Culture-Specific Psychiatric Syndromes: A Review ( part 3 )

MELAPUS.COM
Sep 5, 2018 · 3 min read

Taijin Kyofusho

Taijin kyofusho is a diagnosis found in Japan. Patients with taijin kyofusho (literally “the disorder of fear”) experience extreme self-consciousness regarding their appearance. Patients suffer from intense, disabling fear that their bodies are embarrassing or offensive to others.[1,10] This culture-bound condition has overlapping features with social phobia and body dysmorphic disorder.

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. This behavior has been claimed to occur in response to social pressure to lead a certain way of life expected by one’s family and/or community (ie, farming), whereas tribe members often attribute the behavior to the actions of supernatural beings who want to marry the afflicted persons.[11]This syndrome has features of a dissociative or conversion disorder.

Koro

Koro is intense anxiety related to the belief that one’s own genitalia are shrinking or receding, resulting in possible death. This diagnosis is found in Asia, specifically Southeast Asia. Rooted in Chinese metaphysics and cultural practices, Koro is included in the Chinese Classification of Mental Disorders, Second Edition.[1,12] The disorder has also been associated with the belief that perceived inappropriate sexual acts (eg, extramarital sex, sex with prostitutes, or masturbation) disrupt the yin/yang equilibrium, thought to be achieved during marital sex. Koro has also been thought to be transmitted through food. One could also hypothesize that excessive guilt and shame about fantasized or executed sexual acts might play a role in the delusional belief.

Shenkui/Dhat Syndrome

Dhat derives from the Sanskrit for “elixir that constitutes the body.” Dhat is an Indian folk diagnosis in which patients experience severe anxiety and hypochondria related to the loss of semen through urine, nocturnal emission, or masturbation. A similar condition, shenkui, has been described in China.[1,13]In shenkui, marked anxiety or panic symptoms are accompanied by somatic symptoms, such as dizziness, backache, fatigue, and sexual dysfunction. The excessive loss of semen is feared because it is seen as the loss of one’s vital essence. Similar to koro, one could hypothesize that the intense fear present in dhat and shenkui could be related to fantasized or performed sexual acts that the person feels are forbidden or unacceptable to the self or others. However, the description could also be related to an unrecognized depressive disorder or somatization disorder.

Shenjing Shuairuo (Neurasthenia)

Shenjing shuairuo is a broad Chinese folk diagnosis characterized by fatigue, poor concentration, irritability, pain, and a variety of somatic symptoms. Traditionally, it probably included a range of mental health disorders and accompanying somatic symptoms, which would meet today’s DSM-5 criteria for a mood or anxiety disorder.[1,14] Across all cultures, it is not uncommon that mood disorders are expressed as somatizing, rather than mental, symptoms, in part to avoid the stigma often associated with mental disorders. This would fit with somatoform disorders, such as conversion disorder or somatization disorder. The description of shenjing shuairuo would also fit chronic fatigue syndrome, which remains poorly understood.

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