Culture-Specific Syndromes (adapted from Culture Bound Syndromes — DSM IV-TR)

Country of origin

Syndrome/Symptoms

Explanation of symptoms

Western diagnosis/misdiagnosis (explanation)

Malaysia

Amok

This is a dissociative episode featuring a period of brooding followed by an outburst of aggressive, violent or homicidal behaviour aimed at people and objects. It is often precipitated by a perceived slight or insult. It can be accompanied by persecutory ideas, automatism, amnesia or exhaustion, following which the individual returns to their premorbid state. The victim, who is almost always a male between 20 and 45, has often experienced a loss of social status or a major life change.

Psychotic illness, 
Personality disorders, 
Mood disorders, 
Depression, Schizophrenia,
Acute brain syndrome,
Hysterical dissociation.

Malaysia

Koro

Koro is one of the better known of the culture-bound disorders. The primary symptom is that the penis (in males) or the vulva and breasts (in women) are receding into the body, possibly causing death. It is more common in men, who will go to great lengths to stop this from happening. It's believed to be caused by inappropriate sex, masturbation or sex outside of marriage, which results in an imbalance of the male/female principle (yin and yang). Koro sometimes seems to be spread socially and may be a kind of mass hysteria, causing widespread panics and concern, as well as a disorder of individuals.

People affected may resort to clamps, ties, pegs or hooks to keep their genitals from receding. This can cause physical damage.

Dissociative disorder, 
Panic disorder, 
Psychosis,
Neurotic disorder,
Somatoform autonomic dysfunction of genito-urinary system.

Malaysia

Latah

This tends to occur in women and involves a highly exaggerated response to fright or trauma. Followed by involuntary echolalia, echopraxia, coprolalia, automatic obedience and trance-like states. May be a hyperstartle reaction.

Neurotic disorder,
Dissociative (conversion) disorder.

India

Dhat and Jiryan

Dhat(semen-loss syndrome) is defined as 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. The anxiety related to semen loss can be traced back thousands of years to Ayurvedic texts, where the loss of a single drop of semen, the most precious body fluid, could destabilise the entire body.

Hypochondriasis,
Neurotic disorder,
Somatoform autonomic dysfunction of genito-urinary system.

India

Shyness

The condition is usually described in terms of shyness and nervousness. A common symptom is often heat in the body. It is a more culturally acceptable description than anxiety which has mental illness connotations.

Anxiety disorder.

South Eastern India

Saora

Young men and women in India's Saora tribe will occasionally exhibit memory loss, fainting, and inappropriate crying or laughing. Sufferers often claim to experience the sensation of being repeatedly bitten by insects when none are present. It is claimed that the behaviour occurs in response to social pressure to lead a certain way of life expected by one's family and/or community (ie, farming), while tribe members often attribute the behaviour to the actions of supernatural beings who want to marry the afflicted persons.

Dissociative or conversion disorder.

Japan

Taijin kyofusho/Shinkeishitsu

This involves a fear of social contact, extreme self-consciousness, fear of catching a disease. Includes somatic symptoms of fatigue, insomnia, headache, stomach ache and body aches. Sufferers fear that their bodies, body parts and functions are not pleasing them.

Anthropophobia,
Social phobia.

Japan

Hikikomori

This is a form of acute social withdrawal, with fear in social situations, shyness, and behavioural inhibition. It is typical in adolescents and young adults. It is ego-syntonic and may persist for years.

There are groups of people exhibiting this behaviour and Japanese Ministry of health report about 3,6000 000 hikikomori with one third over the age of 30. It is considered a social problem and its onset occurs often after severe social or academic failure (more typically among boys). Western psychiatry suggests that people with this problem suffer with some form of Pervasive Developmental Disorder (PDD).

Social phobia, 
Panic attack, 
Anxiety disorder,
Schizoid personality disorder,
Chronic or simple schizophrenia.

