Culture shapes how distress is experienced, named, expressed, and brought to clinical attention, and a clinician who misses that layer risks both misdiagnosis and a fractured alliance. DSM-5-TR formalizes three constructs under the umbrella term Cultural concepts of distress: Cultural syndromes, Cultural idioms of distress, and Cultural explanations or perceived causes. The manual pairs these with a structured assessment tool, the Cultural Formulation Interview (CFI), to operationalize culturally informed evaluation in routine practice. Cultural concepts are not exotic add-ons confined to immigrant or international populations; they pattern symptom presentation, help-seeking, and treatment expectations in every patient, including the U.S.-born majority. The clinical bottom line: elicit the patient's own model of the problem, map it onto a DSM-5-TR diagnosis when one fits, and treat without flattening either the diagnosis or the patient's framework.

Cultural concepts of distress are not diagnoses with prevalence estimates in the conventional sense; they are explanatory frames whose distribution tracks the populations that hold them and the conditions that elicit them. What epidemiology can offer is the prevalence of specific named idioms and syndromes within their source populations, and the demographic patterns of help-seeking that follow.

Distribution of named concepts

• Ataque de nervios is reported by roughly 7-15% of community samples in Puerto Rico and among Latinx populations in the United States, with higher rates in women, those with less education, and trauma-exposed groups.^1-2
• Khyâl cap ("wind attacks") is endorsed by approximately 8-11% of Cambodian refugees in U.S. clinical samples and overlaps substantially with panic disorder and PTSD.³
• Shenjing shuairuo ("neurasthenia") was historically the most common psychiatric diagnosis in Chinese clinical settings; its frequency has declined as DSM/ICD depressive and anxiety categories have diffused, though it persists in older adults and rural populations.⁴
• Dhat syndrome, characterized by anxiety attributed to semen loss, is described in roughly 1-3% of South Asian male outpatients in psychiatric and primary-care clinics.⁵
• Susto is reported across Latin American populations with wide variability; community prevalences of 5-20% are described, depending on definition and locale.^2,6

Help-seeking and pathway-to-care patterns

• Across U.S. national samples, Latinx, Asian American, and Black populations consistently access mental health services at lower rates than non-Latinx White populations, even after adjusting for need and insurance.⁷
• Initial help-seeking for symptoms framed as cultural idioms more often goes to primary care, traditional healers, or clergy than to specialty mental health.^7-8
• Limited English proficiency and clinician-patient ethnic discordance independently predict shorter visits, lower medication adherence, and earlier dropout.⁸

Risk factors for cultural-clinical mismatch

• Migration, displacement, and refugee status concentrate trauma exposure and idiom-mediated presentations.^3,9
• Older age, lower acculturation, and rural origin increase the likelihood that distress is expressed in idiom rather than DSM symptom language.^4,8
• Clinician unfamiliarity with the patient's idiom is the single most modifiable risk factor for misdiagnosis.^9-10

Cultural concepts of distress are not separate disease entities with their own pathophysiology; they are culturally patterned ways of experiencing, expressing, and explaining distress that may overlap with one or more DSM-5-TR disorders or stand alone as normative responses to adversity. The relevant "etiology" is therefore biopsychosocial, with culture functioning as the organizing layer that shapes which symptoms are noticed, which are foregrounded, and which causal stories feel true.

Three DSM-5-TR constructs

• Cultural syndromes are clusters of co-occurring symptoms recognized within a specific cultural group as a coherent illness (for example, ataque de nervios, khyâl cap, taijin kyofusho).¹⁰
• Cultural idioms of distress are shared ways of communicating suffering that need not map to a discrete syndrome (for example, "nervios," "thinking too much," "heartbreak").¹⁰
• Cultural explanations or perceived causes are etiologic models patients use to account for symptoms (for example, soul loss in susto, semen depletion in dhat, fright or sorcery in many traditions).¹⁰

