12 - “Idioms of distress” (culturally salient indicators of distress) and anxiety disorders

Summary

This chapter describes the clinical relevance of idioms of distress for the generation and treatment of anxiety disorders, focusing mainly on those related to panic disorder and post-traumatic stress disorder (PTSD) in Southeast Asian and Latino populations. It reviews idioms of distress that are cultural illness syndromes. Certain idioms of distress may indicate impairment in psychosocial functioning, including work and social functioning, as well as general well-being, as assessed by quality-of-life and disability measures. The chapter also presents a model of how anxiety disorders and idioms of distress mutually reinforce each other, forming interacting escalating loops that link expectation, attention, catastrophic cognitions, and activation of the autonomic nervous system. Awareness of the relationship between cultural syndromes and anxiety disorders can enhance clinicians' ability to engage patients about a variety of therapeutic approaches and to tailor evidence-based treatments to patients' cultural understandings and experiences.