Chapter 11 Psychological Disorders 385example, Latinos may experience an ataque de
nervios, an episode of uncontrollable screaming,
crying, and agitation. In Japan, taijin kyofusho
describes an intense fear that the body, its parts,
or its functions displease, embarrass, or are
offensive to others.
• Cultural idiom of distress, a linguistic term
for, or way of talking about, suffering among
people in a particular cultural group. For exam-
ple, the Shona of Zimbabwe have kufungisisa,
“thinking too much”—ruminating on upsetting
thoughts and worries.
• Cultural explanation of symptoms, some-
thing like a culture’s own diagnostic system.
For example, in Haiti, maladi moun (“humanly
caused illness”) is used to explain various medi-
cal and psychological disturbances: Illness is
seen as being caused by other people’s envy and
malice.
By comparing mental and emotional symp-
toms across different times and places, research-
ers can distinguish universal disorders from those
that are specific to particular cultures. One meta-
analysis found that bulimia, involving cycles of
binge eating and vomiting to maintain weight,
is a cultural syndrome that occurs primarily in
the United States and is unknown in most other
parts of the world. In contrast, anorexia nervosa,
a body image disorder in which the sufferer usu-
ally feels too fat even at the point of starving to
death, has been found throughout history and
across cultures (Keel & Klump, 2003). Likewise,
from the Inuit of Alaska to the Pacific Islanders
to the Yoruba of Nigeria, some individuals have
schizophrenic delusions, are severely depressed,
have anxiety disorders, or cannot control their
aggressive behavior (Butcher, Lim, & Nezami,
1998; Kleinman, 1988).Dilemmas of Measurement LO 11.3
Clinical psychologists and psychiatrists usually
arrive at a diagnosis by interviewing a patient and
observing the person’s behavior when he or she
arrives at the office, hospital, or clinic. But many
also use psychological tests to help them decide on
a diagnosis. Such tests are also commonly used in
schools (e.g., to determine whether a child has a
learning disorder) and in court settings (e.g., to try
to determine which parent should have custody
in a divorce case, whether a child has been sexu-
ally abused, or whether a defendant is mentally
competent).Projective Tests. Projective tests consist of
ambiguous pictures, sentences, or stories that theprojective tests
Psychological tests
used to infer a person’s
motives, conflicts, and
unconscious dynamics on
the basis of the person’s
interpretations of ambig-
uous stimuli.Over the years, psychiatrists have quite
properly voted out many other “disorders” that
reflected cultural prejudices, such as lack of vagi-
nal orgasm, childhood masturbation disorder, and
homosexuality (Wakefield, 1992). But some DSM
disorders are still affected by contemporary val-
ues, as when clinicians try to decide if wanting
to have sex “too often” or not often “enough” is
a mental disorder (Wakefield, 2011). Emotional
problems allegedly associated with menstruation
(“premenstrual dysphoric disorder”) are now in
the DSM-5, but behavioral problems associated
with testosterone have never even been consid-
ered for inclusion. In short, critics maintain, many
diagnoses still stem from cultural biases about
what constitutes normal or appropriate behavior.
Critics of the DSM-5 are also worried about
the large number of investigators involved in the
revision who have financial ties to pharmaceuti-
cal companies that make drugs for the disorders
being included. After the fourth edition was criti-
cized because more than half of its researchers had
such ties, members of DSM-5 panels responsible
for specific revisions had to file financial disclo-
sures. Nonetheless, potential conflicts of interest
remained pervasive. For example, 67 percent of
the panel on mood disorders, 83 percent of the
panel on psychotic disorders, and all seven mem-
bers of the sleep/wake disorders panel had ties to
manufacturers of medications for these disorders
or similar conflicts of interest (Cosgrove, 2013).
And in a wonderfully ironic touch, the DSM-5
now contains “antidepressant discontinuation
syndrome”—symptoms a person might have from
trying to withdraw from the antidepressants that
psychiatrists are now freer to prescribe for more
disorders!
Supporters of the DSM maintain that it is
important to help clinicians distinguish among
disorders that share certain symptoms, such as
anxiety, irritability, or delusions, so they can be
diagnosed reliably and treated properly. And they
fully acknowledge that the boundaries between
“normal problems” and “mental disorders” are
fuzzy and often difficult to determine (Helzer et
al., 2008; McNally, 2011). That is why the DSM-5
editors decided to classify many disorders along a
spectrum of symptoms, and in degrees from mild
to severe, rather than as discrete categories.
Moreover, starting with the fourth edition,
the DSM has made a concerted effort to recog-
nize the influence of culture on mental disorders
and their diagnoses. The DSM-5 discusses three
culture-related concepts:
• Cultural syndrome, a set of symptoms spe-
cific to the culture in which they occur. For