As a category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), cultural concepts of distress (CCDs) affirm that a sufferer’s experiences are not irrational or imaginary, but real and meaningful within their sociocultural framework. They are multi-dimensional phenomena that resist interpretation using existing diagnostic criteria. 

When professionals misunderstand culturally specific expressions of distress, they can misdiagnose people with schizophrenia, bipolar disorder, or another severe condition. Recognizing a CCD helps professionals contextualize symptoms and avoid applying inappropriate treatments and labels. 

Recognition as a CCD lends clinical and academic legitimacy, which can be leveraged for better health care access, funding, and culturally competent services. It enables communities and institutions to take sufferers more seriously.  

By recognizing these expressions as legitimate, sufferers are less likely to be dismissed as "non-compliant" or "atypical" in clinical settings. CCDs reframe symptoms as culturally coherent rather than pathologizing them. 

For instance, a "highly sensitive person" does not have a psychiatric disorder. They have deep emotional responses. Such non-clinical labels offer validation and coping strategies without implying illness, which minimizes internal distress. It also offers access to different resources, including online communities and support groups with shared language, identity and advocacy goals. 

Cultural concepts of distress are indications of dynamic life worlds that provide useful clues to help people adapt and grow resilient. This shift away from a stigmatized mental illness reduces societal marginalization by grounding distress in shared cultural narratives.

Ataque de nervios (literally, "attack of the nerves") is a cultural syndrome in the Caribbean, especially Puerto Rico and the Dominican Republic. It is attributed to stressful or traumatic events relating to the family (e.g., death of a close relative, separation or divorce from a spouse, or conflict with spouse or children). Symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. Dissociative experiences, episodic amnesia and blackouts can occur, sometimes in tandem with suicide attempts.  

Brain fag syndrome [sic] ("fag" was British for fatigue), is a culture-bound syndrome first described in the 1960s by psychiatrist Raymond Prince. It was primarily reported among students in West Africa, especially Nigeria. Core symptoms include mental fatigue, difficulty concentrating, headache, pulsing sensations on the head, and feelings of burning on the body and neck. Anxiety, depressive feelings, and emotional distress are also common.

The question of whether chronic fatigue syndrome (CFS) is a culture-bound syndrome is debated in medical anthropology and psychiatry. Also known as myalgic encephalomyelitis (ME), it is characterized by severe, persistent fatigue lasting at least six months, and not explained by other medical conditions. While not fully understood, CFS involves immune dysregulation, nervous system dysfunction, and cellular energy metabolism issues. Because it has historically been dismissed as psychosomatic, it gets compared to culture-bound syndromes. The associated malaise lacks visible biomarkers, similar to many culture-bound syndromes, and patients often report being invalidated by healthcare providers. 

Electrohypersensitivity, specific to industrialized nations, is a compelling example of a cultural concept of distress but not formally classified as such. It attributes a wide range of non-specific symptoms to electromagnetic fields (EMFs). Exposure to cell phones, Wi-Fi routers, power lines, computers and fluorescent lighting, among other technology, can reportedly cause symptoms like headaches, fatigue, skin irritation, dizziness, and sleep disturbances. 

“Falling out” is a culture-bound syndrome attributed to emotional stress, common in African American communities in the southern United States and some Afro-Caribbean cultures. Associated symptoms include sudden collapse, dizziness or lightheadedness preceding the episode, and open eyes, but with a lack of responsiveness, as it occurs. The individual can become unsteady and experience a change in perception or vision. Emotional changes can include crying and shouting. Trembling and sensations of heat rising in the body are commonly reported. Falling out is different than epileptic seizures because convulsions, tongue biting and loss of bowel or bladder control do not occur during falling out episodes.    

As this project's research focus, gangstalking may be a cultural concept of distress in Western European culture. It is a cluster of otherwise anomalous experiences, attributed to unknown attackers, who use secret weapons and technology. Core "symptoms" may include hearing voices and sounds, invasive and paranoid thoughts, and the sense of being watched, surveilled and monitored. Commonly reported somatic symptoms may include burning, crawling or electrical shock sensations, sudden and intense itching, peeling skin, pulses/waves passing over the scalp, rapid heartbeat, and rashes (especially Morgellons Syndrome). Behavioral signs may include inability to focus, argumentativeness, drug and alcohol misuse, hyper-vigilance, impulsivity, insomnia, loss of interest in usual activities, obsessiveness, narcolepsy, and wandering or frequently changing residence. Homicidal and suicidal ideation are not uncommon.  

