking about personal / social concerns.

EXPLANATIONS
 Labels, attributions or features of an
explanatory model that indicate culturally
recognized meaning or etiology for
symptoms, illness or distress.

QUESTIONNAIRES
 The Cultural Formulation Interview (CFI) is a set
of 16 questions that clinicians may use to obtain
information about the impact of culture on key
aspects of an individual's clinical presentation
and care.
 The CFI is a brief semi structured interview.
 Follows a person-centered approach .
 The CFI is formatted as two text columns.

 The 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).

COMMON CBS IN INDIA
1. Possession syndrome
2. Dhat syndrome
3. Koro
4. Bhanmati
5. Gilhari syndrome
6. Suudu
7. Suchibhai syndrome
8. Culture bound suicide (sati,santhra)
9. Jhinjhinia
10.Ascetic syndrome

DHAT
 Dhat derives from the Sanskrit word ‘Dhatu’
meaning ‘metal’ and also ‘elixir’ or
‘constituent part of the body’.
 First described in western texts by Wig
(1960)
 South Asia
 Young males , low socioeconomic status

…
 Vague somatic symptoms of fatigue, weakness,
anxiety, loss of appetite, guilt and sexual
dysfunction
 Attributed by the patient to loss of semen in
nocturnal emissions through urine and masturbation
 Anxiety & distress in the absence of any identifiable
physiological dysfunction.
 Identified as a white discharge noted during
defecation and urination
 Variant seen in women, with whitish vaginal
discharge and similar psychosomatic symptom

KORO
 Malaysia
 Genitals shrinking into the body
 Characterized by 3 features
 Anxiety from a subjective experience of shrinking of their
penis/breasts/labia
 Anticipate not only impotence , but also death.

• Seen in north-eastern states like assam
• Seen in both sexes
• Person applies external retractors to the genitalia in form of
clamps, chains etc. to avoid it retracting back.
• It may occur as epidemics.
• Described as a syndrome in ICD-10 and DSM-IV

BRAIN FAG
 West Africa
 After an intensive period of
intellectual activity
 Associated with college or
high school students
 Watering or dry eyes,
dizziness, difficulty in
concentrating , pain,
fatigue, difficulty sleeping,
shaking hands, rapid heart
beat.

ATAQUE DE NERVIOS
 Attack of nerves’ - Latino descent
 Symptoms of intense emotional upset  anxiety 
physical & verbal aggression.
 Dissociative experiences , Sense of being out of
control , seizure like or fainting episodes ,suicidal
gestures are seen.
 Following a stressful event.
 Total or partial amnesia for the episode.
 Females , low Se status, disrupted marital status.

POSSESSION SYNDROMES
 Women, 15-35 years ,f:m ratio 2:1
 India, Sri Lanka
 Following a sub-acute conflict or stress
 Nonspecific somatic complaints
 Altered behavior –stereotyped and culturally determined
behaviors dramatic,
 Aggressive or violent actions, full or partial amnesia
 Possession is episodic
 Variable outcome
 Can be voluntary or Involuntary ,causing distress ,not a part of
religious / cultural rituals

 ‘Weakness of the nervous system’ – Mandarin Chinese.
 Syndrome composed of 3 out of 5 non hierarchial
symptom cluster :weakness(mentalfatigue), emotions,
excitement, nervous pain, sleep(insomnia).
 Physical & mental fatigue with gradual onset.
 Social & interpersonal stressors  dysregulation of
bodily channels conveying vital forces.
 Weakness and health imbalance due to depletion of
vital energy.
SHENJIN SHUAIRUO

TAIJIN KYOFUSHO (ANTHROPOPHOBIA)
• "Interpersonal fear disorder" in Japanese
• Characterized by anxiety about and avoidance of
interpersonal situations due to the thought, feeling, or
conviction that one's appearance and actions in social
interactions are inadequate or offensive to others.
• Tend to focus on the impact of their symptoms and
behaviors on others.

• Onset- between 15-25 years of age
• Males > Females
• Characteristic: fear is manifested in the presence of
people of intermediate familiarity such as classmates or
colleagues
• This is different from social phobia described in western
societies, where patients have fear of socializing with
strangers.

