Three syndromic types of susto (referred to as cibih in the local Zapotec language) have been identified, each having different relationships with psychiatric diagnoses. An interper- sonal susto characterized by feelings of loss, abandonment, and not being loved by family, with accompanying symptoms of sadness, poor self-image, and suicidal ideation, seemed to be closely related to major depressive disorder. When susto resulted from a traumatic event that played a major role in shaping symptoms and in emotional processing of the experience, the diagnosis of posttraumatic stress disorder appeared more appropriate. Susto character- ized by various recurrent somatic symptoms—for which the person sought health care from several practitioners—was thought to resemble a somatic symptom disorder.
Related conditions in other cultural contexts: Similar etiological concepts and symp- tom configurations are found globally. In the Andean region, susto is referred to as espunto.
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Related conditions in DSM-S: Major depressive disorder, posttraumatic stress disor- der, other specified or unspecified trauma and stressor-related disorder, somatic symp- tom disorders.
Taijin kyofusho (”interpersonal fear disorder” in Japanese) is a cultural syndrome charac- terized by anxiety about and avoidance of interpersonal situations due to the thought, feel- ing, or conviction that one’s appearance and actions in social interactions are inadequate or offensive to others. In the United States, the variant involves having an offensive body odor and is termed olfactory reference syndrome. Individuals with tazjin kyofusho tend to focus on the impact of their symptoms and behaviors on others. Variants include major concerns about facial blushing (erythrophobia), having an offensive body odor (olfactory reference syndrome), inappropriate gaze (too much or too little eye contact), stiff or awkward facial expression or bodily movements (e.g., stiffening, trembling), or body deformity.
Taijin kyofusho is a broader construct than social anxiety disorder in DSM-S. In addition to performance anxiety, tuijin kyofusho includes two culture-related forms: a ”sensitive type,” with extreme social sensitivity and anxiety about interpersonal interactions, and an ”of- fensive type,” in which the major concern is offending others. As a category, tuijin kyofusho thus includes syndromes with features of body dysmorphic disorder as well as delusional disorder. Concerns may have a delusional quality, responding poorly to simple reassurance or counterexample.
The distinctive symptoms of tuijin kyofusho occur in specific cultural contexts and, to some extent, with more severe social anxiety across cultures. Similar syndromes are found in Korea and other societies that place a strong emphasis on the self-conscious mainte- nance of appropriate social behavior in hierarchical interpersonal relationships. Taijin kyo— fusho—like symptoms have also been described in other cultural contexts, including the
United States, Australia, and New Zealand.
Related conditions in other cultural contexts: Tuein kong pa in Korea.
Related conditions in DSM-S: Social anxiety disorder, body dysmorphic disorder, de- lusional disorder, obsessive-compulsive disorder, olfactory reference syndrome (a type of other specified obsessive-compulsive and related disorder). Olfactory reference syndrome is related specifically to the jikoshu-kyofu variant of taijin kyofusho, whose core symptom is the concern that the person emits an offensive body odor. This presentation is seen in var— ious cultures outside Japan.
ICD-9-CM codes are to be used for coding purposes in the United States through
September 30, 2014. ICD—lO-CM codes are to be used starting October 1, 2014.
lCD-9-CM |CD-10-CM Disorder, condition, or problem
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