Culture-Related Diagnostic Issues
Somatic symptoms are prominent in various “culture-bound syndromes.” High numbers
of somatic symptoms are found in population -based and primary care studies around the
world, with a similar pattern of the most commonly reported soma tic symptoms, impair-
ment, and treatment seeking. The relationship  between number of somatic symptoms and
illness worry is similar in different cultures, and marked illness worry is associated with
impairment and greater treatment seeking across cultures. The relationship between nu-
merous somatic symptoms and depression a ppears to be very similar around the world
and between different cult ures within one country.
Despite these similarities, th ere are differences in somatic symptoms among cultures
and ethnic groups. The description of somatic symptoms varies with linguistic and other
local cultural factors. These somatic presenta tions have been described as “idioms of dis-
tress” because somatic symptoms may have special meanings and shape patient-clinician
interactions in the particular cultural cont exts. “Burnout,” the sensation of heaviness or
the complaints of “gas”; too much heat in the body; or burning in the head are examples of
symptoms that are common in some cultures or ethnic groups but rare in others. Explan-
atory models also vary, and somatic symptoms may be attributed variously to particular
family, work, or environmental stresses; general medical illness; the suppression of feel-
ings of anger and resentment; or certain culture-specific ph enomena, such as semen loss.
There may also be differences in medical trea tment seeking among cultural groups, in ad-
dition to differences due to variable access to medical care services. Seeking treatment for
multiple somatic symptoms in general medical clinics is a worldwide phenomenon and
occurs at similar rates among ethnic groups in the same country.