Module 9: Mood Disorders

Cultural Concepts of Distress

Individuals belonging to different cultural groups and subgroups experience, understand, and express mental distress and behavioral problems in unique ways.

These groups of symptoms do not clearly map to the mental disorders and problems described in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Once referred to as “culture-bound syndromes,” these culturally rooted groups of symptoms are now known as “cultural concepts of distress.”1

Cultural concepts of distress comprise three areas:2

  1. Cultural syndromes: Clusters of symptoms that tend to co-occur in certain cultural groups, communities, or contexts
  2. Cultural idioms of distress: Ways of communicating emotional suffering that do not refer to specific disorders or symptoms, yet provide a way to talk about personal or social concerns. Frequently these manifest as physical symptoms (somatization).
  3. Cultural explanations: Symptoms, illness, or distress are perceived by a culture as having specific, local origins or causes

Why is it important to understand cultural concepts?1

  1. Understanding that some mental distress may have unique presentations that are cultural in origin can assist with mental health screening and help avoid misdiagnosis.
  2. Cultural understanding of these symptoms can help build a therapeutic alliance with a patient.
  3. While cultural concepts of distress alone do not indicate the presence of a diagnosable mental disorder, they do indicate vulnerable individuals or populations that could benefit from mental health promotion initiatives and other public health activities.

Specific Cultural Concepts of Distress 2, 3

Ataque de nervios (“attack of nerves”)
Cultural prevalence: Latino, especially women from the Caribbean
Symptoms: Screaming uncontrollably, attacks of crying, trembling, and verbal or physical aggression; fainting or seizure-like episodes and occasionally suicidal gestures
Related DSM disorder: Panic attack, panic disorder

Taijin kyofusho
Cultural prevalence: Japanese
Symptoms: Avoiding interpersonal situations due to intense fear that one’s appearance or actions give offense to others. “Sensitive type” relates to anxiety about interpersonal interactions, while “offensive type” relates to concern about offending others.
Related DSM disorder: Social anxiety disorder and obsessive-compulsive disorder

Hwa-byung (“fire and anger disease”)
Cultural prevalence: Korean and Korean American
Symptoms: A wide variety of physical and emotional symptoms, which patients attribute to physical causes, while they consciously ignore the mental aspects of their situation (e.g., anger).

See the DSM-5 for detailed descriptions of cultural concepts of distress. Additionally, within the DSM-5’s diagnostic classifications, where appropriate, related cultural concepts of distress are indicated.


  1. Kohrt, B.A., Rasmussen A., Kaiser, B.N., Haroz, E.E., Maharjan, S.M., Mutamba, B.B., de Jong, J.T.V.M., & Hinton, D.E. (2013). Cultural concepts of distress and psychiatric disorders: Literature review and research recommendations for global mental health epidemiology. International journal of epidemiology. 43(2): 365-406. doi: 10.1093/ije/dyt227
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. Jacob, J., Gray, B., & Johnson, A. (2013). The Asian American family and mental health: Implications for child health professionals. Journal of pediatric health care, 27(3), 180-188.

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