psychopathology only manifesting in a particular culture or world region and not else where in the world

1. Culture Bound Syndrome
OGUNDIRAN M.O.
OMOTOSO PRECIOUS

2. Outline
• Introduction
• Definition
• History
• Classification
• Management
• Conclusion

3. Introduction
• Also known as culture related specific disorders, culture specific
disorders/syndromes.
• In the American handbook of psychiatry, it is known as exotic
psychiatric syndromes or Rare atypical unclassifiable disorders.
• They all refer to certain illnesses or disorders which occur exclusively
in certain cultures and not found in others.

4. Definition
• Culture refers to a way of life of a group of people.
• Culture in this context refers to the ideas, values, habits and other
patterns of behaviour which a human group transmits from one
generation to another.

5. According to the American Psychiatrist Association,
DSM-IV;
• CBS is a combination of psychiatric and somatic 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.
• Characterised by;

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

7. • Various definitions for CBS have been proposed by Cassidy 1962;
Tseng & Mcdermont 1981; Littlewood & Lipsedge 1986.
• However, the most widely accepted is that proposed by Prince 1985
which states that
“CBS is a collection of signs and symptoms which is restricted to a
limited number of cultures primarily by reasons of certain of their
psychosocial features.”

8. • The concept “Culture bound syndrome” has been debated for a while
now. The debate been that culture is pathogenic* or pathoplastic*
• Pathogenic- an aetiological factor
• Pathoplastic- a contributing factor
Support for the pathogenic theory can be said to
be generated by the appreciation of the role of
psychological, social and cultural factors in illnesses
Pathoplastic theory can also be supported by the fact that culture has
been shown to influence the manifestation of illnesses and may be very

9. History
• Conditions now been referred to as CBS was first described in
Kraepelin textbook of psychiatry, the 8th edition (1909)
• It was Yap, a Chinese psychiatrist in 1962 that introduced it (although
they were described as folk names) into the psychiatric literature first
made an attempt to put into a diagnostic classification scheme.
• CBS were first described outside the west and so were thought to be
only non-western conditions.

10. • As at 1985, 186 conditions was described.
• Culture bound behaviour versus syndrome
• ICD-10 Diagnostic criteria of research describes about 12 though they
are not in any distinct class of their own because they have no sound
descriptions or epidemiological basis that separates them from those
already classified.
• DSM IV describes about 25.
• Some say the are just cultural manifestations of already described
neuropathology.

11. Classification
• Cultural emphasis on fertility and procreation
–genital shrinking (koro /suo-yang), semen loss (dhat) syndromes
• Cultural emphasis on learnt dissociation
–latah type and amok type reactions
• Syndromes related to acculturative stress
- brain fag, Bouffee-delirante type reactions

12. • Idioms of distress – susto/ espanto, nervios, hwa-byung, ataque de
nervios
• Syndromes related to physical appearance- taijin-kyofu reactions
• Reactions to extreme environmental conditions (arctic hysteria) –
windigo psychosis, pibloktoq, kayak-svimmel

13. Brain-fag syndrome
• First described by Prince in 1959 among Nigerians both home and
abroad.
• They believed their brain was fatigued who are exposed to the
Western system of education.
• The psychophysiological theory as well as “forbidden knowledge”
theory has also been proposed*.
• Male to female ratio?- not too true

14. • Note that subnormal intelligence, malnutrition or physical disease do
not account for this symptoms.
• The symptoms are specific such that they differ from the study stress
and exam crises experienced by western or Asian students.

15. • It is characterised by:
1. persistent unpleasant sensations around the head and neck while
studying.
2. An association btw the unpleasant sensation and study
(precipitated or worsened).
3. Inability to concentrate, understand or remember what was read.
4. An associated affective disturbance.
• To make a diagnosis, all 4 features must be present.

16. • History: features, study habit, sleeping pattern etc
• MSE- r/o other possible causes
• Treatment:
-counselling- adjust reading plans, etc
-muscle relaxation exercises
-antidepressants but avoid anxiolytics
*usually, a false diagnosis of anxiety or depression.

