Culture, distress and diagnosis

Watch the video and read the text: what ideas are new or fresh?

It is important to understand how distress and disorder may manifest differently in different cultures. In this animation, the term ‘cultural concepts of distress’ is introduced. The use of cultural concepts of distress within diagnostic manuals is highlighted.

Somatic symptoms and responses to distress and trauma

Evidence has shown that the construct of PTSD as a distinct disorder is valid across many cultures (Foa et al., 2009). However, the cultural context invariably shapes people’s experiences of, responses to, and recovery from traumatic stressors. In their review of the cross-cultural validity of PTSD, Hinton and Lewis-Fernández (2011) highlight that certain clusters of PTSD symptoms are more commonly reported in certain cultures than others. For example avoidance and/or numbing symptoms, or somatic symptoms. However, the DSM-5 criteria for PTSD do not include many somatic symptoms (Regier et al, 2013). Individuals from populations where somatic symptoms are more common following exposure to trauma may, therefore, be less likely to be diagnosed with PTSD and, as a result, less likely to receive the support they need. Examples of somatic symptoms that have been linked to responses to trauma from across the globe are highlighted in the table.


Somatic Symptoms Commonly Experienced in response to Trauma

Refugees from El Salvador

‘A sense of bodily heat’ (Jenkins & Valiente, 1994)

Refugees Exposed to Torture from Bhutan

‘Somatoform pain & unexplained somatic symptoms’ (Van Ommeren et al., 2001)

Refugees from Senegal

‘General body pain’ & ‘body heat’ (Tang & Fox, 2001)

Refugees from Cambodia

‘Gastrointestinal distress’ (Hinton et al., 2007) ‘Neck soreness’ (Hinton et al., 2006a) ‘Tinnitus’ (Hinton et al., 2006b) ‘Orthostatic dizziness’ (Hinton et al., 2008)

Survivors of the Rwandan Genocide

‘Sudden shortness of breath’ (Hagengimana & Hinton, 2009)

A close-up of a panicked person's eyes. A close-up of a panicked person’s eyes. Source:

Cultural concepts of distress

It has been suggested that Western diagnostic criteria for PTSD may overlap with certain cultural concepts of distress. This may lead to PTSD being over-diagnosed in certain populations. For example, ‘ataque de nervios’ or ‘attack of nerves’ is a cultural syndrome which can be found in Latin American cultures. This resembles a panic attack, and which affects Latino individuals who are exposed to a stressful situation. Take some time to think about the importance of culture in the communication of distress and in psychiatric diagnosis.


Foa E.B. , Keane T.M. , Friedman M.J. , Cohen J.A . (2009). Effective treatments for PTSD. Practice guidelines from the International society for traumatic stress studies (2nd ed.). Guilford Press. Retrieved from

Hagengimana, A. & Hinton, D. (2009). Ihahamuka, a Rwandan syndrome of response to the genocide: blocked flow, spirit assault, and shortness of breath. In: Hinton DE, Good BJ (Ed.), Culture and Panic Disorder. Stanford: Stanford University Press; (pp. 205–229).

Hinton, D. E., Chhean, D., Pich, V., Um, K., Fama, J. M., & Pollack, M. H. (2006a). Neck-focused panic attacks among cambodian refugees; a logistic and linear regression analysis. Journal of Anxiety Disorders, 20(2), 119-138. doi:10.1016/j.janxdis.2005.02.001

Hinton, D. E., Chhean, D., Pich, V., Hofmann, S. G., & Barlow, D. H. (2006b). Tinnitus among cambodian refugees: Relationship to PTSD severity: Tinnitus among cambodian refugees. Journal of Traumatic Stress, 19(4), 541-546. doi:10.1002/jts.20138

Hinton, D. E., Chhean, D., Fama, J. M., Pollack, M. H., & McNally, R. J. (2007). Gastrointestinal-focused panic attacks among cambodian refugees: Associated psychopathology, flashbacks, and catastrophic cognitions. Journal of Anxiety Disorders, 21(1), 42-58. doi:10.1016/j.janxdis.2006.03.009

Hinton, D. E., Hofmann, S. G., Pitman, R. K., Pollack, M. H., & Barlow, D. H. (2008). The panic attack–PTSD model: Applicability to orthostatic panic among Cambodian refugees. Cognitive Behaviour Therapy, 37(2), 101-116.

Hinton, D. E., & Lewis-Fernández, R. (2011). The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety, 28(9), 783-801. doi:10.1002/da.20753

Jenkins, J. H., & Valiente, M. (1994). Bodily transactions of the passions: el calor (the heat) among Salvadoran women refugees. In T. J. Csordas (Ed.), Embodiment and experience: The existential ground of culture and self (pp. 163–182). Retrieved from

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry, 12(2), 92-98.

Tang, S. S., & Fox, S. H. (2001). Traumatic experiences and the mental health of Senegalese refugees. The Journal of Nervous and Mental Disease, 189(8), 507-512. doi:10.1097/00005053-200108000-00003

Van Ommeren, M., de Jong, Joop T. V. M, Sharma, B., Komproe, I., Thapa, S. B., & Cardeña, E. (2001). Psychiatric disorders among tortured Bhutanese refugees in Nepal. Archives of General Psychiatry, 58(5), 475-482.

© Music Credit: Magic Scout – Northern Glade Kevin MacLeod Source: Creative Commons

This page is taken from the Future Learn course “PTSD in Global Context” by the University of Glasgow