Culture-bound syndromes refer to patterns of symptoms that are recognized as disorders within specific cultural groups but not necessarily in other cultures. They can involve somatic, cognitive, or behavioral expressions. Examples include amok from Southeast Asia, semen loss from East India, and ataque de nervios from Latin America. There is debate around whether these are best explained by Western psychiatry or as cultural expressions of distress. The DSM-5 moved away from the term "culture-bound syndromes" and instead uses the term "cultural concepts of distress" to emphasize that distress is culturally framed and communicated in culturally specific ways across groups.

1. CULTURE BOUND SYNDROMES
Dr Anubhuti Sharma
Psychiatry Resident
JLN Medical College, Ajmer India
Under guidance of
Dr Parth Singh Meena
Associate Professor, Psychiatry
JLN medical College, Ajmer, India

2. Introduction
 The term culture-bound disorder refers to a pattern of
symptoms (mental, physical, and/or relational) that is
experienced by members of a specific cultural group and that is
recognized as a disorder by members of those groups.
 Culture-bound disorders may involve
◦ somatic expressions (e.g., temporary loss of consciousness or
involuntarily clenched teeth)
◦ cognitions (e.g., a belief that one’s genitals are retracting into the body
or a conviction that one has been abducted by extraterrestrial beings)
◦ behaviors (e.g., extreme startle responses, coprophagia, or speaking in
tongues).

3. The terms culture-bound syndrome, culture-specific disorder, and
folk illness are also used to refer to such phenomena.
Culture-bound disorders occur throughout the parts world. Some
examples are
◦ amok, latah, and koro (parts of Southeast Asia)
◦ semen loss or dhat (East India)
◦ brain fag (West Africa)
◦ ataque de nervios and susto (Latinos)
◦ falling out (US South and Caribbean)
◦ pibloktoq (Arctic and subarctic Inughuit societies)
◦ Zaar possession states (Ethiopia and parts of North Africa).

4.  Yap was the first to describe culture-bound
psychogenic psychoses – a term subsequently
abbreviated to ‘culture-bound syndromes’.
 Yap first defined culture-bound psychogenic
psychoses in 1962.
 He modified the term to culture-bound syndromes 7
years later
 These were seen as ‘rare, exotic unpredictable and
chaotic behaviors at their core among uncivilized
people.’

5. Psychiatric Disorders or Cultural Expression of
Distress ?
 Are they best explained within the conceptual framework of Western psychiatry, or
are they best explained anthropologically as manifestations of structural and
functional elements operating in the societies in which they are found?
◦ It is impossible to produce a definitive list of this group of diagnostic entities (Simons and
Hughes, 1986). It is unclear exactly what sort of things should be included.
◦ How about reports of possession and trance states, which often had local names?
◦ Should descriptively similar patterns of behavior or experience from different cultures be
lumped together or split apart?
◦ What can reasonably be called an illness, and what is better considered a set of customary
beliefs and practices of an entirely different order?
 Hughes concluded that the term culture-bound syndrome "still has little
discriminable [i.e., operationally definable] content" (Simons and Hughes, 1986).
 In theory, culture-bound syndromes are those folk illnesses in which alterations
of behavior and experience figure prominently. In actuality, however, many are
not syndromes at all. Instead, they are local ways of explaining any of a wide
assortment of misfortunes.

6. Debates over Culture Bound Syndromes
 Traditional Debates Traditional debates about culture-bound syndromes concerned
the validity of the concept.
 Conventional psychiatrists argued that it was unnecessary to have a separate
category because such conditions were nothing more than variants of
disorders already defined by western psychiatry. For example
◦ koro (a condition in which a man believes that his genitals are retracting into his body)
could be diagnosed as a form of dysmorphophobia or an obsessive–compulsive disorder.
◦ Pibloktoq was a kind of a hysterical reaction.
 In contrast, culturally oriented psychiatrists, such as those who were part of the
transcultural psychiatry movement, emphasized the defining role of culture.
 They argued that members of different cultural groups experience traumatic events
differently, have a different range of anxieties and personal conflicts, and enact and
communicate suffering in different ways.