Mechanisms by which culture shapes presentation

• Symptom amplification and attention: cultural salience directs attention toward specific bodily sensations (palpitations in khyâl cap, tinnitus and weakness in shenjing shuairuo), increasing their report and perceived severity.^3-4
• Idiom-mediated communication: somatic language is often a more socially sanctioned channel for distress than psychological language, particularly where mental illness is heavily stigmatized.^8,11
• Explanatory model effects: causal beliefs (witchcraft, ancestral displeasure, karmic debt, biomedical "chemical imbalance") shape help-seeking, treatment expectations, and adherence.^8,11
• Stress-response substrates: trauma, autonomic arousal, and HPA-axis activation are common biological substrates across panic disorder, PTSD, and idiom-framed presentations such as ataque de nervios and khyâl cap.^3,9

Integrative model

• Contemporary cultural psychiatry treats cultural concepts as the cultural shaping of universal psychobiological processes rather than as culture-bound exotica.^10-11
• The same patient can simultaneously meet criteria for major depressive disorder and articulate the experience as "thinking too much" or "nervios"; the two framings are complementary, not competing.¹⁰

Cultural concepts of distress are not stand-alone diagnoses in DSM-5-TR; they are descriptive constructs the clinician uses alongside the manual's disorder categories. The diagnostic task is twofold: determine whether the patient meets criteria for a DSM-5-TR or ICD-11 disorder, and document the cultural concept that frames the patient's experience.

DSM-5-TR placement

• Cultural concepts of distress are introduced in DSM-5-TR's Section III ("Emerging Measures and Models") and elaborated in the appendix "Glossary of Cultural Concepts of Distress."¹⁰
• The Cultural Formulation Interview (CFI) is the manual's recommended structured tool for eliciting them.¹⁰
• Nine prototypic concepts receive named entries in the DSM-5-TR glossary: ataque de nervios, dhat syndrome, khyâl cap, kufungisisa, maladi moun, nervios, shenjing shuairuo, susto, and taijin kyofusho.¹⁰

Selected DSM-5-TR glossary entries

• Ataque de nervios: an event of intense emotional upset, with shouting, crying, trembling, heat rising from chest to head, and sometimes dissociative or seizure-like features, typically following an acute stressor.¹⁰
• Khyâl cap: panic-like attacks attributed to dysregulated movement of "khyâl" (a wind-like substance) through the body, with palpitations, dizziness, shortness of breath, and fear of fatal collapse.¹⁰
• Dhat syndrome: anxiety, fatigue, and somatic complaints attributed to semen loss through nocturnal emission, urination, or masturbation, described primarily in South Asian men.¹⁰
• Susto: chronic somatic and psychological symptoms attributed to a frightening event causing the soul to leave the body, described across Latin American populations.¹⁰
• Taijin kyofusho: persistent fear of offending or embarrassing others through one's body, gaze, odor, or expression, described in Japan and overlapping with social anxiety disorder and body dysmorphic disorder.^10,12
• Shenjing shuairuo: weakness of the nerves, with fatigue, headaches, dizziness, sleep disturbance, and irritability, historically prominent in Chinese psychiatry.^4,10
• Kufungisisa ("thinking too much"): rumination framed as a cause of bodily and mental symptoms, described across sub-Saharan Africa and overlapping with depressive and anxiety disorders.^10-11
• Maladi moun ("humanly caused illness"): symptoms attributed to interpersonal envy or sorcery, described in Haitian populations.¹⁰
• Nervios: a broad idiom encompassing chronic vulnerability to stressful life experiences, with somatic, emotional, and behavioral features.^2,10

ICD-11 differences

• ICD-11 does not include a parallel glossary of cultural concepts; it instead instructs clinicians to consider cultural context throughout the diagnostic process and provides cultural notes within selected disorder entries.¹³
• ICD-11 retains "neurasthenia" (6C20) as a discrete category in some regional adaptations, whereas DSM-5-TR treats shenjing shuairuo as an idiom rather than a disorder.^4,13

Documentation

• DSM-5-TR encourages recording the cultural concept in the formulation alongside the formal diagnosis (for example, "major depressive disorder, single episode, moderate; expressed as kufungisisa").¹⁰

Cultural concepts share a few recurring features that help the clinician recognize them at the bedside even when the specific term is unfamiliar. Across syndromes, presentations are typically polysymptomatic, somatically prominent, and embedded in a causal narrative.

