1. CULTURE SPECIFIC DISORDER IN INDIAN CONTEXT
CHAIRPERSON:
MS. YUKTI RASTOGI
(GUEST FACULTY)
PRESENTER:
NIDHI GUPTA
M.PHIL CP 1ST YEAR

2. OUTLINE INTRODUCTION CRITERIA TYPES OF CULTURE SPECIFIC DISORDER
DHAT SYNDROME
POSSESSION SYNDROME
KORO
GILAHARI SYNDROME
BRAHNMATI SORCERY

3. CONT... AN ANALYSIS OF CULTURE BOUND SYNDROME CONCLUSION
6. COMPULSIVE SPITTING
7. CULTURE BOUND SUICIDE (SATI, SANTHRA)
8. ASCETIC SYNDROME
9. JHINJHINIA
10. SUDDU
11. MASS HYSTERIA
AN ANALYSIS OF CULTURE BOUND SYNDROME
CONCLUSION

4. INTRODUCTION
Culture plays a decisive role in coloring the psychopathology of various Psychiatric disorder
However, some psychiatric syndromes are limited to certain cultures
These disorders are called culture specific or culture bound syndromes

5. DEFINING CULTURE SPECIFIC DISORDERS
Culture Specific Syndrome or Culture bound syndrome is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture
No objective biochemical or structural alterations of body organs or functions
The disease is not recognized in other cultures

6. CRITERIA
The term culture - bound syndrome was included in DSM-IV (APA, 1994) which also includes a list of the most common culture-bound conditions
DSM IV defines culture-bound syndrome as recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category

7. CRITERIA
ICD-10 suggests that culture specific disorders may be regarded as local variant of anxiety, depression, somatoform disorder, or adjustment disorder; and so culture specific disorders should be diagnosed under nearest equivalent code
Thus Dhat syndrome and Koro are classified under “other specified neurotic disorders” while Possession syndrome is classified under “Dissociative disorders”
ICD-10 also provides a list of culture specific disorders

8. CONT… No clear cut diagnostic criteria have been devised as of now
Majority of CBS share the following characteristics:
Categorized as a disease in that culture
Widespread familiarity in that culture
Unknown in other cultures
No objectively demonstrable biochemical or organ abnormality
Treated by folk medicine/ traditional healers

9. Common culture bound syndromes in india
DHAT SYNDROME
POSSESSION SYNDROME
KORO
GILAHARI SYNDROME
BRAHNMATI SORCERY
COMPULSIVE SPITTING
CULTURE BOUND SUICIDE (SATI, SANTHRA)
ASCETIC SYNDROME
JHINJHINIA

10. DHAT SYNDROME
It is a semen-loss related physical and psychological distress seen mainly in people of Indian subcontinent
Dhat syndrome is characterized by;
Weakness, anxiety, sleeplessness and guilt which is attributed to semen loss
Frightening as a result of semen loss (through nocturnal emissions and masturbation) because the individual believes it to be harmful to the body
Some patients report a white discharge in their urine which they feel is semen
Sexual dysfunction may or may not be present

11. DHAT SYNDROME
Origin:
Dhat is derived from the sanskrit word “Dhatu” meaning precious fluid
Ancient Indian text of surgery (Susruta Samhita) has described 7 Dhatus in the body; out of all seven, Semen is considered to be the most precious
Ancient text of Indian Medicine (Charak Samhita) describes a disorder resembling Dhat syndrome by the name of Shukrameha

12. DHAT SYNDROME It is assumed that; 40 meals = 1 drop of blood
40 drops of blood = 1 drop of Bone Marrow
40 drops of bone marrow = 1 drop of semen
This gives rise to belief that loss of excessive semen in any form (e.g. masturbation, nocturnal emissions etc) is harmful. On the other hand its preservation will lead to health and longevity.
First described in Western psychiatric texts by Wig (1960)

13. POSSESSION SYNDROME Categorized under Dissociative disorders(ICD-10)
Characterized by;
Loss of both sense of personal identity and full awareness of the surroundings
Patient acts as if possessed (taken over) by another personality usually ‘spirit/soul’ of deceased relative or a local deity
Speaks in changed tone, even gender changes at times if the possessing soul is of opposite sex
There is often a limited but repeated set of movements, postures, and utterances

14. POSSESSION SYNDROME Causal and Maintaining factors:
Majority of these patients are females who otherwise don’t have any outlet to express their emotions
There could be underlying stress which might precipitate the possession attack
Secondary gains may maintain this behaviour
Socio-demographic correlates:
Predominant in females
Prevalent in rural areas or in migrants from rural areas

15. CULTURE BOUND SUICIDE Three types; Sati Jauhar Santhara
Sati : self-immolation by a widow on her husband’s pyre.
According to Hindu mythology, Sati the wife of Dakhsha was so overcome at the demise of her husband that she immolated herself on his funeral pyre and burnt herself to ashes
Was seen mostly in Upper Castes notably Brahmins and Kshatriyas
Banned in India since 19th century

