Culture-Bound Syndromes

The definition and expression of mental illness varies around the world.  According to the DSM-IV, "Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors.  In contrast, culture-bound syndromes are generally limited to specific societies or culture area and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations."  Disorders featuring similar behaviors are listed together.  Not all of them are considered pathological in their society of origin.  Medical Anthropology: Culture Specific Diseases offers good information on the sociology of the disorders

The suggestion has been made that eating disorders such as anorexia and bulimia are culturally specific to the western world, or parts of the world with heavy exposure to western media. 

The following syndromes are listed in the DSM-IV-TR as Culture-Bound Syndromes:

Amok (Malaysia)

Cafard or Cathard (Laos, Polynesia, the Phillipines)

Mal de pelea (Puerto Rico)

Iich'aa (Navajo)

 The origin of the English phrase "running amok", this is a dissociative episode featuring a period of brooding followed by an outburst of aggressive, violent or homicidal behavior aimed at people and objects.  It seems to occur only among males, and is often precipitated by a perceived slight or insult.  It is often accompanied by persecutory ideas, automatism, amnesia or exhaustion, following which the individual returns to their premorbid state.  The victim, who is almost always a male between 20-45, has often experienced a loss of social status or a major life change.  It is now rare, and occurs primarily in rural regions. Source.
Ataque de nervios (Latin America, Latin Mediterranean, Caribbean) Symptoms commonly include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal and physical aggression.  Some prominently feature dissociative episodes, seizure-like or fainting episodes, and suicidal gestures, while others lack those features entirely.  A key feature is a sense of being out of control, and it is usually triggered by a stressful event within the family.  It is commonly thought to be a result of a chronic build up of anger over time.  People may not remember what they did during the ataque, and usually return to normal following the incident. Source.
Bilis or colera or muina (Latinos) The cause of this disorder is seen to be a strongly expressed anger or rage, which disrupts the balance of both emotional and physical humors.  Symptoms may include acute nervous tension, headache, trembling, screaming, stomach disturbances such as nausea, vomiting or diarrhea, and even loss of consciousness.  Chronic fatigue may result from an acute episode.
Boufée delirante (West Africa, Haiti) A sudden outburst of agitated and aggressive behavior, marked confusion and psychomotor excitement.  It may be accompanied by visual and auditory hallucinations or paranoid ideation.
Brain fag or brain fog (West Africa)

Studiation Madness (Trinidad)

 This disorder typically begins after an intensive period of intellectual activity, and is usually associated with college or high school students.  Symptoms may include watering or dry eyes, dizziness, blurring of vision, difficulty concentrating or remembering, pain or feelings of pressure in the head or neck, fatigue and difficulty sleeping, shaking hands, rapid heartbeat, crawling sensations under the skin, feelings of weakness and depression. Source 1.  Source 2.
Dhat (India)

Jiryan (India)

Sukra Prameha (Sri Lanka)

Shen-k'uei (China, Taiwan)

Shenkui (China)

 Dhat (semen-loss anxiety) is a disorder found, obviously, among men only.  In Culture-bound syndromes: the story of dhat syndrome, dhat is defined as "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 and masturbation."  The anxiety related to semen loss can be traced back thousands of years to Ayurvedic texts, where the loss of a single drop of semen, the most precious body fluid, could destabilize the entire body.

Shen-k'uei, a Chinese syndrome, is described in the same article as "A form of sexual neurosis associated with excessive semen loss due to frequent intercourse, masturbation, nocturnal emission or passing of white turbid urine which is believed to contain semen. Young people who think they might be suffering from it become anxious and panicky, and complain of somatic symptoms (with no organic cause) such as dizziness, backache, fatigue, weakness, insomnia, frequent dreams and physical thinness," essentially the same set of symptoms as dhat.  Women may be seen as stealing vital energy through sexual intercourse, and any form of semen loss could lead to an imbalance in chi.