Common cross-cutting features

• Somatic foregrounding: chest tightness, palpitations, dizziness, headache, fatigue, or genital symptoms typically dominate the presentation, with mood and cognitive symptoms reported only on direct questioning.^8,11
• Acute precipitants: many syndromes (ataque de nervios, susto, khyâl cap) follow an identifiable stressor, often interpersonal loss, conflict, or trauma.^1,3,6
• Causal narrative: the patient offers an explanatory model that locates the cause outside the biomedical frame (soul loss, wind, nerves, sorcery, semen depletion).^10-11
• Help-seeking pluralism: patients commonly consult traditional healers, family elders, or clergy in parallel with biomedical providers.^7-8

Prototypical presentations

• Ataque de nervios: a Puerto Rican woman in her 40s, after a funeral, develops sudden screaming, crying, trembling, a sensation of heat rising, and brief loss of awareness; symptoms remit within hours and she has no memory of part of the episode.^1,10
• Khyâl cap: a Cambodian refugee describes recurrent dizziness on standing, palpitations, cold extremities, and a fear that wind moving upward in the body will cause sudden death; symptoms cluster in the morning and after exertion.^3,10
• Dhat syndrome: a young South Asian man presents with months of fatigue, anxiety, weight loss, and the conviction that nocturnal emissions are draining vital essence and causing his symptoms.^5,10
• Taijin kyofusho: a Japanese university student avoids classes because of conviction that his body odor and gaze are repulsing classmates; the focus is on offending others rather than self-embarrassment.^10,12

Course features

• Some concepts denote acute episodes (ataque de nervios, susto onset, khyâl cap attacks) and others denote chronic states (dhat syndrome, kufungisisa, shenjing shuairuo).¹⁰
• Recurrence is common when the underlying stressor or comorbid disorder is untreated.^3,9

Red flags requiring escalation regardless of cultural framing:

• Active suicidal ideation, plan, or recent attempt.¹⁴
• Command auditory hallucinations, persecutory delusions, or first-rank symptoms.¹⁴
• Rapid weight loss, dehydration, or signs of catatonia.¹⁴
• Acute confusion, focal neurologic findings, or altered consciousness — assume a medical cause until ruled out.¹⁴

Cultural concepts are not diagnoses of exclusion, but they require the same disciplined differential as any other presentation. The clinician's task is to map the idiom onto a DSM-5-TR or ICD-11 disorder when one fits, and to rule out medical mimics that the patient's explanatory model may obscure.

Psychiatric conditions to consider

• Panic disorder: ataque de nervios and khyâl cap overlap heavily; the syndromes typically include acute autonomic surge, but ataque de nervios more often follows an identifiable interpersonal precipitant and includes dissociative features.^1,3,15
• Major depressive disorder: kufungisisa, shenjing shuairuo, and nervios frequently mask depressive episodes; screen for anhedonia, neurovegetative symptoms, and suicidal ideation regardless of the idiom.^4,8,11
• Generalized anxiety disorder and somatic symptom disorder: chronic worry-plus-somatic presentations (shenjing shuairuo, nervios, dhat) frequently meet criteria for one or both.^4-5,11
• PTSD: khyâl cap among Cambodian refugees commonly co-occurs with PTSD, and the wind-attack narrative may be tied to traumatic memory.³
• Social anxiety disorder and body dysmorphic disorder: taijin kyofusho overlaps with both, with the offensive-type variant most distinctive to Japanese cultural framing.¹²
• Dissociative disorders: ataque de nervios includes transient dissociation that can be misread as a dissociative disorder if the cultural frame is missed.^1,15
• Psychotic disorders: explanatory models invoking spirits, witchcraft, or possession are not delusions if they are shared by the patient's reference group; a delusion is idiosyncratic and not culturally sanctioned.^10,14

