Wednesday, 10 October 2012

Culture-Bound Syndrome or Folk Illness

Culture-Bound Syndrome or Folk Illness


There are some diseases that have very
limited distributions around the world due to
the fact that they are caused by unique
combinations of environmental circumstances
and cultural practices. These are generally
referred to as culture-bound syndrome, culturespecific
syndrome or folk illness. These are
generally limited to specific societies or culture
areas and are localized, folk, diagnostic
categories that frame coherent meanings for
certain repetitive, patterned and troubling sets
of experiences and observations.

Meaning of Culture

Patterns of behavior (values, perceptions,
meaning, beliefs and practices) shared by a
group of people performing essential tasks of
daily living.

Meaning of Culture bound

Whenever people live as part of a culture,
they are to some extent imprisoned by it – with
limited exposure to other cultures or ways of
thought. They think that their culture is
superior to all others.

Definitions of culture-bound syndrome

a. Culture-bound syndromes are a
combination of psychiatric and somatic
symptoms that are considered to be a
recognizable disease only within a specific
society or culture. There is no objective
biochemical or structural alterations of body
organs or functions, and the disease is not
recognized in other cultures.
b. Culture-bound syndromes are defined
as‘episodic and dramatic reactions specific to
a particular community - locally defined as
discrete patterns of behavior’.

Prevalence and etiology

Culture-bound syndrome or folk illness is
very familiar in the culture. This syndrome is
more common in teenagers and adults, it affects
both sexes equally. This syndrome’s exact cause
is idiopathic, but may be due to certain ego
defence mechanisms. Projection, depression
and shame or guilt arealso reasons for culturebound

Some common features

Culture-bound syndrome patients usually
have some kind of acting out that attracts
cultural attention, amnesia is common. The
triggers of their behavior may be difficult to
isolate as they are not being perceived in
Western culture as stressors. Culture-bound
syndromes are often seen in people having
histrionic personalities, and somatic symptoms
are often predominant. The patient’s
laboratory investigations reveal no biochemical
or tissue abnormalities. These syndromes
improve spontaneously or need sedation or
antipsychotic medications. Treatment requires
collaboration with traditional healers.

Cultural influences on psychiatric syndromes

• Cultural influence on the formation of a
disorder (Pathogenic effect).
• Culture selecting certain coping patterns
to deal with stress, like family suicide
(Psychoselective effect).
• Culture promoting the frequency of
occurrence (Psychofacilitating effect).
• Culture shaping folk responses to the
clinical condition (Psychoreactive effect).


Psycho-Pharmacological management for
reducing the symptoms, psychological
management like culture bound psychotherapy
and collaboration with folk / traditional healer
are some of the measures included under


Culture bound syndrome is a clusters of
symptoms and behaviors that can be probably
related to cultural emphases and to specific
stress situations which are typical of particular
populations and complete lack of familiarity
of the condition to people in other cultures.
Therefore awareness of culture bound
syndromes is very important for all the levels
of health care professionals in order to make
culturally appropriate diagnoses, timely
management and appropriate treatment.

Types of culture-bound syndromes seen in Asian countries are,

Name of the disease, Geographical localization, Symptoms

1. Running amok
Malaysia, Indonesia,
Philippines, Brunei,
Suddenly withdraws from family and
friends, then bursts into a murderous rage,
attacking the people around him often
followed by a claim of amnesia.

2. Dhat syndrome 
India and Bangladesh
Comprises vague somatic symptoms of
fatigue, weakness, anxiety, loss of appetite,
guilt and sexual dysfunction, attributed by
the patient to loss of semen in nocturnal
emissions, through urine.

3. Koro
Chinese and Malaysian
Populations In Southeast
Asia; Assam
An episode of sudden and intense fear or
delusion that the penis (or in the rare female
cases, the vulva and nipples) will recede into
the body and possibly cause death.

4. Latah 
Malaysia and Indonesia
Hypersensitivity to sudden fright, often with
echopraxia, echolalia, command obedience,
and dissociative or trance like behavior. The
Malaysian syndrome is more frequent in
young girls.

5. Shenjing shuairuo
Similar to neurasthenia, symptoms include
physical and mental fatigue, dizziness,
headaches and other pains, difficulty
concentrating, sleep disturbance, and
memory loss.

6. Shenkui 
Marked anxiety or panic symptoms
including dizziness, backache, fatigability,
general weakness, complaints of sexual
dysfunction, insomnia.

7. Taijin kyofusho 
Fear and guilt about embarrassing others
with one’s appearance or behavior
prominent in younger people.


1. Jilek W.G. Psychiatric Disorders: Culture-specific.
International Encyclopedia of the Social and
Behavioral Sciences. Elsevier Science Ltd; 2001.
2. Kaplan & Sadock’s Comprehensive Textbook of
Psychiatry, 8th Edition. Lippincott Williams &
Wilkins publication, 2005; 618-620.
3. Oxford handbook of psychiatry. Transcultural
Psychiatry, 2nd edn. Oxford University
Press, 2009; 852-859.
4. Verna Benner Carson. Mental Health Nursing. The
Nurse-Patient Journey, 2nd end. Sounders, 2000;
5. American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders, 4th ed. Text
revision. American Psychiatric Pub, 2000; 898.
6. Guarnaccia, Peter J. & Rogler, Lloyd H, Research
on Culture-Bound Syndromes: New Directions.
American Journal of Psychiatry 1999; 56: 1322–1327.

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