14.2 Culture-Bound Disorders

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric (brain) and somatic (body) symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) which also includes a list of the most common culture-bound conditions.

Within the ICD-10 (Chapter V) framework culture-specific disorders are characterized by:

• Categorization as a disease in the culture.
• Widespread familiarity in the culture.
• Complete lack of familiarity or misunderstanding of the condition to people in other cultures.
• No objectively demonstrable biochemical or tissue abnormalities.
• The condition is usually recognized and treated by the folk medicine of the culture.

Some culture-specific syndromes involve somatic symptoms (pain or disturbed function of a body part), while others are purely behavioral. Some culture-bound syndromes appear with similar features in several cultures, but with locally specific traits. The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists. Some examples of culture-bound syndromes currently identified in the global community include Dhat syndrome, Zar, and Susto.

• Dhat syndrome is a condition found in the cultures of the Indian subcontinent in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine.
• Zar is the term for a demon or spirit assumed to possess individuals, mostly women, and to cause discomfort or illness. This condition is found in the cultures of the Horn of Africa and adjacent regions of the Middle East.
• Susto is a cultural illness primarily among Latin American cultures. It is described as a condition of being frightened and “chronic somatic suffering stemming from emotional trauma or from witnessing traumatic experiences lived by others.”

Changes to society in the last decade, including technological advancements and increased globalization, has broadened cross-cultural influences and reduced cultural isolation. Recent changes to DSM-5 (reduced from 25 to 9 disorders) and the ICD-11 suggest a trend toward better understanding cultural influences rather than culturally specific disorders. Some researchers (Ventriglio, Ayonrinde, and Bhugra, 2016) argue that this interconnection calls into question our perception of truly culturally specific conditions. Idioms and culture-specific descriptions of disorders often overlap with symptoms seen in another culture (just called something else). Rather than disorders being confined to specific cultures, the emphasis has changed to better recognition of the expression of symptoms and sources of distress within each culture in order to improve healthcare and treatment.