Medical mimics not to miss

• Thyroid disease: hyperthyroidism mimics anxiety and panic; hypothyroidism mimics depression and shenjing shuairuo.¹⁴
• Cardiac arrhythmia and ischemia: palpitations and chest tightness in khyâl cap or ataque de nervios warrant ECG and clinical evaluation.^3,14
• Vestibular and neurologic disease: episodic dizziness and "falling out" presentations require neurologic examination.¹⁴
• Anemia, B12 deficiency, and electrolyte disturbance: fatigue-dominant presentations (dhat syndrome, shenjing shuairuo) warrant basic labs.^5,14
• Substance intoxication and withdrawal: stimulant and alcohol use can produce panic-like and dissociative episodes; collateral and toxicology help distinguish.¹⁴

Culturally informed assessment is a structured extension of standard psychiatric evaluation, not a separate exercise. The CFI is the manual's recommended tool and can be completed in routine clinical time when used selectively.

Cultural Formulation Interview

• The CFI is a 16-item semi-structured interview embedded in DSM-5-TR Section III, designed to elicit the patient's cultural definition of the problem, perceived causes, stressors, supports, and prior help-seeking.^10,16
• Twelve supplementary modules expand specific domains (explanatory models, level of functioning, social network, immigration and refugee experience, spirituality, caregivers, school-age children).^10,16
• An informant version allows interview of family members or caregivers when appropriate.¹⁰
• Field-trial data show acceptable feasibility and clinician/patient acceptability across multiple sites and languages.¹⁶

Mandatory history elements

• The patient's own name and description of the problem before any clinical reframing.^10,16
• Causal models and prior help-seeking, including traditional, religious, or alternative providers.^10,16
• Stressors and supports relevant to the patient's social world, including migration history when applicable.^10,16
• Language of the interview and need for a trained medical interpreter; record the interpreter's role.^8,10

Physical examination and laboratory workup

• A focused medical exam is appropriate for any new psychiatric presentation; do not skip it because the framing is cultural.¹⁴
• Reasonable baseline labs in fatigue or somatic-prominent presentations: TSH, CBC, comprehensive metabolic panel, B12, urine toxicology when indicated.¹⁴
• ECG if palpitations, chest pain, or recurrent syncope are part of the presentation.¹⁴
• Imaging is not routine and should be driven by exam findings.¹⁴

Validated rating scales

• Cultural Formulation Interview (CFI), DSM-5-TR.^10,16
• PHQ-9 and GAD-7 are validated in multiple translations and are the most pragmatic depression and anxiety screens for primary-care and psychiatric settings.¹⁷
• Refugee Health Screener-15 (RHS-15) for refugee populations.¹⁸
• Hopkins Symptom Checklist-25 (HSCL-25) and Harvard Trauma Questionnaire are widely used in cross-cultural and refugee mental-health research.¹⁸

Treatment of cultural concepts of distress is treatment of the underlying DSM-5-TR or ICD-11 disorder, modified by the patient's explanatory model, language, and help-seeking pathway. There is no separate "treatment for ataque de nervios" — there is treatment for the panic disorder, PTSD, or adjustment reaction the episode signals, delivered in a way the patient can accept.

Pharmacotherapy

• Standard evidence-based pharmacotherapy applies once a DSM-5-TR diagnosis is established: SSRIs and SNRIs for major depressive disorder, panic disorder, and PTSD; antipsychotics for primary psychotic disorders.^14,19
• Pharmacogenomic variation in CYP2D6 and CYP2C19 metabolizer phenotypes differs across ancestral groups and can affect SSRI and antipsychotic dosing; consider lower starting doses in known poor metabolizers.^19-20
• Evidence suggests that nonadherence is higher when the prescribed model conflicts with the patient's explanatory model; explicit negotiation of the rationale improves adherence.^8,11
• Limited evidence supports specific dose adjustments by ethnicity beyond pharmacogenomic indications; treat the patient, not the population.^19-20

