, JW SG D van Ommeren The editors of Beyond Trauma: Cultural and Societal Dynamics have created a volume that goes beyond the individual's psychological dynamics of trauma, exploring its social, cultural, politica!, and ethical dimensions from an international as well as a global perspective. et al. They adapted this treatment in many ways, including using culturally salient metaphors, describing skills as universally applicable, and having members involved in this sociocentric culture. Reis , BJ , K , MA U , : Enhanced life distress inventory: Development and validation in two African countries. web pages Confusion of the senses: implications of ethnocultural variations in somatoform and dissociative disorders for PTSD The integration of culturally relevant reactions follows the approach outlined by Bolton and Tang (40), which has been applied in many cultural settings (4143). Smith Although Kaiser Another cultural manifestation of distress within this population are khyl attacks (wind attacks), which involve fear of death, dysregulation within the body when standing up, and shared symptoms of panic attacks (24). Jarvis Therefore, clinicians and researchers must be cautious of what Arthur Kleinman described in 1977 as a category fallacy (2): This refers to the misconception that categories created in one cultural context apply equivalently to another. First, they found that the presence of the numbing-avoidance clusterpresent in the DSM-IVvaried considerably across cultures. Beyond Trauma: Cultural and Societal Dynamics. : Trauma and PTSD in the WHO World Mental Health Surveys. M PTSD symptom clusters consist of biological abnormality through autonomic nervous system reactivity (e.g., re-experiencing, arousal), behavioral abnormality through coping responses (e.g., avoidance), and affective abnormality through sustained cognitive and mood changes (e.g., negative alterations in cognition and mood). , , , This article considers diagnostic variations in trauma reactions across cultures, evidence-based assessment strategies to account for culturally distinct trauma : A mixed methods study, The latent structure of post-traumatic stress disorder: tests of invariance by gender and trauma type, The epidemiology of trauma, PTSD, and other posttrauma disorders. People in resource-constrained settings experience poverty-related stress, vulnerability to sexual violence, food insecurity, lack of resources, insecure housing, and the threat of future physical or political violence (36). Notably, the DSM-5 Cultural Formulation Interview is a semi-structured interview. et al. , Publication date. Toward a Theory of Cultural Trauma Yip B : PTSD and key somatic complaints and cultural syndromes among rural Cambodians: the results of a needs assessment survey. In fact, mounting evidence suggests that PTSD is just one type of trauma-related disorder and that trauma reactions are quite culturally variable (4). Cross-cultural PTSD research from low- and middle-income countries and within contexts of relative deprivation in high-income countries has centered on chronically poor communities and conflict-affected people, for whom ongoing stressors are pervasive. Before Regmi Roberts : Assessing local instrument reliability and validity: a field-based example from northern Uganda. Bass Keeley MK BJ on the Internet. Pham , This interview encourages culturally formulated idiographic assessment and builds off the work of global mental health and transcultural psychiatry in previous decades. et al. T , Cultural sensitivity is defined by cultivating awareness of ones own and others cultural identities, using culturally formulated case conceptualization, and tailoring services to each client (53). BJ IH PSY WebBeyond trauma : cultural and societal dynamics. et al. Ongoing stressors are daily stressful events that can reduce peoples ability to cope with stressors overall. Palermo Jordans Culture and psychopathology: general view This latter approach would, therefore, challenge whether PTSD or any psychiatric disorder is applicable outside the culture where it was developed as an illness category. Van Ommeren Idioms of distress may also be important diagnostic indicators of PTSD (22). The application of etic approaches assumes that psychopathology is a universally experienced phenomenon, regardless of culture, and this largely follows a biological view. Kaiser Hinton As posttraumatic stress disorder (PTSD) is a consequence of traumatic experiences, it is natural to assume that PTSD should exist and be the key psychiatric condition among people exposed to trauma. Third, explanations attributed to trauma-related suffering vary by cultural setting, and such explanations shape distinct illness experiences. AL Validation takes several forms, including structural and factorial validity, largely assessed using confirmatory factor analysis; convergent and discriminant validity, which is assessed by evaluating the test against other constructs that are known to correlate (or not correlate) with the construct under study; and criterion validity, which is the examination of whether the instrument performs against a gold standard and to establish a clinical screening cutoff score to assess the disorder. et al. WebThe author explains how culturally sensitive therapists draw upon multiple strategies for treating patients and are aware of both dominant group privilege and of their own identity Reviews of culturally adapted cognitive behavioral therapy also highlight the usefulness of incorporating cultural concepts gleaned from formative assessment work into treatment (33). When clinicians incorporate explanatory models into the assessment process, the accuracy of clinical diagnoses is enhanced. Borisova S Inclusion in an NLM database does not imply endorsement of, or agreement with, LK According to cultural betrayal trauma theory, within-group violence confers a cultural betrayal that contributes to outcomes, including symptoms of posttraumatic , Finally, cultural groups experiencing ongoing adversity may not fit into Western biomedical diagnoses such as PTSD. , ; in. Komproe DeSilva LJ : Benuto Hall Accessibility WebCLINICAL SYNTHESIS Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to Assessing Trauma Reactions Anushka R. Patel, Ph.D., and Brian J. , Federal government websites often end in .gov or .mil. , The notion that some PTSD symptom clusters appear biologically invariant whereas others may be culturally shaped bolsters the finding that PTSD symptom presentation varies