What are the differences in symptom pattern of the different expressions ofanxiety across cultures?
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To examine cultural aspects in social anxiety and social anxiety disorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and social anxiety disorder. This has direct relevance for the upcoming DSM-V.
The defining feature of social anxiety disorder (SAD) is the fear of negative evaluation by others. Therefore, SAD is directly linked to social standards and role expectations, which are culture dependent. Recognizing the intricate interplay between culture and social anxiety, some research has focused on psychopathologic manifestations of SAD across cultures , while in other studies the focus has been on comparing disorder-typical symptoms across cultures . It should be noted that most of the studies on cultural differences in SAD have examined Eastern (especially Japanese, Korean, and Chinese) and Western (US American and European) samples.
The following is a review of the evidence pertaining to the validity of the DSM-IV-TR criteria for social anxiety disorder (SAD) as it relates to culture, race, and ethnicity. We use the term “race” when we refer to broad differentiations based on physiognomy (e.g., White), “ethnicity” when we refer to “common descent” and affiliation with a historically continuous community (e.g., Latino), and “culture” when we refer to social groups with specific or homogenous attributes. We particularly concentrate on culture as a source for the nosological revisions to explore whether certain cognitive/ behavioral elements (e.g., interpretations of illness; patterned reactions to stressors) affect the development or expression of psychiatric syndromes.
The search methods for the current review entailed a thorough computer search using the Pubmed and PsychInfo databases for articles published since the publication of the DSM-IV in 1994. Specifically, key words relevant to SAD (i.e., “social phobia” or “social anxiety disorder”) were combined with the terms “culture”, “ethnic*”, and “race”. This approach yielded 602 articles, which were evaluated for relevance to the present topic. Finally, bibliographies of key articles were inspected, as well as references from 1965–1994 (as appropriate), to augment the final reference list.
In this review, we first discuss cultural differences in rates of SAD, in the form that SAD takes (emphasizing the well-researched case of TKS), and in treatment response. The final section examines key factors that generate SAD and affect its presentation, and discusses how these key mechanism may be influenced by culture. We end with a discussion of the implications of the review.
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