Semen-loss anxiety is known in the West, although it is largely considered to be a thing of the past.  The Victorians, in particular, are particularly well known for being almost obsessive about masturbation and nocturnal emissions, blaming them for wasting away, paleness, cold sweats, hairy palms, tremors, exhaustion, muscle weakness, pimples, and a variety of other symptoms.  In fact, one of the reasons circumcision became popular was because it was believed to reduce a man's urge to masturbate.
Falling-out or blacking out (Southern USA, Caribbean) The individual experiences dizziness and a spinning sensation before a sudden collapse.  Although the eyes may be open, the person reports being unable to see, although they hear and understand what is happening around them without being able to interact.
Ghost Sickness (Navajo) Weakness, bad dreams, feelings of danger, confusion, feelings of futility, loss of appetite, feelings of suffocation, fainting, dizziness, hallucinations and loss of consciousness.  May become preoccupied with death or with someone who died.  Source.
Hwa-byung or ul-hwa-byeong or wool-hwa-byung (Korea) Literally translates to "fire illness", and most often occurs in elderly or middle-aged women who are less educated, come from a lower socio-economic level and live in rural areas.  It is believed to be caused by a build-up of unresolved anger, which disturbs the balance of the five bodily elements.  The triggering cause is external events, particularly intra-familiar stressors.  Sufferers complain of a heavy feeling in the chest, perceived abdominal mass pushing up into the chest, sleeplessness, dizziness, headaches, indigestion, sexual dysfunction, intolerance to heat, dry mouth, hot and cold flushes and blurred vision.  They show evidence of anxiety, pervasive depression, obsessions and compulsions, anorexia and expressions of hatred, shame, paranoia, fearfulness, destructive impulses, irritability and absent mindedness.  Source 1. Source 2.
Koro (Malaysia)

Shuk yang or shook yong or suo yang (China)

Jinjinia bemar (Assam)

Rok-joo (Thailand)

 Koro is probably one of the better known of the culture-bound disorders.  The primary symptoms is that the penis (in males) or the vulva and breasts (in women) are receding into the body, possibly causing death.  It is more common in males, who will go to great lengths to stop this from happening.  Similar to dhat, or semen-loss syndrome, Koro is sometimes believed to be caused by inappropriate sex, such as masturbation or sex outside of marriage, which result in an imbalance of the male/female principle (yin and yang).  It may also be caused by outside causes - a recent rise in cases was caused by reports that eating pork from pigs inoculated against swine flu caused two cases of koro.  Source.

In other parts of the world, the belief may be that, rather than the genitals shrinking into the body, they are being stolen by supernatural methods.  In the Guangdong region in China, it is believed that a fox spirit can steal penises, while it is more likely to be ascribed to sorcerers or black magic in regions of Africa.  Often, those believed to be responsible are publicly accused. The theft is carried out when the sorcerer touches the affected person. The person may believe that, although his penis has been returned, it is smaller, malformed or the property of another person entirely. Koro: A Natural History of Penis Panic goes into great detail about the disorder around the world.

Koro sometimes seems to be spread socially and may be a kind of mass hysteria, causing widespread panics and concern, as well as a disorder of individuals.  Afflicted persons may resort to clamps, ties, pegs or hooks to keep the genitals from fully receding, sometimes resulting in damage to the organs.
Further information.
Latah (Malaysia)

Amurakh, irkunii, olan, myriachit or menkeiti (Siberian)

Bah tschi, bah-tsi or baah-ji (Thailand)

Imu (Ainu, Sakhalin, Japan)

Mali-mali or Silok (Phillipines)

Jumping (French-Canadian)

 Latah is an exaggerated startle response, typically found among women.  Being surprised may result in screaming, cursing, dancing and hysterical laughter that might last a half hour or more.  They may imitate the people around them or things they see or hear in the media.  Relatives and friends may provoke episodes for the entertainment value, but latah episodes can be very embarrassing in public.

