The cross-cultural and transdiagnostic nature of unwanted mental intrusions / Expresión transcultural y naturaleza transdiagnóstica de las intrusiones mentales no deseadas

Background/Objective: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. Method: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. Results: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. Conclusions: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders

Introducción/Objetivo: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. Método: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. Resultados: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. Conclusiones: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos

Hypochondria as withdrawal and comedy as cure in Dr. Willibald's Der Hypochondrist (1824).

Balthasar von Ammann's comedy Der Hypochondrist, published in 1824 under the pseudonym Dr. Willibald, foregrounds the social, sexual, and political implications of hypochondria. The play engages with early nineteenth-century medical and popular conceptions of hypochondria to co-opt potentially subversive elements and to promote a specific social, sexual, and political agenda. The text promotes literature ­ specifically comedic drama ­ as a cure for hypochondria. Hypochondria functions as a code for withdrawal. The hypochondriac withdraws medically from healthy society, gaining exceptional status. He withdraws sexually from society by remaining a bachelor, possibly engaged in non-normative sexual behaviour. Furthermore, the politically disenfranchised protagonist voices his political frustrations via a coded medical metaphor. The hypochondriac poses a threefold challenge to the social, sexual, and political order, and the play engages with contemporary conceptions of the disease to provide the solution: comedy. The text, presented as a cure for hypochondria, replaces the coded questioning of the social order via hypochondria with the less threatening code of heraldry. A comedy-within-the-comedy uses the hypochondriac's love of heraldry to cure him, resulting in the elimination of his medical problems and exceptional status, in the purification of his bachelorhood from non-normative elements, and in the pre-emption of political frustrations.

Influence of cultural and social factors on the epidemiology of idiopathic somatic complaints and syndromes.

OBJECTIVE: To review international research on somatic presentations often seen together with or attributed to psychopathology. For conceptual clarity, we refer to these presentations as "idiopathic somatic complaints and syndromes" (ISCS). This review will also pose specific questions on cultural issues affecting these somatic manifestations. METHOD: Selective review of the international literature dealing with the phenomenology, epidemiology, and cultural profile of ISCS focusing on papers published in refereed journals and written in English. RESULTS: Major problems with much of the previous research in this area are the use of different definitions and ascertainment procedures. As currently conceptualized in the literature, ISCS are universal and seem closely related to psychological issues (stress) and psychopathological conditions such as depression worldwide. Although there are many similarities regarding the form and content of these somatic presentations across cultures, there is some evidence for cultural patterning of symptoms. Unfortunately, current classifications for ISCS are unsatisfactory. CONCLUSIONS: We outline specific recommendations for conducting future research and for improving the classification of ISCS of presumed psychological origin or import in future nosologies.

A systematic review of the epidemiology of somatisation disorder and hypochondriasis.

BACKGROUND: This paper reviews current knowledge regarding the prevalence and associated features of somatisation disorder and hypochondriasis in population-based and primary care samples. METHOD: A systematic review of the literature, which used a standardised definition of somatisation disorder or hypochondriasis and which examined the characteristics and associated features of these disorders in population-based samples or primary care settings. RESULTS: In population-based studies the prevalence of somatisation disorder and hypochondriasis was too low to examine associated features reliably. In studies using abridged criteria, a clear female predominance was not found in either disorder; there was a consistent relationship with few years of education. There was a close relationship with anxiety and depressive disorders, with a linear relationship between numbers of somatic and other symptoms of distress in several studies, including longitudinal studies. No studies showed that these symptom clusters fulfil the criteria of characteristic onset, course and prognosis required to merit the status of discrete psychiatric disorders. CONCLUSIONS: On existing evidence, somatisation disorder and hypochondriasis cannot be regarded as definite psychiatric disorders. There is some evidence that numerous somatic symptoms or illness worry may be associated with impairment and high health care utilisation in a way that cannot be solely explained by concurrent anxiety and depression, but further research using population-based samples is required.

Culture-bound syndromes: the story of dhat syndrome.

BACKGROUND: Culture-bound syndrome is a term used to describe the uniqueness of some syndromes in specific cultures. Dhat (semen-loss anxiety) has been considered to be an exotic 'neurosis of the Orient'. AIMS: To ascertain the presence of similar symptoms and syndromes in different cultures and historical settings. METHOD: Electronic and manual literature searches were used to gather information on the existence and description of semen-loss anxiety in different cultures and settings. RESULTS: Most of the empirical studies on dhat syndrome have emerged from Asia, whereas its concepts have been described historically in other cultures, including Britain, the USA and Australia. The different sources indicate the universality of symptoms and global prevalence of this condition, despite its image as a 'neurosis of the Orient'. CONCLUSIONS: It appears that dhat (semen-loss anxiety) is not as culture-bound as previously thought. We propose that the concept of culture-bound syndromes should be modified in line with DSM-IV recommendations.

Somatization as a core symptom of melancholic type depression. Evidence from a cross-cultural study.

The study questions whether different types of somatization may be a core symptom of melancholia, thus, being invariable across cultures and being a candidate for neurobiological research and diagnostic criteria. 51 Turkish patients and 51 education-matched German patients with melancholic depression were compared for two types of somatization. Turkish patients had higher frequencies of somatic preoccupation and hypochondriasis but they were not different in the perception and experience of somatic symptoms. It is concluded that: (1) somatization has to be differentiated psychopathologically; (2) it may be a neurobiological core symptom of melancholia in the well-defined sense of 'perceiving abnormal somatic symptoms'; and (3) it may be a culture-bound symptom in the sense of 'being abnormally concerned with somatic symptoms or hypochondrial fears'.

[Relevance of ethnic discrimination in psychiatric diseases]. / Zur Relevanz ethnischer Diskriminierung bei psychiatrischen Erkrankungen.

Ethnic discrimination represents a social and psychological reality. As can be shown by case-material, it affects in a way specific for the individual developmental processes and psychic well-being. Referring to Goffman's concept of social identity the psychological impact of ethnic discrimination is described in psychiatric patients. Finally therapeutic and preventive implications are outlined.

Symptoms and social adjustment in Jewish depressives.

In 25 Jewish and 26 non-Jewish depressives resident in Hackney, the PSE revealed that 'hypochondriasis' and 'tension' were more common in the Jewish group, and special features of depression, containing symptoms connected with guilt, was less common. These differences could not be explained by variation in severity of illness as both groups had similar scores on the HRSD. The 'social maladjustment' scores were similar, very probably reflecting an elderly, deprived, inner-city population.