Psychotherapy

• Strong evidence supports cognitive behavioral therapy for depression, panic disorder, and PTSD; culturally adapted CBT shows moderate additional benefit over unadapted CBT in ethnic-minority populations.^21-22
• Culturally adapted CBT for Cambodian refugees with PTSD and khyâl cap-related panic shows efficacy in randomized trials.^3,22
• Interpersonal psychotherapy has been adapted and tested in low- and middle-income country settings, including for depression in postpartum women and adolescents.²²
• Trauma-focused therapies (prolonged exposure, EMDR, narrative exposure therapy) are commonly recommended for refugee populations with PTSD; narrative exposure therapy was developed specifically for survivors of organized violence.^22-23

Neuromodulation

• Electroconvulsive therapy is recommended for severe, treatment-resistant, or psychotic depression, and for catatonia, regardless of cultural framing; cultural attitudes toward ECT vary and informed consent should anticipate them.^14,19
• Repetitive transcranial magnetic stimulation is approved for treatment-resistant depression and OCD in many jurisdictions; cross-cultural data are limited.¹⁴

Adjunctive

• Some experts recommend coordinated care with traditional or religious healers when the patient is already engaged with one, though high-quality evidence is lacking.^8,11
• Family engagement, particularly in collectivist cultures, frequently improves treatment retention.⁸
• Trained medical interpreters and bilingual mental-health providers reduce dropout and improve outcome measures relative to ad-hoc interpretation.⁸
• Address concrete social determinants (immigration documentation, housing, employment) when they are central to the patient's stress narrative; clinical improvement is often gated on them.⁹

The harms picture in this domain is less about adverse drug effects and more about clinical errors that follow from cultural misalignment, plus the limits of an evidence base built largely in Western, English-speaking samples.

Common clinical pitfalls

• Pathologizing normative cultural responses as psychiatric illness, particularly bereavement, possession-trance experiences, and acute idioms following major stressors.^10-11
• Missing serious psychiatric or medical illness because the cultural frame is taken at face value.¹⁴
• Misclassifying culturally sanctioned beliefs as delusions, especially in patients from religious or spiritualist traditions.^10,14
• Over-relying on family interpreters, which compromises both fidelity and confidentiality.⁸

Serious or rare harms

• Diagnostic errors flow into medication errors: an unrecognized psychotic disorder framed as "nerves" can be undertreated, and a culturally normative possession experience misread as psychosis can be inappropriately exposed to antipsychotics.^10,14
• Coercive treatment delivered without cultural negotiation predicts disengagement from care across subsequent episodes.⁸

Monitoring and discontinuation considerations

• When pharmacotherapy is started, monitor adherence and explanatory-model alignment at every visit; nonadherence is the most common reason for apparent treatment failure.^8,11
• Plan for discontinuation discussions in the patient's idiom; "finishing the medicine" carries different meanings across traditions.¹¹

Limitations of the evidence base

• Most psychotherapy and pharmacotherapy trials enroll predominantly White, English-speaking participants; effect-size generalization to other groups is inferred, not demonstrated.^19,21
• Cultural-adaptation trials are heterogeneous in what they adapt (language, content, therapist match, explanatory frame) and cannot easily be pooled.^21-22
• The DSM-5-TR glossary covers nine prototypic concepts; many idioms in active clinical use are not represented.¹⁰
• Field-trial data on the CFI come from a limited number of sites and may not generalize to under-resourced settings.¹⁶

Cultural concepts of distress intersect with every demographic axis routinely flagged in clinical training. The principles below are not exhaustive; they highlight where the cultural lens most commonly changes the bedside decision.