Variants:
• Fear of facial flushing (erythrophobia),
• Fear of having an offensive body odor (olfactory
reference syndrome),
• Fear of maintaining an inappropriate gaze (too much
or too little eye contact),
• Fear of showing stiff or awkward facial expression or
bodily movements
Two types:
• Sensitive type: concern about how others might be
viewing him
• Offensive type: concern about how he might be
affecting others

MALADI MOUN
 Haitian communities
 Interpersonal envy and malice harming their enemies
by sending illness such as : Psychosis, depression,
social/academic failure, inability to perform daily
activities
 Young healthy children at risk
 Evil eye
 Humanly caused illness / sent sickness

KUFUNGISISA
 Zimbabwe – idiom of distress – ‘thinking too much’
 Causative of anxiety , depression, somatic problems
 Involves ruminating on upsetting thoughts
 Indicative of interpersonal and social difficulties
 As an explanation, it is considered to be causative of anxiety,
depression, and somatic problems (e.g., “my heart is painful
because I think too much”).

KHYAL CAP
 Panic attack like condition seen in Cambodia.
 Characterized by “Khyal attacks” or “Wind attacks”
 Symptoms : Panic attacks, Dizziness, Palpitations, SOB, Cold
extremities, Anxiety, Autonomic arousal Eg: tinnitus and
neck soreness.
 Triggers: Worrisome thoughts; orthostasis ; specific odors
with negative association ; agoraphobic type cues (crowded
spaces or riding in a car).

SUSTO
 US , Mexico, Central America , South America
 Frightening event  unhappiness and sickness
 Low mood , low self worth ,lack of motivation, feeling of sadness,
appetite disturbances and inadequate sleep
 Social and functional impairment.
 Somatic complaints –aches, pains, diarrhea, pallor, cold extremities
 Related to three syndromes types – MDD, PTSD, Somatic symptom
disorder.

GILHARI SYNDROME
 Squirrel/lizard syndrome
 West Rajasthan
 Experiences a blood filled swelling on the body changing its position
eventually reaching the neck blocks the airway
 Trusts the condition to be intense and lethal unless it has been
removed.
 Medically due to contraction of particular group of muscles
following serious tension & stress.

JHIN-JHINIA
 West Bengal
 It means Tingling and numbness
 Spreads all over the body astounded and
unmoving crash on the ground
 Vanishes in a couple of hours

ASCETIC SYNDROME
 Depicted by Neki in 1972
 Seen in Adolescents and young adults
 Characterized by Social withdrawal, sexual
abstinence, practice of religious routines, lack of
concern with physical appearance and
considerable weight loss.

SUUDU
 South India – Tamil culture
 Males and females
 Excruciating pain in urination and pelvic heat
 Extreme abdominal torment, dark yellow urine, painful & burning
micturition, headaches, fatigue, constipation, dry mouth.
 It is due to increase in inner heat of body often due to dehydration.
 Relieved by applying sesame oil or castor oil in navel / pelvic area,
oil massage f/b warm water shower, intake of fenugreek seeds
doused overnight in water.

SUCHI – BHAI SYNDROME
 Bengali term which means Obsessional neurosis.
 seen in Widows .
 Washing too often , washing of money , bathing for 4 hours
twice a day, changing of street clothes, hanging clothes
outside on a tree and enters house naked, hopping while
walking, not eating anywhere outside, sprinkling cow dung
water on all visitors, remaining immersed in holy river for
most part of the day.

MASS HYSTERIA
 Mass hysteria is where hundreds to thousands of individuals
apparently was accepting and carrying on in a way that
they usually don’t.
 Atypical hysteria epidemic ( reported by choudhary et al.)
in a tribal village of Tripura, India where 4 males and 8
females affected within a span of 10 days.
 It is self-limiting and the individual shows improvement in
symptoms in the course of 1-3 days

 The central feature of the episode is a trance state of 5 – 15
minutes with restlessness
 Attempts of self injury
 Running away
 Inappropriate behaviour
 Inablity to identify family members
 Refusal of food
 Intermittent mimicking of animal sounds.

CULTURE BOUND SUICIDE
 SATI:
 It is an act of self-immolation by a widow on her spouse’s fire – bed.
 Seen in Brahmins & Kshatriyas.
 Prohibited in India since 19th century.
 JAUHAR IN RAJASTHAN:
 It is a suicide conferred by ladies even before the passing of her
husband when looked by prospect of shame from another man
(normally an over coming lord).

 SANTHARA / SALLEKHANA:
 In this people, deliberately surrender life by fasting unto
demise over some undefined time frame for religious
motivations to attain Moksha (salvation).
 Seen as a part of Jain community.
 It is believed that the individual (performing the act) will
get rid of anger, ego, attachment, greed, old age and
terminal illnesses.

CULTURAL BOUND SYNDROME

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