Culture‑Bound Syndromes and Cultural Concepts of Distress in Psychiatry

Culture‑bound syndromes (CBS) and cultural concepts of distress include syndromes or disease manifestations whose occurrence is related to particular cultural contexts. The term CBS is controversial, because ultimately all psychiatric and medical conditions are associated with culture. They constitute different points of view on mental health based on alternative explanatory models of mental distress. These idioms of distress have experienced a growing interest in Western countries either by an increase in the number of cases or the influence that transcultural psychiatry has come to conquer. This review describes clinical, epidemiological and contextual characteristics of most commonly reported CBS and briefly discusses the relationship between culture and psychiatric disorders. Modern societies are increasingly multi‑ethnic and multicultural and thus, discussion of these concepts remains relevant, aiming to integrate CBS in current classification systems or establishing criteria that best define them as legitimate nosological entities.

Transcultural psychiatry

This chapter covers transcultural psychiatry and culture-bound disorders. It covers culturally influenced variants of universal broad categories of mental disorder, to enable meaningful diagnostic formulation and development of appropriate treatment plans. Summarizing the recent developments in global mental health, it puts cultural context to the presentation of psychiatric disorders, and examples of common cultural concepts of distress are defined.

Keeping it together: Idioms of resilience and distress in Thai Buddhist mindlessness

Mindfulness is increasingly lauded as a mark of well-being around the world, but less often is its opposite, mindlessness, articulated in discussions of mental health. In Thailand, where people follow the kinds of Theravāda forms of Buddhism that have inspired today's global mindfulness movement, “mindlessness” is understood as a culturally salient mark of distress. In this article I address what mindlessness looks like for people in and around the Northern Thai city of Chiang Mai, where mindlessness can be thought of as ephemeral and passing as a fleeting forgetfulness that necessitates re-reading a page in a book, or as long lasting and powerful as a destabilizing condition to be treated in the in-patient ward of a psychiatric hospital. I emphasize local meanings and contexts of mindlessness, and their entanglement with broader discourses in the mindfulness movement, in order to point to mindlessness as a type of local and potentially international idiom of distress. I do this to argue for both the continued importance of cultural concepts of distress in our psychiatric nosology, and for further study into the slippages that can occur when local idioms like mindfulness go global.

Global Psychiatric Epidemiology

This chapter offers an introduction to and discussion of the basic principles, concepts, and challenges of global psychiatric epidemiology, including the classification of mental illness, cultural concepts of distress, and the current understanding of global epidemiology and its limitations. The authors discuss how practitioners can use this information to improve their awareness of how their personal backgrounds and professional training impact their classification, understanding, and treatment of mental illness, and how they can take actions toward improving their cultural competence and ultimately improving patient relationships and care management. This discussion focuses primarily on the challenge of understanding global epidemiology through the lens of biomedical diagnostic classification systems, and on the importance of understanding how culture and society affect our knowledge of and approach to the diagnosis and treatment of illness.

Culture in the DSM-5

This chapter focuses on the revision of the DSM-IV to DSM-5, including an increased emphasis on the role of culture in psychopathology. The DSM-5, published in 2013, includes a revision of DSM-IV’s Outline for Cultural Formulation and includes the newly added standardized and manualized Cultural Formulation Interview (CFI), the 12 supplementary modules to the CFI, and a Glossary of Cultural Concepts of Distress. With these changes, DSM-5 strives to provide clinicians with a practical interpretive framework to explore patients’ varied experiences and expression of mental distress, increasing the clinical significance of each patient’s ethnic and cultural context. This chapter explores these additions to and revision of the DSM-5, reviews some of its criticism, and offers best practices for using these tools in the evaluation and management of diverse patients.

Understanding the cultural concept of “highly sensitive person” among bipolar patients

IntroductionThe concept of “highly sensitive person” is a cultural concept, which has become popular in western societies including Sweden. A highly sensitive person (HSP) is usually described as having hypersensitivity to external stimuli, different cognitive processing and high emotional reactivity. Although the concept lacks diagnostic validity, psychiatric patients may refer to this concept.AimsTo examine the feasibility of the Cultural Formulation Interview (CFI) and the clinical relevance of cultural concepts of distress among patients with bipolar disorder that report being a HSP.MethodsA case series of three patients with a diagnosis of bipolar disorder that report HSP. The CFI was conducted with all patients and the applicability of the DSM-5 cultural concepts of distress tested.ResultsIn all three cases, the CFI facilitated the clinical consultation as reported from the patients and in one of the cases also increased the treatment engagement. The HSP-concept could be conceptualized as a cultural syndrome, idiom of distress and as an explanatory model.ConclusionThe CFI and the cultural concepts of distress proved to be useful for understanding the concept of HSP as also they increased the cultural validity of the diagnostic interview. The three cases illustrate the challenges when encountering patients with other cultural references than clinicians. This highlights the necessity to integrate anthropological thinking in our current diagnostic work in order to reduce the “category fallacy” and promote a more person-centered approach in psychiatry.Disclosure of interestThe authors have not supplied their declaration of competing interest.