Cultural Factors in Anxiety Disorder

Anxiety Disorders.

Cultural differences in the expression of anxiety have been documented. For instance, although posttraumatic stress disorder (PTSD) can be diagnosed in American populations and Southeast Asian refugees, clinicians and researchers have found higher levels of dissociation among Southeast Asian refugees with PTSD. This may be due to the greater cultural acceptance of dissociative states in Southeast Asian culture. Similarly, among many African-American populations, isolated sleep paralysis is associated with anxiety.

In some cases, these cultural expressions of anxiety were misinterpreted as psychotic symptoms and diagnosed as such. Most studies have focused on the way culture influences the causes and content of anxiety, which may be related to specific cultural norms and values. For instance, the emphasis on interpersonal harmony and appropriate social behavior in many Asian cultures may result in distinct social triggers of anxiety. In Japan, allocentricism, issues of amae (i.e., dependence), the denial of the self, and the importance of harmonious interpersonal relationships result in the existence of ‘‘taijin kyofusho.’’ ‘‘Taijin kyofusho’’ is marked by fear that one’s body is displeasing or offensive to others, fear of eye-to-eye confrontation, fear of giving off an offensive odor, and fear of having unpleasant facial expressions. Although ‘‘taijin kyofusho’’ has been compared to social phobia in the United States, the two disorders involve considerably different fears. Whereas social phobia is a fear of strangers and people, ‘‘taijin kyofusho’’ is a fear that one might not be acceptable to others. Moreover, many of the fears of social phobics are different from those harbored by sufferers of ‘‘taijin kyofusho’’.

Cultural differences also occur in the content of specific obsessions and compulsions. For example, in many cultural contexts, the content of obsessions and compulsions is related to the dominant religion. Substance Abuse and Dependence.Almost no studies have examined how the expression of alcoholism and other forms of substance abuse vary across cultures. Studies are needed to fill this gap in the literature. In summary, cultural values and beliefs, views of emotion, concerns about social relationships, and religious traditions appear to influence the expression of symptoms associated with major mental disorders.