7. Critical Debates
 An important line of critical inquiry has investigated racist and colonial
biases in early accounts of culture-bound syndromes.
 Colonial-era psychiatrists’ accounts of the mental disorders found among
colonized subjects often claims about the moral and intellectual
inferiority of subjugated populations, claims by which colonizers
justified their regimes of control.
 Colonized and racialized peoples were sometimes deemed as primitive,
psychologically underdeveloped, childlike, or lower on the
evolutionary scale than white Europeans (Fernando, 2003).
 Biases still inflect discussions of culture-specific disorders.
 Symptom presentations that are common in western high income
societies are regarded as standard or normative; other symptom
presentations are regarded as anomalous.
DSM’s list of culture-bound syndromes does not contain any disorders that are
identified as occurring among white European or North American groups

8. ICD-10 (1992)
The ICD-10 recognizes a number of culturally uncommon
symptom patterns and presentations referred to as ‘culture-
specific disorders.’ While acknowledging that these
sydromes have diverse characteristics, they also have two
common features:
 1 They are not easily accommodated in established and
international diagnostic categories.
 2 Their initial description is in a particular population or
cultural area and their subsequent association is with this
community or culture.

9. DSM-IV-TR (2000)
In the DSM-IV-TR,7 culture-bound syndromes were seen as recurrent,
locality-specific patterns of aberrant behavior and troubling experience
that may or may not be linked to a particular DSM-IV diagnostic category.
The following characteristics were seen as crucial for culture-bound
syndromes:
 1Indigenously considered illnesses or afflictions – therefore a
recognition within the society as a deviation from normal or
healthy presentation.
 2 Local names – the ascription of a specific local name to the
experience of mental distress. This is often in the indigenous or key
language of communication and may be components of folk
diagnostic categories

10.  3 Symptoms, course and social response often influenced
by local cultural factors – for instance the folk healing
systems for the symptoms based on the explanatory
model of the experiences.
 4 Limited to specific societies or cultural areas – this may
be a geographical region, areas with shared ethnic history
or identity. For instance some cultural practices and
artifacts of theYoruba culture of western Nigeria may also
be found in Brazil
 5 Localized–therefore experiences that are not globally
recognized or span different regions.

11. DSM-V
The DSM-5 discarded the concept of culturebound
syndromes with a preference for the term ‘cultural
concepts of distress.’
 This has been defined as ‘ways cultural groups
experience, understand, and communicate
suffering, behavioral problems, or troubling
thoughts and emotions.’


12. Consequently three cultural concepts have been
identified:
 ‘syndromes’ (clusters of symptoms and attributions
occurring among individuals in specific cultures);
 ‘idioms of distress’ (shared ways of communicating,
expressing or sharing distress); and
 ‘explanations’ (labels, attributions suggesting
causation of symptoms or distress).

13.  Interestingly, the DSM-5
◦ emphasizes that all mental distress is culturally framed
◦ acknowledges that different populations carry varying and
culturally determined ways of communicating distress along
with explanations of causality, coping methods and help-
seeking behaviors

14. Appear to Be "True" Syndromes
Dissociative Phenomena
 In a remarkable number of CBSs, the predominant symptom is
dissociation.
 dissociation is more common, more recognized, or more
accepted in other cultures.
 culture affects the form of dissociative symptoms more than it
is able to affect any other emotional phenomena

15.  As individuals are highly suggestible during dissociative states
◦ a psychopathologic entity characterized (or created by)
dissociation would be Thus the content of dissociative
symptoms and process of dissociative disorders reflect the
diversity of cultures,
 Although the mental mechanisms underlying these
symptoms may be presumed to be universal

16. Amok
 cathard in Polynesia
 pseudonite in the Sahara
 mal de pelea in Puerto Rico
 wihtiko among the Cree Indians,
 "jumping Frenchman" in Canada,
 imu in Japan,
 myriachit in Siberia,
 pibloktoq among polar Eskimos,
 'frenzied anxiety state" in Kenya,
 "wild man behavior" in New
Guinea,
 "Whitman syndrome" in the
United States.
Amok is a Malaysian term used to describe a syndrome characterized by homicidal frenzy,
preceded by brooding and followed by amnesia.
the predominant and most dramatic aspect of the syndrome is mass assault,
A variety of syndromes have been described as being "amok-like," including
In many of these, dissociation is the dominant feature and there is no mass assault. Imu,
myriachit, and "jumping Frenchman" also have been described as being similar to latah, a
very different syndrome.2

17. Falling Out or Blacking Out
 This phenomenon is found in the Southern United States and
the Caribbean,
 Characterized by sudden collapse in which the eyes are open
but the afflicted claim an inability to see.
 Patients may be aware of their surroundings but feel helpless
to move.
 Could also be conceptualized as a conversion disorder.