Latah often occurs following a traumatic episode. Source.
Locura (Latin America, Latinos in US) A chronic state of severe psychosis, attributed to multiple life stressors, inherited vulnerability, or a combination of both.  Symptoms include agitation, incoherence, audio and visual hallucinations, inability to follow the rules of social interaction, unpredictability and possible violence.
Mal de ojo (Mediterranean) The "evil eye".  Children and infants are especially at risk.  With adults, women are more likely to be affected.  Symptoms include fitful sleep, crying without apparent cause, diarrhea, vomiting and fever.
Nervios (Latino societies) Refers both to a sense of vulnerability to stressful life experiences and the symptoms produced by that vulnerability.  The person may experience emotional distress, somatic complaints and inability to function.  Common symptoms are headaches, irritability, stomach disturbances, sleep difficulties, nervousness, inability to concentrate, easy tearfulness, trembling, tingling sensations and mareos (dizziness with vertigo-like sensations).
Pibloktoq (Inuit) Also known as Arctic hysteria, this often follows the loss or perceived loss of a valued person or object.  Symptoms include brooding, depressive silences, loss or disturbances of consciousness, seizure-like episodes, tearing off clothes, fleeing or wandering, rolling in snow, speaking in tongues or echolalia (echoing other people's words).
Qi-gong Psychotic Reaction (China) Qi-gong (exercise of vital energy) is a Chinese method of meditation, based on traditional Chinese medicine.  The best known in the West is Tai Chi, although there are around 2,200 methods in total.  The DSM IV and Chinese Classification of Mental Disorders define it as an acute, time-limited episode characterized by dissociative, paranoid and other psychotic and non-psychotic symptoms that occur after participation in Qigong.  An alternate name for the syndrome is Qigong Deviation Syndrome.  According to a recent study by Dr. Huaihai Shan, folk-beliefs attribute the condition to "adverse flow in the body," "uncontrollable behavior," "over-meditation" and "spirit possession".  Over a third of 129 respondents described sensory problems (32%), mood symptoms (90%) and behavioral problems (37%).  Other symptoms listed were memory problems (24%), attention difficulties (26%), thought disorders (18%) and disordered consciousness (2%).  Nearly all patients report "the Qi moving within the body, and dashing or rushing into the head."  Somatic symptoms may include headaches, dizziness or disorientation, and strange sensations in the lower abdomen (the Dan-Tian point).  They may demonstrate hypochondriasis, anxiety, sadness and feelings of being out of control.  In addition, they may experience visual and auditory hallucinations.  The symptoms occur after Qigong practice and may last two weeks to a month.

 
Rootwork (southern US, Caribbean)

Mal puesto or brujeria (Latino societies)

 The conviction that illnesses are brought about by supernatural means, such as witchcraft, voodoo, or evil influence.  Symptoms include anxiety, gastrointestinal complaints, and fear of being poisoned or killed.
Sangue dormido (Portuguese Cape Verde Islanders) "Sleeping blood," pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection and miscarriage
Shenjing Shuairuo (Chinese) This disorder is the equivalent of neurasthenia, a disorder no longer recognized by the DSM-IV.  It includes elements of depression and anxiety disorders, such as physical and mental fatigue, dizziness, headaches, gastrointestinal problems, difficulty concentrating, sleep disturbance, memory loss, sexual dysfunction, irritability and excitability.
Shin-byung (Korean) Anxiety and somatic complaints, such as general weakness, dizziness, fear, loss of appetite, insomnia and gastrointestinal problems, followed by dissociation and possession by ancestral spirits
Spell (Southern United States) Individuals communicate with deceased relatives or spirits.  They may show distinct personality changes.  Spell is not considered pathological in the culture of origin.
Susto (Latino societies) Literally "fright", this generally falls into either natural or supernatural origin.  Natural origins are cultural stressors, and are more likely to affect women than men.  Supernatural origins may be thought to have been sent by a sorcerer, and may be triggered by witnessing supernatural phenomenon such as ghosts.  Symptoms include nervousness, anorexia, insomnia, listlessness, fatigue, despondency, muscle tics and diarrhea.
Taijin kyofusho (Japan) A feeling of intense anxiety centered around the dread of hurting or offending others.  Taijin kyofusho is divided into four categories: sekimen-kyofu (phobia of blushing), shubo-kyofu (phobia of a deformed body), jikoshisen-kyofu (phobia of eye-to-eye contact), and jikoshu-kyofu (phobia of a foul body odor). Source.
Zar (North African and Middle Eastern societies) Those affected believe they are possessed by a spirit, and may experience dissociative episodes when they shout, laugh, weep, sing or hit their heads on the wall.  They may also become apathetic, withdrawn and unable to carry out daily tasks.  Some develop a relationship with the possessing spirit.  It may not be considered pathological.

