1. Culture , Race, and Gender
PMHN

2. Culture and Race
 Culture bound syndrome
 Preferentially displayed in particular socio-cultural contexts
 Given culturally sanctioned contexts
 Have culturally specific remedies
 Examples
 Ataque de nervios-uncontrollable shouting trembling, crying and
dissociative experiences (Latin Carribean )
 Falling out-sudden collapse accompanied by dizziness and
complaints of being unable to see, closely resembles hysterical
conversion (Southern United States)
 Mal de ojo-fitful sleep, crying, diarrhea, vomiting and fever

3.  Culture bound syndrome examples
 Spell-commnication with dead persons or spirits (Southern US)
 Anorexia-nervosa- refusal to eat, fear of being fat, altered body
image, lanugo, amennorhea (US, South America, and Europe)
 Susto- unhappiness and sickness following a frightening event
which caused the soul to leave the body (Latinos)
 Koro- fear that the penis in men and nipples and vluva in women
will disappear into the body (South and East Asia)
 Latah- echopraxia, echolalia, and command obedience folllowing
a frightening event (Malaysia)
 Postpartum depression-crying, irritability, poor concentration
from one year to two years following giving birth (US)

4.  Therapies for culture bound syndromes
 Culture specific and ethno-related
 Bio-medical models usually ineffective
 Need knowledge of the patient’s explanatory model of illness
 (What does patient think caused the illness?)
 Need knowledge of the patient’s explanatory model of cure
 (How does patient think the illness can be cured?)
 Cognitive behavioral therapy can help.

5. Gender Identity Disorders
 Children
 Symptoms of wanting to be the other sex are evident before
age 3
 Sex ratio of referred children under the age of 12 is 4 to 5 boys
for 1 girl
 Girls insist they have a penis, refuse to urinate in a sitting
position, have an avid interest in playing with male
companions and in rough and tumble sports
 Boys enjoy wearing female clothes, are disgusted by their
genitalia and believe they will grow up to be women.

6.  Adolescents and adults
 Desire to be of the other sex
 Do not identify as homosexual, gay, or lesbian
 Desire to have treatment to change to sex
 Uncomfortable wearing clothes of their assigned sex
 Dysphoria with sexual condition

7. Intersex Conditions
 Congenital viralization adrenal hyperplasia
 Overproduction of androgens in a female-trypically raised as
boys-many have gender identity disorder
 Androgen insensitivity syndrome
XY karyotype-tissue unable to use testosterone- raised as girls
but have undeveloped testes-usually sense themselves as
female
Turner’s syndrome- missing a Y sex chromosome karyotype X
female genitalia but require exogenous estrogen to develop
secondary sex characteristics

8.  Kleinfeler’s syndrome- extra X chromosome XXY causes
gynecomastia and small testes- resultant dysphoric mood
 Reductase deficiency
 Male appears female at birth and does not viralize until
puberty-gender confusion results
 Hermaphrodism and pseudohermaphrodism-
 Presence of both sex genitalia or ambiguous genitalia