18. Latah
 Described among the Malaysians, is marked by
◦ hypersensitivity to sudden fright or startle, often with echopraxia,
echolalia, command obedience, and dissociative or trancelike behavior.
 Other non-Malaysian terms thought to describe similar
phenomena include
◦ amurakh, irkunii, ikota, olan, myriachit, menkeiti, bahtschi, bah-tsi,
imu, mali-mali, and silok.
 Spiegel and Cardena(34) compared this phenomenon to "a
spontaneous state of hypnosis:
◦ an event which suddenly grabs the subject's attention, is followed
by an excessive immediate reaction and then by a state of
extreme suggestibility."

19.  Prince and Tcheng-Laroach(28) suggest that latah not be
defined as a disorder, as it is not recognized as such in the
Malaysian culture.
 Many scholars disagree, considering latah a disorder because
of the distress it evokes in those affected by it.
 Simons refers to the Malay dictionary Kamus Dewan which
defines latah as a "penuakit saraf" or "neurological
disease."19)
 Considering latah a disorder of attention, Simons(31) suggests
that it be classified in conjunction with the other attention
disorders. (4)

20. Pibloktoq
 Found among the Arctic and Subarctic Eskimos
 Characterized by abrupt episodes of extreme excitement,
often followed by apparent seizures and transient coma.
 The victim may be withdrawn or irritable prior to the
performance of irrational and dangerous acts, and report
complete amnesia afterwards.
 Also described as Arctic hysteria and piblokto

21.  pibloktoq has been compared with amok, and, indeed, may
have some similarities with the amok phenomenon.
 In contrast to amok, however, pibloktoq occurs primarily
in women, and the individuals afflicted do not necessarily
display violence against others.
 well-documented behavior includes eating of feces, tearing
off of clothing, fleeing from shelters, and breaking of
furniture.(1 5)

22. Grisi Siknis
 This CBS is found among the Miskito people who live in
villages that line the Atlantic coasts of Nicaragua and
Honduras.
 This syndrome, affecting mainly young women, consists of
a dissociative state in which the victim believes she is
being attacked or raped by "devils," and proceeds to run
through the village or into the bush.(11)
 Running is the most distinctive feature of the syndrome;
those affected also may display aggressive behavior.

23.  This syndrome has been described in epidemics and likened
to pibloktoq.
 Simons and Hughes(32) grouped these two syndromes in a
"Running Taxon," and suggested they could be classified
within the category of atypical dissociative disorders, or
psychogenic fugue.
 Spiegel and Cardena(34) noted that as DSM-IV psychogenic
fugue no longer requires the development of a new identity,
such a diagnosis fits well with grisi siknis.

24. Shin-Byung
 This is a Korean syndrome characterized initially by anxiety and
somatic complaints, and later followed by dissociation.
 The patient might complain of being weak, dizzy, or fearful, and
might have difficulty eating and sleeping.
 Because this syndrome is attributed to possession by ancestral
spirits, it also could be conceptualized as an "illness of attribution.“
 Such "possession states" are found worldwide, and, in some
cultures, are not considered pathologic.
 Dissociation appears to be the predominating process in these
phenomena

25.  Although anxiety is a universal phenomenon, the events
precipitating it are highly influenced by culture.
 Beck and Emery(5) explained that it is the perception of a
situation, or the cognitions associated with it, that determine
the extent to which anxiety will be evoked.
Because these cognitions are culturally mediated, we may
not recognize the similarities between the Wes tern
syndromes and their "culture-bound" counterparts.

26. Anxiety States

27.  Some syndromes also may be understood as somatoform
disorders, for cognitions that generate anxiety often are
associated with fear of bodily change.
 Because dissociative symptoms often coexist with anxiety states,
as in post-traumatic stress disorder, some CBSs could be
conceptualized as dissociative disorders.