Pediatric

• Children's symptoms are filtered through caregiver explanatory models; interview both child and caregiver, separately when possible.^8,10
• School refusal, somatic complaints, and behavioral change in immigrant children frequently reflect family-level stress that the child's idiom alone may not surface.⁸

Geriatric

• Older adults from non-Western backgrounds more often present cognitive complaints as somatic or moral concerns rather than as memory loss; lower the threshold for cognitive screening.^4,8
• Shenjing shuairuo and similar idioms are disproportionately reported by older adults and may delay recognition of major depressive disorder.⁴

Perinatal

• Postpartum cultural practices (confinement, dietary restrictions, prescribed visitor patterns) are protective in many traditions and should not be reflexively pathologized.¹¹
• Perinatal depression and anxiety are underdetected across most non-Western populations; the Edinburgh Postnatal Depression Scale has been translated and validated in many languages.¹⁷

Comorbid medical illness

• Diabetes, cardiac disease, and chronic pain interact bidirectionally with idioms of distress; patients may attribute somatic symptoms to the medical illness when a treatable psychiatric illness is also present, and vice versa.^8,14

Comorbid substance use

• Alcohol and stimulant use produce panic-like and dissociative episodes that can be conflated with cultural syndromes; collateral and toxicology are essential.¹⁴
• Stigma around substance use varies markedly across cultures and shapes both disclosure and treatment uptake.⁸

Refugee and forcibly displaced populations

• Trauma exposure is common; PTSD frequently co-occurs with idioms such as khyâl cap and presents predominantly somatically.^3,9
• Use validated refugee screens (RHS-15, HSCL-25, Harvard Trauma Questionnaire) at intake.¹⁸
• Coordinate care with resettlement agencies and language-matched community organizations when available.⁹

Prognosis is the prognosis of the underlying disorder, modified by alliance, treatment access, and the patient's social context. Cultural framing in itself does not worsen outcome; mismatched care does.

Course features

• Acute idioms (ataque de nervios, susto onset, single khyâl cap attack) typically remit within hours to days; recurrence rate depends on the underlying disorder.^1,3,6
• Chronic idioms (dhat, kufungisisa, shenjing shuairuo) follow a course similar to the comorbid depressive or anxiety disorder when one is present.^4-5,11
• Untreated PTSD and depression in refugees show high chronicity, with persistent symptoms documented years after resettlement.⁹

Outcome data

• Limited evidence suggests that culturally adapted treatment improves retention more reliably than it improves symptom-scale outcomes per session.^21-22
• Strong evidence supports the claim that earlier engagement in evidence-based treatment improves long-term outcomes across psychiatric disorders, regardless of cultural framing.^14,19

Mortality and suicide considerations

• Suicide risk varies by cultural group, with elevated rates documented in specific populations (older Asian American women, Indigenous adolescents in several countries, sexual and gender minority youth across cultures).²⁴
• Idioms framing distress as moral failure or family shame can both facilitate and obstruct disclosure of suicidal ideation; ask directly and in the patient's idiom.^8,24

Cultural concepts do not change the emergency assessment; they change the language in which it is conducted. The clinician's task is to translate the safety questions into the patient's idiom without losing diagnostic precision.

Acute presentations

• An ataque de nervios in the emergency department typically remits with calm environment, reassurance, and assessment for medical mimics; benzodiazepines are not first-line and may obscure subsequent assessment.^1,15
• Khyâl cap presenting acutely warrants ECG and standard panic-evaluation workup before reassurance.³
• Possession-trance presentations require psychiatric evaluation when they are distressing, occur outside sanctioned ritual contexts, or are accompanied by self-harm or psychotic features.^10,14

Hospitalization criteria

• Standard criteria apply: imminent risk to self or others, grave disability, inability to care for self.¹⁴
• Cultural framing does not lower the threshold; if a patient meets criteria, hospitalize while continuing cultural negotiation around treatment.¹⁴

Suicide-risk assessment

• Use direct, idiom-aware questioning; "thinking too much," "heart pain," or "wanting to disappear" may signal suicidal ideation in patients who do not endorse "suicide" in clinical English.^8,24
• Limit access to lethal means as in any high-risk assessment.^14,24

Agitation management

• Verbal de-escalation in the patient's preferred language, with a trained interpreter, is first-line.¹⁴
• Standard pharmacologic options (oral or IM antipsychotics, benzodiazepines) apply when verbal de-escalation fails; cultural framing does not alter the algorithm.¹⁴

The field has moved beyond "culture-bound syndromes" but the underlying questions about validity, generalizability, and the boundary between cultural variation and disorder remain open.