China

Shenkui

This is a form of sexual neurosis associated with excessive semen loss due to frequent intercourse, masturbation, nocturnal emission or passing of white turbid urine which is believed to contain semen. Young people who think they might be suffering from it become anxious and panicky, and complain of somatic symptoms (with no organic cause) such as dizziness, backache, fatigue, weakness, insomnia, frequent dreams and physical thinness. Essentially the same set of symptoms as Dhat. Women may be seen as stealing vital energy through sexual intercourse, and any form of semen loss could lead to an imbalance in chi.

Anxiety disorder,
Somatization.

China

Shenjing Shuairuo

This disorder is the equivalent of neurasthenia, which is not recognised by the DSM-IV. It includes elements of depression and anxiety disorders, such as physical and mental fatigue, dizziness, headaches, gastrointestinal problems, difficulty concentrating, sleep disturbance, memory loss, sexual dysfunction, irritability and excitability.

Mood and anxiety disorder,
Depression.

China

P'a Leng

This involves a fear that wind or cold will cause a loss of yang and imbalance of the body. Also believed to cause impotence, fatigue and death. The person becomes obsessed with being warm, and may wear winter clothing in the middle of summer.

Frigophobia.

China

Qi-gong Psychotic Reaction

This is an acute, time-limited episode characterized by dissociative, paranoid and other psychotic and non-psychotic symptoms that occur after participation in Qigong. The symptoms may last two weeks to a month.

Depression,
Psychosis.

Korea

Shin-byung

This is similar to Chinese P'a Leng. Anxiety and somatic complaints, such as general weakness, dizziness, fear, loss of appetite, insomnia and gastrointestinal problems, followed by dissociation and possession by ancestral spirits. Also called a "divine illness"

Anxiety disorder.

Korea

Hwa-byung

Translates to "fire illness" or "anger illness" and most often occurs in middle-aged women in their 40s and 50s who are less educated, come from a lower socio-economic level and live in rural areas. The individuals typically live in traditional families, which stress the value of males while devaluing women. A woman's virtue is to quietly bear misfortune and unhappiness while maintaining harmony.

Hwa-byung is thought to be caused by a build-up of unresolved anger, which disturbs the balance of the five bodily elements. Familiar stressors such as spousal infidelity and conflict with in-laws can trigger the illness. Expressing anger is not acceptable, because of the cultural emphasis on familial harmony and peace, so the anger is suppressed, and builds on itself over time. The supressed anger, hate and despair is known as haan, or "everlasting woe".

This syndrome has a strong psychosomatic component. Anger is often experienced as a heavy mass, which pushes up from the abdomen into the chest. Sleeplessness, dizziness, headaches, indigestion, sexual dysfunction, intolerance to heat, dry mouth, hot and cold flushes, weakness, heart palpitations, and blurred vision can all be symptoms of this illness.

Western diagnoses range from major depression, anxiety disorders such as phobias, generalised anxiety and obsessive-compulsive disorder, and somatization disorders.

Singapore

Wei Han Zheng

This involves fear that wind or cold will result in a loss of yang and imbalance of the body. The person becomes obsessed with being warm, and may wear winter clothing in the middle of summer.

Frigophobia.

Burma

Thaw ka/Seit poo

This means "hot mind". Clients describe feelings of sadness.

Stress.

Thailand

Kriad

Feeling worry

Stress.

Thailand
Assam
Tamil
India

Rok-joo
Jinjinja bemar
Suudu

The primary symptom is that the penis (in males) or the vulva and breasts (in women) are receding into the body, possibly causing death. It is more common in males, who will go to great lengths to stop this from happening.

Dissociative disorder, 
Panic disorder,
Psychosis,
Neurotic disorder,
Somatoform autonomic dysfunction of genito-urinary system.

Vietnam (Hmong)

Lost soul

This includes symptoms of soul loss: weakness, tiredness, fever and headache, loss of appetite, thirst, insomnia or dreams of being in a strange place with a stranger. It can be caused by feeling sad and lonely. It is cured by a soul calling ceremony.

Depression.