16. CULTURE BOUND SUICIDE 2. Jouhar :
Suicide committed by a women even before the death of her Husband when faced by prospect of dishonour from another man (usually a conquering king)
3. Santhara/Sallekhana :
Voluntarily giving up life by fasting unto death over a period of time for religious reasons to attain God/Moksha
Seen in Jain Community who celebrates these events as religious festivals
Person initially takes liquids, later even refusing to take them

17. KORO Seen in northeastern states (e.g., Assam)
Fear of genitalia retracting into abdomen leading ultimately to death
Person applies external retractors to the genitalia in form of clamps, chains etc. to avoid it retracting back
Seen in both sexes
Described as a syndrome in ICD-10 and DSM-IV

18. ASCETIC SYNDROME First described by Neki in 1972
Appears in adolescents and young adults.
Characterized by :-
Social withdrawal
Severe sexual abstinence
Practice of religious austerities
Lack of concern with physical appearance and
Considerable loss of weight

19. JHIN JHINIA Occurs in epidemic from in India (e.g. West Bengal)
Characterized by;
A sudden appearance of bizarre and seemingly involuntary contraction of muscles and spasms
A sudden feeling of a sensation of tingling and numbness in the legs which spread upward throughout the body (the person feels stuck)

20. JHIN JHINIA
Within a few seconds the patient is seized with the horror of impending death and cries for help before he becomes speechless and motionless
Appears dramatically and recovers within few hours
Both men and women are affected
Nosological status unclear

21. BHANMATI SORCERY This CBS is seen in South India
Belief in magical spells that produce evil spirits to cause psychiatric illness i.e. conversion disorders, somatization disorders, anxiety disorder, dysthymia, schizophrenia etc. or physical illnesses
Nosological status unclear

22. SUUDU Reported in south India, especially in the Tamil culture
Characterized by;
Painful urination and pelvic “heat”
Attributed to an increase in the “inner heat” of the body often due to dehydration
It occurs in both males and females

23. GILHARI SYNDROME
Gilahari syndrome is considered to be a fatal illness in cultures of Rajsthan
Patients complain of small swelling on the body changing its position from time to time as if a gilhari is crawling underneath the skin with intense anxiety and apprehension of death
Symptoms Characterized by;
Swelling underneath the skin in the back
Swelling in neck Difficulty in breathing
Feeling of obstruction in the airways

24. GILHARI SYNDROME Fear of death Palpitation and apprehension
Abnormal body movements
Fits of unconsciousness
Rolling movement of the body
Maladaptive behavior (Shouting, Running, Crying etc.)
Cultural belief that if the swelling (Gilahari) will not be crushed, they will not improve
Nosological status not clear.
Occurs in both male and female

25. MASS HYSTERIA Also referred as Mass Psychogenic Illness (MPI)
Characterized by a group of symptoms that usually mimic an organic disease, but without any identified cause, and occurs in those who share a common belief that those symptoms constitute a definite illness
Cases reported in West Bengal, occurs both in male and female

26. MASS HYSTERIA Cardinal features
An episodic trance state of 5 to 15 minutes duration with
Restlessness
attempts at self-injury
running away
inappropriate behaviour
inability to identify family members
refusal of food and
intermittent mimicking of animal sounds

27. An analysis of culture bound syndrome
Bhatia, M.S. (1999) analyzed 60 cases of CBS and reported;
Out of various forms of CBS;
Dhat syndrome was most common (76.7%),
followed by possession syndrome (13.3%), Koro (5%), Ascetic syndrome, Bhanmati sorcery.

28. An analysis of culture bound syndrome
Co-morbidity:
When the associated physical and psychiatric co- morbidity was analyzed in patients with Dhat syndrome;
3 patients had sexually - transmitted diseases (6.5%)
11 patients had depression (24%)
6 patients had anxiety disorder (13%)
3 patients had Hypo-chondriasis (6.5%)

29. REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR fourth edition (text revision).
Bhatia MS, Malik SC. Dhat syndrome – a useful diagnostic entity in Indian culture. Br J Psychiatry 1991; 159 :
Bhatia, M. S. (1999). An analysis of 60 cases of culture bound syndromes. Indian journal of medical sciences, 53(4), 149.
Chowdhury, A. N., & Brahma, A. (2005). An epidemic of mass hysteria in a village in West Bengal. Indian journal of psychiatry, 47(2), 106.

30. REFERENCES
Neki JS. The Ascetic syndrome. Mimeographed. New Delhi: All India Institute of Medical Sciences 1972; 1-5.
Singh G. Dhat syndrome revisited. Indian J Psychiatry 1985; 27 :
Verma, K. K., Bhojak, M. M., Singhal, A. K., Jhirwal, O. P., & Khunteta, A. (2001). “Gilahari (lizard) syndrome” is it a new culture bound syndrome?-A case report. Indian journal of psychiatry, 43(1), 70.
World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research.

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