  The other approach to cultural variation, as mentioned, is to treat different diagnoses as manifestations of the same underlying DSM condition. The issue is how different a diagnosis needs to be before it stops being a form of a DSM condition and becomes a culture-bound syndrome. It has been suggested that anxiety disorders, for example, should have their “worry domains” expanded because people from other cultures may worry about things that Euro-Americans don’t fret over (Lewis-Fernandez et al 2010). The assumption here is that anxiety disorders are common enough in all human cultures to merit treating as a universal, but that this can be missed if clinicians do not appreciate the different triggers, reactions and conceptions that distinguish the anxiety disorders in different populations. We need to recognise the greater variety of symptoms among sufferers from anxiety who live in Western cultures but don’t show the typical symptoms of a Westerner. Lewis-Fernandez and his team (2010) argue that a majority of Latino sufferers from ataque de nervios would meet panic disorder criteria, for example, if the DSM amended the requirement that a panic attack lasts only a few minutes. Ataque de nervios was listed as a culture-bound syndrome in DSM-IV-TR. Its symptoms commonly include a mix of classic panic attack symptoms like palpitations and sensations of bodily heat and loss of control. But it may also involve uncontrollable shouting and threats of violence, together with other symptoms less often found in panic attacks, and it may last much loner. Lewis-Fernandez is interested in the idea that ataque de nervios can be assimilated to existing anxiety diagnoses provided we take the variation in symptomatology more seriously.