Ataque de nervios ("attack of nerves”) is a syndrome among individuals of Latino descent, characterized by symptoms of intense emotional upset, including acute anxiety, anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive. Dissociative experi- ences (e.g., depersonalization, derealization, amnesia), seizure—like or fainting episodes, and suicidal gestures are prominent in some ataques but absent in others. A general feature of an ataque de nervios is a sense of being out of control. Attacks frequently occur as a direct result of a stressful event relating to the family, such as news of the death of a close relative, con- ﬂicts with a spouse or children, or witnessing an accident involving a family member. For a minority of individuals, no particular social event triggers their atuques; instead, their vul- nerability to losing control comes from the accumulated experience of suffering.
order, although several disorders, including panic disorder, other specified or unspecified dis- sociative disorder, and conversion disorder, have symptomatic overlap with atuque.
In community samples, ataque is associated with suicidal ideation, disability, and out- patient psychiatric utilization, after adjustment for psychiatric diagnoses, traumatic expo- sure, and other covariates. However, some atuques represent normative expressions of acute distress (e.g., at a funeral) without clinical sequelae. The term utaque de nervios may also refer to an idiom of distress that includes any ”fit”-like paroxysm of emotionality (e.g., hysterical laughing) and may be used to indicate an episode of loss of control in response to an intense stressor.
Related conditions in other cultural contexts: Indisposition in Haiti, blacking out in the Southern United States, and falling out in the West Indies.
Related conditions in DSM-S: Panic attack, panic disorder, other specified or unspec- ified dissociative disorder, conversion (functional neurologic symptom) disorder, inter- mittent explosive disorder, other specified or unspecified anxiety disorder, other specified or unspecified trauma and stressor-related disorder.
Dhat syndrome is a term that was coined in South Asia little more than half a century ago to account for common clinical presentations of young male patients who attributed their various symptoms to semen loss. Despite the name, it is not a discrete syndrome but rather a cultural explanation of distress for patients who refer to diverse symptoms, such as anx- iety, fatigue, weakness, weight loss, impotence, other multiple somatic complaints, and depressive mood. The cardinal feature is anxiety and distress about the loss of dhat in the absence of any identifiable physiological dysfunction. Dhat was identified by patients as a white discharge that was noted on defecation or urination. Ideas about this substance are related to the concept of dhatu (semen) described in the Hindu system of medicine,
Ayurveda, as one of seven essential bodily ﬂuids whose balance is necessary to maintain health.
834 Glossary of Cultural Concepts of Distress
Although dhat syndrome was formulated as a cultural guide to local clinical practice, related ideas about the harmful effects of semen loss have been shown to be widespread in the general population, suggesting a cultural disposition for explaining health problems and symptoms with reference to dhat syndrome. Research in health care settings has yielded diverse estimates of the syndrome’s prevalence (e.g., 64% of men attending psychiatric clinics in India for sexual complaints; 30% of men attending general medical clinics in Pakistan). Although dhat syndrome is most commonly identified with young men from lower socioeconomic backgrounds, mid- dle-aged men may also be affected. Comparable concerns about white vaginal discharge (leu— korrhea) have been associated with a variant of the concept for women.