758 Cultural Formulation
Cultural Concepts of Distress
Cultural concepts of distress  refers to ways that cultural groups experience, understand, and
communicate suffering, behavioral problems, or troubling thoughts and emotions. Three
main types of cultural concepts may be distinguished. Cultural syndromes  are clusters of
symptoms and attributions that tend to co -occur among individuals in specific cultural
groups, communities, or contexts and that ar e recognized locally as coherent patterns of
experience. Cultural idioms of distress  are ways of expressing distress that may not involve
specific symptoms or syndromes, but that pr ovide collective, shared ways of experiencing
and talking about personal or social concerns . For example, everyday talk about “nerves”
or “depression” may refer to widely varying forms of suffe ring without mapping onto a
discrete set of symptoms, syndrome, or disorder. Cultural explanations  or perceived causes
are labels, attributions, or features of an ex planatory model that indicate culturally recog-
nized meaning or etiology for symptoms, illness, or distress.
These three concepts—syndromes, idioms, and explanations—are more relevant to
clinical practice than the older formulation culture-bound syndrome. Specifically, the term
culture-bound syndrome  ignores the fact that clinically important cultural differences often
involve explanations or experience of distress  rather than culturally distinctive configura-
tions of symptoms. Furthermore, the term culture-bound  overemphasizes the local partic-
ularity and limited distribution  of cultural concepts of di stress. The current formulation
acknowledges that all  forms of distress are locally shaped, including the DSM disorders.
From this perspective, many DSM diagnoses can be understood as operationalized proto-
types that started out as cultural syndromes, and became widely accepted as a result of