Presentation: Acute paroxysmal crying, shouting, trembling, and pseudoseizures/fainting triggered by severe family/interpersonal stress. Rapid return to baseline.
Diff: Panic attack or brief psychosis; diff by cultural trigger and rapid self-resolution.
Dhat Syndrome (South Asian / Indian):
Presentation: Young male w/ fatigue, generalized weakness, and severe anxiety attributed to loss of semen (nocturnal emissions or cloudy urine). c
Diff: Somatic symptom disorder or MDD.
Taijin Kyofusho (East Asian / Japanese):
Presentation: Interpersonal anxiety; fear that one’s own body odor, gaze, or appearance will offend/displease others.
Diff: Social Anxiety Disorder (where Pt fears being embarrassed themselves, not embarrassing others).
Koro (Southeast Asian / Chinese):
Presentation: Acute panic episode with fear that the penis (or vulva) is retracting into the abdomen, causing death; may use mechanical clamps/traction.
Amok (Southeast Asian):
Presentation: Sudden, unprovoked violent or homicidal rampage followed by exhaustion and complete amnesia.
Susto (Latin American):
Presentation: Chronic somatic complaints, insomnia, and depressive Sx attributed to a traumatic fright causing “soul loss”.
Shenjing Shuairuo (East Asian / Chinese):
Presentation: Physical and mental exhaustion, headaches, and insomnia; somatic manifestation of MDD/GAD.
Step 2 CK Exam Rules
Communication: Always use a certified medical interpreter; never use family or non-clinical staff.
Exploration: Ask the Pt’s illness explanation model before challenging cultural beliefs.
Management: Rule out organic etiology → treat underlying comorbid DSM-5 disorder (e.g., SSRIs + CBT) while respecting safe cultural practices.