28. Ataque de Nervios
 This syndrome, seen in Latin American populations, also has been
labeled "Puerto Rican Syndrome.“(18)
 Symptoms include
◦ Shaking
◦ Palpitations
◦ Flushing
◦ Numbness
 often accompanied by
◦ shouting or striking out
◦ followed by falling
◦ convulsive body movements
◦ amnesia.
 An attack can resemble panic disorder with dissociative features.
Ataque de nervios is described by some as an "idiom of distress,"
commonly precipitated by certain upsetting events, such as a death in
the family, a conflict with a family member, separation, or divorce.

29.  A typical Western patient will experience considerable anxiety
following his or her first panic attack, fearing that it was due
to :
◦ A dangerous and unpredictable physical or mental defect.
 In contrast, a patient who experiences ataque can be
presumed almost to expect these symptoms as the
sequelae of psychosocial stress.

30. Dhat
 Also known as jiryan among Asian Indians
 this syndrome occurs in individuals who experience extreme
anxiety and hypochondriasis associated with discharge of
semen, often following nocturnal emissions.
 Associated symptoms include feelings of weakness and
exhaustion.
 Those afflicted imagine they are losing semen in their urine,
and become terrified, believing that semen is vital for life

31.  Loss of semen in any form is feared to lead to depletion of
physical and mental energy.(10)
 Many Asian peoples share this belief and similar syndromes
are found in Sri Lanka (sukra prametra) and China (shen-
k'uei).
 One might conceptualize this as a somatoform disorder
because the anxiety is in response to a somatic
preoccupation. (3)

32. Koro
 koro occurs when extreme anxiety is evoked in response to a
somatic preoccupation.
 afflicted individual is seized with terror when he believes
that his penis is retracting into his body, and complete
retraction will eventuate in death.
 Desperate measures are taken to prevent retraction, including
applying clamps or strings and summoning friends and family
to assist.

33.  Less commonly, koro is found in women who fear labial
and breast involution
 koro frequently occurs in epidemics.
 Terms for similar syndromes include shuk yang, shook yang,
and suo yang (Chinese), jinjinia bemar (Assam), and roo-
joo (Thailand)

34. Kayak Angst
 This Inuit Eskimo term refers to intense anxiety associated
with the fear of capsizing and drowning when going out
on the open sea in a kayak.
 The Greenlandic term for this syndrome is nangiarpok.(33)
 It is fairly common among the polar Eskimos, and is
characterized by an acute state of panic and disorientation.
 This also has been conceptualized as a culture-bound form
of panic disorder.
 As with panic disorder, there is considerable anticipatory
anxiety, avoidance, and social impairment

35. Taijin Kyofusho
 Prevalent among the Japanese, is similar to social phobia.
 It also is referred to as "anthropophobia.“(33)
 The afflicted are intensely anxious that their bodies, their
body parts, or body functions may offend, embarrass, or
displease others.
 Typical concerns include embarrassing others by blushing, or
causing discomfort by one's gaze, facial expression, or body
odor.
 Especially prevalent among youth, the disorder can be so
debilitating that social support groups have developed to aid
victims.

36. Affective Somatoform Disorders

37.  It is unusual in non-Western cultures to find affective
disorders isolated from high levels of and preoccupation
with somatic distress.
 This may be explained in part by traditional cultural
values that discourage expressions of emotional
distress but accept and address physical complaints.
 Eastern cultures are not subject to the mind/body
dualism prevalent in Western thinking.
 Individuals from these cultures often view psychological
distress as emanating from bodily imbalances and,
therefore, understand their illness in somatic terms.

38. Brain Fag
 The predominant complaint is fatigue.
 The term originated in West Africa and is used to refer to a
condition experienced by students, primarily male, in response
to the stress of their schooling.
 Symptoms include
◦ pain, pressure or tightness in the head and neck
◦ difficulty concentrating
◦ Agnosia
◦ Anxiety
◦ visual complaints
 Victims complain of "brain tiredness" from "too much thinking,"
and might also have problems with reading, remembering, and
understanding.

