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Influence of Cultural and Social Factors on the Epidemiology of Idiopathic Somatic Complaints and Syndromes

From the Department of Psychiatry (J.I.E.), UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey; and Department of Psychiatry (O.G.), University of Ibadan, University College Hospital, Ibadan, Nigeria.

ABSTRACT

Objective: To review international research on somatic presentations often seen together with or attributed to psychopathology. For conceptual clarity, we refer to these presentations as "idiopathic somatic complaints and syndromes" (ISCS). This review will also pose specific questions on cultural issues affecting these somatic manifestations.

Method: Selective review of the international literature dealing with the phenomenology, epidemiology, and cultural profile of ISCS focusing on papers published in refereed journals and written in English.

Results: Major problems with much of the previous research in this area are the use of different definitions and ascertainment procedures. As currently conceptualized in the literature, ISCS are universal and seem closely related to psychological issues (stress) and psychopathological conditions such as depression worldwide. Although there are many similarities regarding the form and content of these somatic presentations across cultures, there is some evidence for cultural patterning of symptoms. Unfortunately, current classifications for ISCS are unsatisfactory.

Conclusions: We outline specific recommendations for conducting future research and for improving the classification of ISCS of presumed psychological origin or import in future nosologies.

Key Words: somatoform disorders • medically unexplained physical symptoms • somatization • hypochondriasis • psychiatric classification • cross-cultural psychiatry

Abbreviations: ISCS = idiopathic somatic complaints and syndromes; SCL-90 = Symptom Checklist 90; GHQ = General Health Questionnaire; DIS = Diagnostic Interview Schedule; CIDI = Composite International Diagnostic Interview; SD = somatization disorder; AS = abridged somatization; NESARC = National Epidemiologic Survey of Alcohol and Related Conditions; ECA = Epidemiologic Catchment Area Study

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