Culture and Race Culture bound syndrome Preferentially displayed in particular socio-cultural contexts Given culturally sanctioned contexts Have culturally specific remedies Examples Ataque de nervios-uncontrollable shouting trembling, crying and dissociative experiences (Latin Carribean ) Falling out-sudden collapse accompanied by dizziness and complaints of being unable to see, closely resembles hysterical conversion (Southern United States) Mal de ojo-fitful sleep, crying, diarrhea, vomiting and fever
Culture bound syndrome examples Spell-commnication with dead persons or spirits (Southern US) Anorexia-nervosa- refusal to eat, fear of being fat, altered body image, lanugo, amennorhea (US, South America, and Europe) Susto- unhappiness and sickness following a frightening event which caused the soul to leave the body (Latinos) Koro- fear that the penis in men and nipples and vluva in women will disappear into the body (South and East Asia) Latah- echopraxia, echolalia, and command obedience folllowing a frightening event (Malaysia) Postpartum depression-crying, irritability, poor concentration from one year to two years following giving birth (US)
Therapies for culture bound syndromes Culture specific and ethno-related Bio-medical models usually ineffective Need knowledge of the patient’s explanatory model of illness (What does patient think caused the illness?) Need knowledge of the patient’s explanatory model of cure (How does patient think the illness can be cured?) Cognitive behavioral therapy can help.
Gender Identity Disorders Children Symptoms of wanting to be the other sex are evident before age 3 Sex ratio of referred children under the age of 12 is 4 to 5 boys for 1 girl Girls insist they have a penis, refuse to urinate in a sitting position, have an avid interest in playing with male companions and in rough and tumble sports Boys enjoy wearing female clothes, are disgusted by their genitalia and believe they will grow up to be women.
Adolescents and adults Desire to be of the other sex Do not identify as homosexual, gay, or lesbian Desire to have treatment to change to sex Uncomfortable wearing clothes of their assigned sex Dysphoria with sexual condition
Intersex Conditions Congenital viralization adrenal hyperplasia Overproduction of androgens in a female-trypically raised as boys-many have gender identity disorder Androgen insensitivity syndrome XY karyotype-tissue unable to use testosterone- raised as girls but have undeveloped testes-usually sense themselves as female Turner’s syndrome- missing a Y sex chromosome karyotype X female genitalia but require exogenous estrogen to develop secondary sex characteristics
Kleinfeler’s syndrome- extra X chromosome XXY causes gynecomastia and small testes- resultant dysphoric mood Reductase deficiency Male appears female at birth and does not viralize until puberty-gender confusion results Hermaphrodism and pseudohermaphrodism- Presence of both sex genitalia or ambiguous genitalia