39.  The sensation of "worms crawling in the head" also has
been described.
 Similar syndromes have been described in Africa, not always
in students. One is ori ode, literally "hunter in the head," a
condition described in Nigeria and characterized by
◦ somatic complaints
◦ Palpitations
◦ "noises in the ears,“
◦ sensation of an organism crawling in the brain.
 According to Nigerian folk beliefs, the noises are ascribed to
the voice of a malevolent enemy. (25)

40. Shenjing Shuairuo
 Known in Western terminology as neurasthenia, this condition is
highly prevalent among the Chinese, and is characterized by
◦ feelings of physical and mental exhaustion
◦ difficulty concentrating, memory loss
◦ Fatigue
◦ dizziness.
 A number of associated physical complaints similar to those
seen in depression include difficulty sleeping, appetite
disturbance, sexual dysfunction, headaches, and irritability.
 There is an ongoing debate regarding whether or not this is a
Chinese label for major depressive disorder

41. Anorexia Nervosa
 This disorder, along with bulimia, involves an obsessive
preoccupation with weight loss and an almost delusional
distortion of the patient's ability to assess her body image.
 Many have described this as a Western CBS, reflecting the
value Western cultures place on body image, particularly
slimness.

42. Chronic Fatigue Syndrome
 This controversial entity may be the Western equivalent of
neurasthenia.
 Symptoms include overwhelming fatigue as well as a variety
of somatic and psychological complaints.

43. Psychotic States

44.  Psychosis is a well-known phenomenon across cultures.
 In several psychotic states, the character of the syndrome is
highly influenced by the indigenous culture.
 These are primarily brief and reactive to environmental
stresses.

45. Boufee Delirante
 French term is used to describe a syndrome, observed in
West Africa and Haiti, that consists of
◦ a sudden outburst of aggressive behavior
◦ Confusion
◦ psychomotor agitation.
 There also may be paranoid ideation and auditory and
visual hallucinations.
 This seemingly psychotic state generally is transient and may
have dissociative features.
 The most likely Western counterpart is brief psychotic
disorder.

46. Qi-gong
 Literally an "exercise of vital energy," qi-gong is a folk
health-enhancing practice based on the Chinese
metaphysical theory of yin/yang balance and ch'i (vital
energy).
 Some individuals, particularly those who become heavily
involved in the practice, are vulnerable to the development
of brief psychotic episodes marked by paranoia and
dissociation.
 The episodes are acute and time-limited, such as is
described in a brief psychotic disorder

47. Illnesses of Attribution

48.  Many folk terms are used to describe illness defined not by
specific signs and symptoms but by real or presumed
causes.
 These terms do not describe specific syndromes;
 More typically, an assortment of physical and emotional
symptoms are attributed to an emotion such as fear or
anger, an outside supernatural force such as witchcraft or
possession, or an organic disturbance such as "bad blood"
or semen loss.

49. 1. Induced by Anger
A. Bilis, Calera, or Muina:
 In many Latin American cultures, it is thought that anger
disturbs the core body valences and the material and
spiritual aspects of the body.
 Symptoms include tension accompanying somatic
expressions and fatigue.

50. B. Hwa-Byung or Wool-Hwa-Byung:
 In the Korean language, hwabyung literally means "anger
sickness”
 The suppression of anger is seen as a causative factor in
the development of somatic symptoms including indigestion,
dyspnea, fatigue, and the sensation of a mass in the
stomach.
 Emotional symptoms include fearfulness, panic, and
general dysphoria.
 Although this is an illness of attribution, it also has been
described as a syndrome.

51. 2. Induced by Fright
A. Susto
 Seen throughout Latin America,
 Also is known by the terms, espanto, pasmo, tripa ida,
perdida del alma, or chibih.
 It is believed that sudden fright will cause the soul to leave
the body, making the individual vulnerable to a variety of
ills, even for many years following the fright.
 Numerous physical and emotional symptoms have been
attributed to susto.

52. B. Kesambet
 In North Bali, fright to a child's mother is thought to be a
common cause of child mortality.
 Folk theory holds that fright can turn a mother's milk bitter
or hot, or cause it to stop flowing.
 Babies who become febrile and colicky are thought to suffer
from kesambet, also known as turutan.

53. 3. Induced by Witchcraft
A. Ghost Sickness
 Navajo folk tradition holds that witches and malevolent
supernatural powers can induce an illness with symptoms
such as delirium, nightmares, terror, weakness, poor
appetite, anxiety, and confusion.
 Ghost sickness has also been described as a Native American
preoccupation with death and the deceased.