 

The following syndromes are not in the DSM-IV-TR but meet the definition of Culture-Bound Syndromes:

Aiyiperi (Yoruba) Hysterical convulsive disorder, posturing and tics, psychomotor seizures.  Source.
Amafufunyana (Zulu and Xhosa of South Africa) This occurs when people believe they have been invaded and possessed by evil spirits as a result of witchcraft.  Afflicted people may claim to hear voices speaking different languages than their own coming from their stomach area, fatigue, loss of appetite, uncontrollable anger, sleep difficulties and disturbing dreams.  The voices may be threatening or taunting.  Patients may have bouts of extreme agitation, when they break objects or attack people.  Some people attempt suicide or experience command hallucinations.  They may speak in voices other than their own, and believe it is the voice of the spirit.

Although the symptoms sound very much like a psychotic episode, Amafufunyana also occurs during episodes of mass phenomenon.  From 1981-1983, over 400 children in a junior secondary school in Transkei complained of the symptoms following complaints of stomach pains.  It was claimed that the voices, speaking in Zulu (it is a Xhosa speaking in area), could be heard when the children's stomachs were squeezed. Source.

Anfechtung (Hutterites in Manitoba, Canda) Withdrawal from social contact, feelings of having sinned, feelings of religious unworthiness, temptation to commit suicide.  Source.
Ashanti Psychosis (Africa) Individual becomes frightened and frenzied, believing they are being punished for some offense.  They may believe they are witches and harming others without conscious intent - this may follow a difficult childbirth, the death or illness of an infant, or a physical illness with fever.  The person may become withdrawn, hallucinate, dance and sing, tear at clothing and eat feces.
Gururumba (New Guinea) The 'wild man' syndrome.  Individual is usually male and married, and begins by burglarizing homes for minor items, which they believe to be valuable.  He becomes hyperactive and clumsy, and may have speech and hearing disturbances; he then runs into the forest.  After some days, he returns without the items.  Typically, he will not remember what he did during the episode.
Hikikomori (Japan) Typically occurring in teens and young adults, hikikomori refers to the withdrawal from society, seeking extreme degrees of isolation and confinement.  The Japanese Ministry of Health defines Hikikomori  as a person who remains isolated in his parent's home, usually staying isolated in one room, for at least six months, although it may last for years.  It often begins as a refusal to go to school.  It is most common in eldest sons.  This article goes into some depth about the syndrome.  Possible contributing factors include highly stressful and demanding school environments, an unstable job market, economic uncertainty, and intense pressure to conform to a narrow set of standards.
People with hikikomori often spend time with pornography, watching TV, playing computer or console games or using the internet.  They may lose social skills, and become obsessed with manga, television or games.  They may eventually disintegrate far enough that they simply sit and stare at the wall for hours at a time.  He may become violent towards family members, particularly in response to pressure to come out of isolation.  It is considered an embarrassment to the family, and there might be a long delay between the onset of symptoms and the time help is sought.  Although it is unlikely that the person will become violent outside of the home, Sakakibara and Nevada-tan, children who killed their peers, demonstrated many of the symptoms of Hikikomori.
Hmong Sudden Death Syndrome (Laos)
Bangungut (Oriental Nightmare Death)
Voodoo Death		 The person dies in his or her sleep, as a result of being attacked by spirits in a dream.  Belief in this most often occurs in people who have been subjected to trauma.
Izizwe (Zulu) This is a Zulu possession trance state, where those afflicted experience severe shaking and speaking in strange languages, and show signs of another identity.  Source.
Old Hag Syndrome This is actually fairly common across a multitude of cultures.  A type of sleep paralysis, the hag is believed to be a witch or other type of supernatural being which comes and sits on a person's chest as he slept.  The person experiences an inability to move, feelings of pressure on the chest, and difficulty breathing. They may see red eyes or feel feet or fingers.  They may also hear the hag breathing.  Visitations from the hag tend to cross multiple generations in a family.