Hwa-byung, or “fire illness" is a recognized culture-bound syndrome in Korean culture. Found primarily among middle-aged Korean women, though not exclusively, it is attributed to unresolved or suppressed anger, usually stemming from family or social conflict. Symptoms include irritability, anxiety or panic, depression or sadness, rage or frustration, sensations of heat or pressure in the chest, heart palpitations, insomnia, fatigue, headaches and digestive problems.   

Jinn (or jinni) spirit possession is a cultural concept of distress in Islamic societies and parts of the Middle East, North Africa, South Asia, and Southeast Asia. It refers to psychological, emotional, or physical symptoms caused by an unseen spiritual force. Symptoms include sudden mood swings, social withdrawal, intrusive thoughts, hearing voices, insomnia, nightmares, numbness, pain, and abnormal physical sensations with no clear medical cause.   

Koro is a culture-bound syndrome in Southeast Asia and southern China associated with an intense fear that the genitals (especially the male’s penis) are retracting into the body. It is characterized by the sudden onset of anxiety and panic along with a fear of imminent death. Somatic symptoms include palpitations, sweating, breathlessness, and dizziness. It is often fueled by rumors, media, or social stress, leading to mass panic and unusual group behaviors. During the 1967 “Koro Epidemic” in Singapore, fear spread rapidly through mass hysteria, especially in communities with strong shared beliefs. Koro sufferers often attribute their problems to a secret and conspiratorial group of attackers. 

Kufungisisa is a cultural concept of distress from Zimbabwe, which translates literally as “thinking too much.” Attributed to lack of support from family or community, it is considered a sign of social imbalance or economic distress. It is characterized by a mix of psychological and somatic symptoms, including sadness, irritability, low self-esteem, negative rumination, poor concentration, forgetfulness and a sense of not being oneself. Individuals also report body aches and insomnia. Severe cases can involve suicidal thoughts, hallucinations, substance abuse, and psychosis.   

Kyal khap is a cultural concept of distress recognized in Cambodian (Khmer) communities, attributed to the movement of "wind" or energy in and around the body. Symptoms include dizziness or lightheadedness, palpitations or rapid heartbeat, shortness of breath, chest tightness or pain, numbness or tingling, a sense of impending doom and fear of dying. Episodes of this panic-like syndrome are often triggered by emotional distress, minor physical complaints, or situations perceived as threatening to the individual.   

Maladi Dyab is a cultural concept of distress reflecting Vodou beliefs in Haiti and is attributed to spiritual attacks, witchcraft, curses, and punishment for breaking social taboos. It is characterized by emotional, psychological, and somatic distress. Symptoms include hearing voices, hallucinations, seizure-like episodes, nightmares and sleep paralysis, feeling “possessed” or controlled by an unseen force, unexplained body pain and sudden changes in behavior. 

Multiple Chemical Sensitivity refers to adverse physical symptoms after low-level exposure to common chemicals, such as perfumes, cleaning agents, cigarette smoke, paint, plastics, and pesticides. Symptoms can include headaches, fatigue, dizziness, nausea, breathing difficulties and poor mental clarity (“brain fog”). It emerged prominently in the 1980s–90s, alongside growing environmental awareness, concerns about "sick buildings," and a rise in chronic illness. It is more common in high-income countries with increased exposure to synthetic chemicals and a strong public discourse around health, purity, and pollution. 

Open mole is a cultural concept of distress found mainly in parts of West Africa, especially Liberia, attributed to a soft spot on the top of the head, similar to the fontanelle in infants.  Symptoms include persistent or severe headaches, fatigue, dizziness or lightheadedness, neck or back pain, poor concentration or forgetfulness, and a fluttering sensation on the crown of the head.  

Susto is a cultural concept of distress primarily found in Mexico, Central America, South America, and parts of the United States. Characterized by physical and psychological symptoms caused by sudden scare or emotional shock, symptoms include nervousness, confusion, nightmares, agitation, feelings of anguish, fear of unfamiliar people and places, and being easily startled at night. Delusions and hallucinations, especially involving encounters with frightening entities, occur in severe cases. 

Witchcraft in African contexts refers to the perceived use of supernatural powers—either innate or acquired—to cause harm, illness, bad luck, or death, often secretly and maliciously. Though not explicitly classified as a cultural concept of distress, it fits into all three major categories as a syndrome, idiom and explanation. People experiencing psychosis, epilepsy, trauma, or depression may interpret their condition as due to witchcraft or spiritual attack. It offers clear, socially accepted reasons for unexpected disease, poverty, misfortune or conflict. This culturally rooted framework for explaining, experiencing, and responding to suffering often involves accusations against family, friends, neighbors, healthcare providers and local or foreign governments.