54. B. Rootwork or Voodoo:
 A set of cultural interpretations ascribe illness to hexing,
witchcraft, or the evil influence of another person.
 A variety of emotional and physical symptoms, and even
death, can result.
 This condition is found in many cultures, including those in
the Caribbean and the Southern United States.

55.  Latin American terms with the same meaning include
malpuesto and brujeria.
 Commonly, victims experience a profound hopelessness
that can result in rejection of food or water.

56. 4. Induced by the "Evil Eye"
 A variation on witchcraft, this concept is widespread in
Mediterranean cultures, and is known as mal de ojo in
Latin American cultures.
 A fixed stare by an adult is believed capable of causing
physical or emotional problems in a child or another
adult.
 These problems also can be induced by a comment that is
taken to be envious of a child.
 Symptoms in children who are thought to be afflicted include
crying, fitful sleep, diarrhea, vomiting, and fever.

57. 5. Induced by Perceived Organic Disturbance
A. Sangue Dormida
"Sleeping blood" is thought by Cape Verdeans to cause a
multitude of ailments including pain, numbness, tremors,
paralysis, convulsions, stroke, blindness, heart attacks,
infection, and miscarriage .

58. B. Dhat Syndrome

 Although mentioned as a "true syndrome," in many Asian
cultures, semen loss is attributed to a heterogeneous
range of ailments.
 This is consistent with Eastern notions of the importance of
balance between the yin and the yang, which can be disrupted
by any excesses in emotion or behavior.

59. 6. Induced by Possession
 The notion that individuals can be "possessed" by spirits
or supernatural creatures is widespread and described in
numerous cultures.
 Although "possession" frequently is used as an
explanation for psychotic, dissociative, or otherwise
abnormal behavior or experiences, often it is seen as a
normal, expected, or desired phenomenon.
 In Simons and Hughes' 1985 glossary of CBSs, some
reference to possession was found in 10% of the 185
entries.

60. Idioms of Distress
1. Nervios:
 This is a Latin American term also known as nevra among
the Greeks.1
 Certain individuals are thought to be especially vulnerable
to stressful life events.
 The vulnerability may be inherent, or the result of an
adverse circumstance or trauma. This vulnerability makes
them susceptible to a wide variety of physical and
emotional illnesses, which are generically referred to as
nervios.

61.  As such, nervios is a general term used as an idiom for
stress-related illness.
 It is neither a specific syndrome, nor a notion of
disease causation.
 The best English translation probably would be a
highly nonspecific "nervous disorder."

62. 2. Locura
 This is Latin American/Spanish term that refers to
the most severe form of chronic mental illness.
 Its equivalent English term might be "craziness.“
 Locura is used to describe individuals who are
thought to be incoherent, agitated, unpredictable, and
possibly violent.

63.  They may suffer from hallucinations and be unable to
follow rules of social interaction.
 This term basically covers any chronic and severe
psychotic illness including those similar to
schizophrenia or caused by medical conditions

64. Cultural Bound Syndromes in India

65. 1. Dhat Syndrome
 . Dhat is derived from sanskrit word ‘Dhatu’ meaning
precious fluid.
 Susruta Samhita (ancient Indian text of surgery) has
described 7 Dhatus in the body. Dhatus are elixir of the
body.
 Disturbances of it can cause physical and mental
weakness. Of all seven, Semen is considered to be the
most precious.
 Charak Samhita (ancient text of Indian Medicine)
describes a disorder resembling Dhat Syndrome by the
name ‘Shukrameha’. Shukra is the word used for sperms
in Sanskrit. Another term

66. Another term denoting semen is ‘Veerya’ which in
Sanskrit means bravery, valor and strength
 • 40 meals = 1 drop of blood
 • 40 drops of blood = 1 drop of Bone Marrow
 • 40 drops of bone marrow = 1 drop of semen
This gives rise to belief that loss of excessive semen in
any form e.g. masturbation, nocturnal emissions etc. is
harmful.

