The clinical characteristics of possession disorder among 20 Chinese patients in the Hebei province of China.

OBJECTIVE: This paper describes the clinical characteristics of 20 hospitalized psychiatric patients in the Hebei province of China who believed they were possessed. METHODS: A structured interview focused on clinical characteristics associated with possession phenomena was developed and administered to 20 patients at eight hospitals in the province. All patients had been given the Chinese diagnosis of yi-ping (hysteria) by Chinese physicians before being recruited for the study. RESULTS: The subjects' mean age was 37 years. Most were women from rural areas with little education. Major events reported to precede possession included interpersonal conflicts, subjectively meaningful circumstances, illness, and death of an individual or dreaming of a deceased individual. Possessing agents were thought to be spirits of deceased individuals, deities, animals, and devils. Twenty percent of subjects reported multiple possessions. The initial experience of possession typically came on acutely and often became a chronic relapsing illness. Almost all subjects manifested the two symptoms of loss of control over their actions and acting differently. They frequently showed loss of awareness of surroundings, loss of personal identity, inability to distinguish reality from fantasy, change in tone of voice, and loss of perceived sensitivity to pain. CONCLUSIONS: Preliminary findings indicate that the disorder is a syndrome with distinct clinical characteristics that adheres most closely to the DSM-IV diagnosis of dissociative trance disorder under the category of dissociative disorder not otherwise specified.

Suicide among immigrants from the Indian subcontinent: a review.

OBJECTIVE: Studies of suicide among immigrants from the Indian subcontinent (India, Pakistan, Bangladesh, and Sri Lanka) were examined to increase awareness of suicide risk and to better understand social and psychological factors contributing to suicide in this group. METHODS: An online search was conducted of MEDLINE for the years 1966 to 1994 and Psychological Abstracts for the years 1974 to 1994, and all references on completed suicides in the target population were selected for review. RESULTS: Suicide rates of young women immigrants from the Indian subcontinent are consistently higher than those of their male counterparts and of young women in the indigenous populations of the countries to which they immigrate. Suicide rates among older men in this immigrant group have been reported to be low, although reports are less consistent. Use of violent methods such as hanging, burning, and poisoning is common among both men and women. A disproportionately higher number of immigrant Hindus commit suicide. Family conflict appears to be a precipitating factor in many suicides, whereas mental illness is rarely cited as a cause. Depression, anxiety, and domestic violence may contribute to the high rates. Affective disorders may be underdiagnosed in this population. CONCLUSIONS: More research is needed on the epidemiology of psychiatric illnesses and their contribution to suicide in this group.

Culture-bound syndromes.

Since its inception, scholars have struggled with the concept of CBSs. This struggle is reflected in the continuing use of a term that is confusing and inaccurate. Most authors would agree that the term "culture-bound syndrome" was intended to describe forms of otherwise common mental illness that are rendered unusual because of the pathoplastic influence of culture. It was intended not only to describe specific syndromes, but also meanings of illness and non-Western notions of disease causation. The term has become an anachronism, for the word, "syndrome," implies specific disease entities, not illnesses of attribution of idioms of distress. Furthermore, the word "bound" implies that the entities described are restricted to a single culture. Close examination reveals that many of the so-called "culture-bound" syndromes are found in multiple cultures that have in common only that they are "non-Western." It may be unreasonable to expect one term to describe these different concepts. The most accurate of the designations offered might be "folk diagnostic categories." Perhaps the most difficult question remaining is "How can we understand (and classify) these phenomena in such a way that highlights their uniqueness but does not dismiss them as too rare and exotic to warrant attention?" The first step is to recognize that the CBSs are a heterogeneous group of conditions. We must next acknowledge that the concepts represented may be difficult for the average Western clinician to recognize but, in their respective cultures, are neither rare nor unusual. With 80% of our increasingly shrinking world coming from "non-Western" cultures, a familiarity with non-Western notions of disease causation is particularly important for modern clinicians. Many authors have recommended that those CBSs that are "true" syndromes be classified together with their Western counterparts. In order to do this, the folk labels need to be put aside and the fundamental components of each disorder examined. Each entity would have to be placed in the body of the classificatory manual, and defined by its symptoms, not by the fact that its form is highly influenced by culture.(ABSTRACT TRUNCATED AT 400 WORDS)

Classification of amok in DSM-IV.

Culture-bound syndromes have been described worldwide in many individuals and, for certain syndromes, in epidemic proportion, yet these disorders have been classified as rare and exotic conditions warranting minimal attention. Development of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and the tenth edition of the International Classification of Diseases offers an opportunity for providing a more sophisticated classification of these phenomena. The authors examine amok, a syndrome first described in Malaysia that consists of homicidal frenzy preceded by a state of brooding and ending with somnolence and amnesia. They discuss the concept of and criteria for a culture-specific disorder and propose that amok be classified as a culture-specific explosive behavioral disorder in DSM-IV.

Koro: proposed classification for DSM-IV.

Koro, a culture-specific disorder consisting of complaints of genital retraction and fear of death associated with genital retraction, has been recognized in Asian cultures in single cases and in epidemic proportions. Koro has been described in non-Asian patients as well, leading to debate concerning the true nature of the syndrome. The authors review past attempts to define and classify koro and present a classification for DSM-IV that they believe could be used to classify other culture-bound syndromes as well.

Efficacy of acupuncture on osteoarthritic pain. A controlled, double-blind study.

Forty patients, randomly assigned to an experimental and a control group, participated in a double-blind study to assess the effectiveness of acupuncture in reducing chronic pain associated with osteoarthritis. The experimental group received treatment at standard acupuncture points, and the control group at placebo points. Analysis before and after treatment showed a significant (P less than 0.05) improvement in tenderness and subjective report of pain in both groups as evaluated by two independent observers and in activity by one observer. Comparison of responses to treatment between the two groups showed no significant (P greater than 0.05) difference. Thus, both experimental and control groups showed a reduction in pain after the treatments. These results may reflect the natural course of illness, and various attitudinal and social factors.