17. Bouffee delirante reaction
• Described by Africans.
• Equated to “frenzied anxiety” by Lambo.
• A transient psychotic illness that is sudden in onset and brief.
• Its characterised by paranoid delusions, visual and auditory
hallucinations, extreme anxiety with acting out behaviour.
• Not linked to an organic pathology but due marginilisation and loss of
supportive kin network. Its embedded over anxieties of witchcraft
and sorcery that increase under rapid socio cultural changes.

18. Koro
• Means head of tortoise in Japanese, shrinking of the penis in Chinese.
It is characterised by 3features:
1. The individual feels an acute state of anxiety from a subjective
experience of shrinking of their penis / breasts/ labia.
2. They anticipate not only impotence /sterility but also death!
3. They are also able to convince people in their immediate
environment and so “life saving” measures are taken! (beating up
the accused, pulling on the penis with a string)
*Psychoanalysts refer to it as oedipal complex of anxiety.

19. • Koro was initially thought to be restricted to South East Asia where it
was thought to be caused by excessive sexual intercourse
/masturbation or promiscuity.
• It has been described in other areas such as Nigeria, England!
• They however do not have all 3 key features and they are also
associated with a psychotic illness and so they are described as “koro-
like” disorder

20. • Management involves:
-history taking
-MSE- r/o psychotic illness
-physical examination- confirm the px’s claim
-psycho therapeutic intervention
-if comorbidities are present, treat.

21. Semen-loss
• Referred to as “dhat” in India, shen k’uei in China.
• Commoner in young males.
• The have an imagined loss of sperm via urine or nocturnal emissions
causing them to be generally weak, lack of concentration. Impaired
sexual functions, vague somatic sensations as well as an anxious and
dysphoric mood state.
• Similar to ?hypochondrical delusions.

22. Amok
• Amok is a Portugese-indian word “amuco” which refers to heroic
warriors who die in battle. (A.k.a. berserkr)*
• The acts can be likened to “Rambo”.
• Characterised by a prodromal phase of brooding, withdrawal and
dysphoria, a trivial upsetting incident alters conciousness causing fear
and rage, an increase in kinetic energy (–amok run)
• The amok run ends with suicide or he is overpowered, falls in a deep
sleep & then forgets.
• Seen in South east Asia.
• Some may describe it as a dissociative d/o
• Commoner in males

23. Latah
• Commoner in South Asia
• Means “ticklish”. Latah in Malaysia, Bah-tschi in Thailand, Mali-mali in
Phillipines.
• Also in the North Eurasian zone. A.k.a imu, Lapp- panic, miryachit
• Commoner in females.

24. • It is characterised by an exaggerated startle response to a stimuli
(unexpected visual or acoustic perception, touching, tickling).
• It is followed by coprolalic utterances like cunt, prick or ass.
• They then enter a transient dissociative state (echolalia, echopraxia)
• Described by some as the cultural elaboration of the
neurophysiological startle reflex

25. Susto
• A.K.A. espanto, miedo
• Spanish terms meaning an experience of fright/ scare.
• Symptoms usually follows a frightful experience, which causes their
soul to separate from their body.
• It resembles a neurotic /somatoform disorder.

26. Nervios
• A Spanish term similar to the English term –nerves!
• Chronic dysphoric mood states with various somatic manifestations
following psychosocial stress.
• Similar to hwa-byung (fire-illness) in China /Korea.

27. Windigo psychosis
• A.k.a. witiko, witigo which means mythical monster, a supernatural
being possesses the individual, causing them to have cannibalistic
urges!
• It has been reported among Eskimos.
• The term windigo is now used by Ojibwas to mean a depressed mood
of deep sorrow and hopelessness.

28. • ?Anorexia nervosa
• An eating disorder found mostly in young females from the West
because of their cultural value of slimness.
• A few cases in Africans that are highly Westernised!

29. Conclusion
• Before diagnosing apparently unusual behaviour or ideas in a person
of another cultural group, the psychiatrist has to get information from
others in the same cultural group if such behaviour or ideas are
congenial or pathological in a given situation to prevent a
misdiagnosis!

30. THANK YOU