Somatic Disorders

A Community Study of Somatization Among

Ethnocultural Groups

Even where cultural differences among groups in the

prevalence of somatization are found, socioeconomic and

social structural differences in health care systems make their

interpretation problematic. In many cases, somatization may

simply reflect the availability of specific types of health care

within a society. For example, the availability of psychiatric

services only for the most severely ill—except in a few

developed countries—makes people emphasize somatic

symptoms in coming to the doctor to ensure that they get

appropriate attention (25). Beiser and Fleming (26) suggest

that because Southeast Asians are more likely to consider

somatic symptoms rather than depressive feelings as legitimate

reasons for consulting a physician, samples of depressed

Southeast Asians in clinics may be composed of that subgroup

of depressed patients in the community who suffer concurrently

from prominent somatic symptoms.

To examine cultural differences in somatization more

CULTURE AND SOMATIZATION

ological ideas about the body can give rise to culture-specific

somatic symptoms and complaints, such as heat in the head,

loss of semen in the urine, and specific types of conversion

symptoms (1). These symptoms are not included in conventional

psychiatric nosology and, with few exceptions, have

received little epidemiological study. The tendency in crossnational

studies to use lists of symptoms derived from clinical

experience in the United States or the United Kingdom

hampers progress toward a more inclusive nosology. Any

psychiatric nosology that hopes to have universal applicability

must consider these local variations.

But there is a more basic nosological issue raised by these

somatic syndromes and by the recurrent finding of high

correlations between somatic and emotional distress. Current

nosology tends to view somatization either in terms of a

discrete set of disorders or as...