Anxiety Disorders
The effect of culture on anxiety is similar to that
on depression, especially since cross-cultural studies have shown a marked
ten-dency for anxiety and depression to overlap (American Psychi-atric
Association, 1994). Cultural factors affect the precipitants, symptom
presentations, pathological thresholds and specific syndrome criteria of the
anxiety disorders (Good and Kleinman, 1985). For example, the cross-cultural
validity of criterion A for the Diagnostic
and Statistical Manual of Mental Disorders, Third Edition, Revised
(DSM-III-R) generalized anxiety disor-der (GAD) has been challenged because it
restricts the diagnosis of chronic pathological anxiety to a disturbance
stemming from undue worry in the absence of actual stressors or excessive worry
after minor stress. This leaves out the much larger group of pa-tients in
developing societies and devalued minorities in the West who experience chronic
pathological anxiety as a result of recur-rent stress (Lewis-Fernández and
Kleinman, 1995).
Cultural and ethnic elements have been invoked to
explain local differences in anxiety disorder prevalence that persist af-ter
controlling for other social factors. For example, the higher rate of simple
phobia social phobia and agoraphobia among the African-Americans, as compared
with whites (Neal and Turner, 1991), has been attributed to the stress
resulting from racial dis-crimination (Brown et al., 1990). In fact, the cross-cultural epi-demiological
literature reveals a complex pattern of similarities and differences with
regard to the anxiety disorders, and opin-ions differ as to the role of culture
in this process (Guarnaccia and Kirmayer, in press). For example, it is
presently unclear why the Mexicans born in Mexico, when compared with those
born in the USA, show a markedly lower rate of anxiety and other disorders.
Suggested explanations include selective migrations, different thresholds for
perceiving and reporting a disorder stem-ming from distinct cultural
interpretations of what constitutes a “hard life’’ and acceptable suffering,
and a combination of both explanations (Shrout et al., 1992).
Multiple cross-cultural studies point to the
coappearance of anxiety, depression, somatoform complaints and dissociative
symptoms among the nonWestern groups. A markedly somatic idiom predominates,
often in the form of culturally specific symp-toms (Ebigbo, 1982). These often
coalesce distinctively as cul-ture-bound syndromes characterized also by
specific etiological factors, demographics, patterns of impairment and
help-seek-ing choices (Hughes et al.,
in press). It is far from clear that this represents the comorbidity of the
Western disorders rather than a different organization of pathological
experience (Maser and Dinges, 1992). Examples include ataque de nervios among the Latinos, koro in the Asian communities and taijin kyofusho among the Japanese (Guarnaccia and Kirmayer, in
press). Each of these disorders exhibits significant differences that prevent
simple one-to-one correlations with the established Western cat-egories (Weiss,
1996).
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