67.  On the other hand its preservation will lead to health
and longevity.
 Thus the belief in precious and life-preserving
properties of semen is deeply ingrained in Indian
culture.
 The belief is further reinforced by traditional healers
and perpetuated by friends and elders who had
suffered from this syndrome

68. The term was first used by Wig in 1960
• A whitish discharge is blamed by patient to be responsible
for the physical and mental symptoms which patient suffer
from
• However there is no objective evidence of such a
discharge
• Sometimes patient also reports of foul smelling semen
and less viscous semen
• Generalised weakness,
• Aches and pains all over body,

69. • Tingling and numbness in various parts of body
especially peripheries
• Easy fatigue
• Lassitude
• Loss of apetite, weight loss loss of attention and
concentration • Excessive worrying •
• Panic attacks
• Sadness of mood
• Forgetfulness

70. • Feelings of guilt (especially towards masturbation during
adolescence)
• Sexual complaints are that of premature ejaculation and
erectile dysfunction
• In majority of cases there is absence of any physical illness
like Diabetes, local genital abnormalities, sexually
transmitted diseases
• The syndrome is seen usually in people from lower
socioeconomic strata who seek help from traditional healers
before reaching Hospitals
• Present all over the country

71. • Also seen in surrounding countries like Sri Lanka (Sukra
Prameha), Pakistan and even in China (Sen-k’uri)
• Concomitant psychiatric morbidity like depression,
somatoform disorder, anxiety disorder may be present
• Treatment mainly consists of dispelling of myths by
psychoeducation, reassuring the patient, treating any
underlying psychiatric disorder, even symptomatic relief (of
severe anxiety that these patients suffer) with the help of
medications in initial stages of treatment is required to gain
confidence of the patient

72. Possession Syndrome
 Diagnosable under Dissociative disorders.
 Patient is possessed usually by ‘spirit/soul’ of deceased
relative or a local deity. Speaks in changed tone, even
gender changes at times if the possessing soul is of
opposite sex.
 Usually seen in rural areas or in migrants from rural
areas. Majority of these patients are females who
otherwise don’t have any outlet to express their emotions.
 Treatment includes careful exploration of underlying
stress which precipitated the possession attack. Also to
decrease any secondary gains patient may be getting from
this behaviour. •

73.  • Antidepressant Syndrome is seen in all parts of India
• Many religious shrines hold special annual festivals
where hundreds of people get possessed
simultaneously
 • These people are looked upon as special by their
families and villages which reinforce the secondary
gains
 • Included in ICD-10 under Dissociative disorders

74. Ascetic Syndrome
 • First described by Neki in 1972
 • Appears in adolescents and young adults
 • Characterised by social withdrawal, severe sexual
abstinence, practice of religious austerities, lack of
concern with physical appearance and considerable
loss of weight

75. Jhin Jhinia
 • Occurs in epidemic from in India
 • Characterised by bizarre and seemingly involuntary
contractions and spasms
 • Nosological status unclear

76. Bhanmati Sorcery
 This CBS is seen in South India.
 It is believed to be due to psychiatric illness i.e.
conversion disorders, somatization disorders, anxiety
disorder, dysthymia, schizophrenia etc.
 • Nosological status unclear

77. Suudu
 It is a culture specific syndrome of painful urination
and pelvic “heat” familiar in south India, especially in
the Tamil culture.
 It occurs in males and females.
 It is popularly attributed to an increase in the “inner
heat” of the body often due to dehydration.

78.  It is usually treated by the following:
1.Applying a few drops of sesame oil or castor oil in the
navel and the pelvic region
2.Having an oil massage followed by a warm water bath
3. Intake of fenugreek seeds soaked overnight in water
The problem has also been known to exist in other parts
of South India and the methods of treatment are also
similar

79. Gilhari Syndrome
• Characterised by patient complaining of small
swelling on the body changing its position from time to
time as if a gilhari (squirrel) is tavelling in the body
• Not much literature available
• Nosological status not clear

80. Chotikatwa
 The syndrome’s genesis is based on frequent
occurrence of tail lock of hairs of female patients
getting cut under mysterious circumstances.
 Such cases are being reported from different North
Indian states. The description of four cases is being
presented in the report.
 The occurrences occurred only with females under
settings of stress and comorbid cluster B traits .
 The phenomenon has not been discussed in academic
literature

81. Mass Hysteria
• Short lasting epidemics of Mass Hysteria where
hundreds to thousands of people were seen to be
believing and behaving in a manner in which ordinarily
they wont.
E.g. the God Ganesha’s idols drinking milk all over India
in 2006 lasted for almost a week