Open debates

• Whether DSM-5-TR's nine prototypic glossary entries reflect global clinical reality or a curated subset weighted toward longstanding research traditions.^10-11
• Whether "cultural concepts of distress" should be considered alongside DSM disorders or treated as a separate axis; the manual chose the former, but operational uptake is uneven.^10-11
• Whether the CFI changes diagnostic decisions or primarily improves alliance; field-trial evidence supports alliance and information yield more clearly than diagnostic reclassification.¹⁶
• Whether culturally adapted psychotherapy adds clinically meaningful benefit beyond unadapted, well-delivered evidence-based treatment; meta-analytic estimates are modest and heterogeneous.^21-22
• Whether DSM and ICD frameworks themselves are exportable global standards or culturally specific products of Anglo-American psychiatry; this critique drives the global mental health "category fallacy" debate.¹¹

Regulatory and structural issues

• DSM-5-TR placed cultural concepts in Section III ("Emerging Measures"), signaling provisional status; some have argued for promotion to the main text.¹⁰
• ICD-11's choice not to include a parallel glossary creates documentation asymmetry across systems.¹³
• Reimbursement structures rarely fund the additional time required for full CFI administration.¹⁶

• DSM-5 (2013) and DSM-5-TR (2022) replaced "culture-bound syndromes" with three constructs: cultural syndromes, cultural idioms of distress, and cultural explanations or perceived causes.¹⁰
• The Cultural Formulation Interview is a 16-item semi-structured tool in DSM-5-TR Section III with 12 supplementary modules and an informant version.^10,16
• Ataque de nervios is a Latinx idiom characterized by acute emotional upset with shouting, trembling, heat rising, and dissociative features following a stressor.^1,10
• Khyâl cap is a Cambodian "wind attack" panic syndrome with palpitations, dizziness, and fear of fatal collapse, frequently comorbid with PTSD.^3,10
• Dhat syndrome is anxiety attributed to semen loss, described primarily in South Asian men.^5,10
• Susto is a Latin American syndrome attributing chronic somatic and psychological symptoms to soul loss following fright.^6,10
• Taijin kyofusho is a Japanese syndrome of fear of offending others through one's body, gaze, or odor, overlapping with social anxiety disorder and body dysmorphic disorder.^10,12
• Shenjing shuairuo ("weakness of nerves") historically dominated Chinese psychiatric diagnosis and overlaps with major depressive disorder, generalized anxiety disorder, and somatic symptom disorder.^4,10
• A culturally sanctioned belief shared by the patient's reference group is not a delusion under DSM-5-TR.^10,14
• Family interpreters are not adequate substitutes for trained medical interpreters in psychiatric assessment.⁸
• Culturally adapted CBT shows modest additional benefit over unadapted CBT in ethnic-minority populations, with the largest effects when language and explanatory model are matched.^21-22
• Evidence suggests that pharmacogenomic variation in CYP2D6 and CYP2C19 differs across ancestral groups and can affect SSRI and antipsychotic dosing.^19-20
• ICD-11 does not include a parallel cultural-concepts glossary; it incorporates cultural notes within disorder entries instead.¹³
• An ataque de nervios in the emergency department is typically managed with environmental calm and assessment for medical mimics; benzodiazepines are not first-line.^1,15
• Suicide-risk assessment should use the patient's idiom; "thinking too much," "heart pain," or "wanting to disappear" may signal suicidal ideation in patients who do not endorse the term "suicide."^8,24

No external funding. No conflicts of interest declared. Peer-review status: pending.