It is not generally considered pathological. Sleep paralysis is a common sleep disturbance, although it is less common for people to experience the sensation of the "old hag".  A modern version of the old hag may be found in some alien abduction stories, which feature the same general themes.

Shamanic Initiatory Illnesses

Intwaso (Xhosa, Zulu)

 Shamanic initiatory illnesses, may not be considered pathological in the culture of origin.

In the Saora tribe in India, young men and women in their teens and young adulthood may begin to cry at inappropriate times, have memory loss, pass out and claim to have the sensation of being repeatedly bitten by ants when no ants are present.  Typically, the individuals are under considerable social pressure at the time.  The symptoms are believed to be caused by supernatural beings who want to marry them.  After the marriage is done, the person becomes a shamanic healer.  Source.

Intwaso: The debilitating symptoms are seen as a calling to becoming a shamanic healer.  If the calling is not heeded, the illness is unlikely to be cured, and may die.  The only cure is to progress through training in the importance of dreams, entering altered states of consciousness, performance of rituals and using extra sensory-perception.  More details are available here.  Similar disorders occur around the world.
Jerusalem Syndrome This is an interesting phenomenon in which people who are mentally healthy prior to visiting Jerusalem experience religiously themed obsessive ideas, delusions or other psychosis-like experiences upon visiting.  The themes are intensely religious and typically resolve within a few weeks or leaving the area.  Similar syndromes exist in places such as Mecca and Rome.  This phenomena was well known in the Middle Ages, and continues to take place in modern times.  More details on the types of Jerusalem Syndrome are here.
Shinkeishitsu (Japan) Fear of meeting people, feelings of inadequacy, anxiety, obsessive-compulsive symptoms and hypochondriasis.
Stendahl Syndrome Similar to Jerusalem Syndrome, Stendahl Syndrome is triggered by exposure to great artistic masterpieces.  This is best known in Florence, Italy, where the Santa Maria Nuova Hospital receives patients suffering the symptoms at least once a month.  Symptoms include rapid heartbeat, dizziness, fainting, confusion and hallucinations.
Wacinko (Oglala Sioux) Often a reaction to disappointment or interpersonal problems, this is an episode of anger, withdrawal, mutism and immobility.  It frequently leads to attempted suicide.
P'a Leng (Wind Illness) (China) Fear that wind or cold will result in a loss of yang and imbalance of the body.  The person becomes obsessed with being warm.
Windigo Psychosis (Native American) The Windigo is a figure in Northern Algonquin mythology, a fierce supernatural cannibal able to infect humans and make them into cannibalistic creatures by turning their hearts into ice.  Windigo Psychosis occurs when a person becomes filled with anxiety that they are becoming a Windigo, and may increasingly view those around them as edible.  The person also complains of poor appetite, nausea and vomiting, and may become suicidal or homicidal.  Source 1. Source 2.