Culture may provide coping strategies that enhance resilience in response to illness, or sug- gest help seeking and options for accessing health care of various types, including alterna- tive and complementary health systems. Culture may inﬂuence acceptance or rejection of a diagnosis and adherence to treatments, affecting the course of illness and recovery. Culture also affects the conduct of the clinical encounter; as a result, cultural differences between the clinician and the patient have implications for the accuracy and acceptance of diagnosis as well as for treatment decisions, prognostic considerations, and clinical outcomes.
Historically, the construct of the culture-bound syndrome has been a key interest of cultural psychiatry. In DSM-5, this construct has been replaced by three concepts that offer greater clinical utility: 1. Cultural syndrome is a cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context (e.g., ataque de nervios). The syndrome may or may not be recognized as an illness within the culture (e.g., it might be labeled in various ways), but such cultural patterns of distress and features of illness may nevertheless be recognizable by an outside observer.
2. Cultural idiom of distress is a linguistic term, phrase, or way of talking about suffering among individuals of a cultural group (e.g., similar ethnicity and religion) referring to shared concepts of pathology and ways of expressing, communicating, or naming es- sential features of distress (e.g., kufungisisa). An idiom of distress need not be associated with specific symptoms, syndromes, or perceived causes. It may be used to convey a wide range of discomfort, including everyday experiences, subclinical conditions, or suffering due to social circumstances rather than mental disorders. For example, most cultures have common bodily idioms of distress used to express a wide range of suf- fering and concerns.
3. Cultural explanation or perceived cause is a label, attribution, or feature of an explanatory model that provides a culturally conceived etiology or cause for symptoms, illness, or distress (e.g., maladi moun). Causal explanations may be salient features of folk classi- fications of disease used by laypersons or healers.
These three concepts (for which discussion and examples are provided in Section III and the Appendix) suggest cultural ways of understanding and describing illness experi- ences that can be elicited in the clinical encounter. They inﬂuence symptomatology, help seeking, clinical presentations, expectations of treatment, illness adaptation, and treat- ment response. The same cultural term often serves more than one of these functions.
Sex and gender differences as they relate to the causes and expression of medical conditions are established for a number of diseases, including selected mental disorders. Revisions to
DSM—S included review of potential differences between men and women in the expression of mental illness. In terms of nomenclature, sex d(fierences are variations attributable to an individual’s reproductive organs and XX or XY chromosomal complement. Gender diﬂer— ences are variations that result from biological sex as well as an individual’s self—represen- tation that includes the psychological, behavioral, and social consequences of one’s perceived gender. The term gender dz'fi’erences is used in DSM-S because, more commonly, the differences between men and women are a result of both biological sex and individual self-representation. However, some of the differences are based on only biological sex.