across cultures (4, 7, 8, 10). WV , , A , Hiar et al. Store TIRBook.com - Beyond Trauma Although a tension exists between what is reified as psychiatric canon and what culture might teach us about mental illness, one should not fully abandon their own training and beliefs. With the rise of migration to Western countries, the historical contexts that necessitated this migration and the geopolitical processes that may have led to collective or individual trauma should not be ignored. S FOIA , For example, studies have used images of people carrying larger weights on their heads (43), facial images that range from smiles to frowns (47), or circles filled in by quarters to show how much of a symptom is present (42). This interview can be augmented with the administration of clinical instruments assessing both universal and culturally relevant trauma reactions for a comprehensive clinical assessment. : How do clinicians define cultural sensitivity? An illustrative example of using cultural concepts of distress in treatment comes from Nepal. For example, this group adapted dialectical behavior therapy to target dysregulated emotions and suicidality in Nepal (58). Most trauma-focused treatments target PTSD, which is a common outcome of interpersonal violence across cultures (1, 54, 55). : The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression. Valid and reliable assessment is a cornerstone of evidence-based clinical intervention. The final step is to validate the instruments. Request PDF | Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to Assessing Trauma Reactions | Although trauma exposure is a global phenomenon, However, the only significant moderator accounting for this difference was modification of the illness myth, also known as the explanatory model. LT et al. $22.95. , Tol We will keep fighting for all libraries - stand with us! The essential question when working with diverse cultural groups remains: is PTSD a valid construct applicable to quantify suffering within this population? Validating the instruments and assess their psychometric properties. , : Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders. : Treatment change of somatic symptoms and cultural syndromes among Cambodian refugees with PTSD. , When such assessments are not available, clinicians can listen for idioms of distress and use their clinical assessment skills to probe into the lived experience for each patient. Komproe The .gov means its official. In 2011, Benish et al. Over time, these behaviors become culturally socialized as either adaptive and desired in a cultural context or maladaptive and to be avoided (7). M , Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications. In the process of cultural socialization, behaviors are rewarded, punished, and ignored. , Rousseau A recent study used this approach to measure pre- and postmigration stressors among Filipino migrants, providing more context for interpreting PTSD and anxiety findings (49). WebBeyond trauma 4 and dreaming, which in turn make possible claims to historical experiences and demands for justice and accountability, while exploring what may come RC DE , Friesen Similarly, clinicians can position themselves as curious learners and practice cultural humility with patients to improve engagement with clinical services and enhance trust toward health care systems as a whole. , Das : Pan-cultural elements in facial displays of emotion, Tseng Each approach uses visual representations, which are likely to communicate burden in gradients more effectively than numeric Likert-type scales. WA , WebCultural Competence, 43 Ethical Issues, 44 Chapter 2: Introduction to the Program 45 The Curriculum 45 Group Composition, 46 Using the Facilitator Guide 47 Session Outlines, As these expressions hold cultural meaning, they are also less stigmatizing than Western psychiatric concepts (27), which may not possess cultural salience and could be interpreted incorrectly. , , BJ Kirmayer et al. Hall, Ph.D. However, humility affords the opportunity to consider alternative explanations for the symptoms or reactions, the expectations of norms of behavior, and the predicted course of the illness. Ekman In a global context, individuals receiving Western psychiatric diagnoses may lack agency, resources, and engagement with those in power, thereby preventing equitable co-creation of knowledge regarding the Western psychiatric concepts being applied to them. Rather than relying only on Western psychiatric diagnoses, culturally diverse perspectives on health and well-being should continue to be rigorously studied and meaningfully incorporated into assessment and treatment. : School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial, Toward a culture-informed epidemiology: Combining Qualitative and Quantitative Research in Transcultural Contexts, Comparative validity of screening instruments for mental distress in Zambia, An alternative approach to cross-cultural function assessment. et al. This method follows five steps: In the first step, qualitative interviews engage members of the cultural group in a discussion about priority needs. : The AFhan symptom checklist: a culturally grounded approach to mental health assessment in a conflict zone. HHS Vulnerability Disclosure, Help They confirmed that culturally adapted treatment is, in fact, more effective than unadapted treatment (d=0.32). , et al. R et al. : Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis, Community-based research partnerships: challenges and opportunities. : World Health Organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead. Hall Finally, because determining PTSD is complicated in conditions of ongoing stress and adversity, instrument findings can be strengthened by querying for experiences of ongoing stress and adversity at the time of the assessment. Pich Researchers and clinicians should be aware of historical events occurring between cultural groups, as these may shape expectations and activate stereotypes that may not be helpful for the assessment process. Our distinguished International Scientific Advisory Committee and Honor ary Committee, whose membership was drawn from over 60 countries, the cooperation of six United Nations bodies, and the participation anei endorse ment of numerous nongovernmental organizations and institutions attest to the Society's emerging presence as a major international forum for profes sionals of ali disciplines working with victims and trauma survivors. Cambodian refugees, who survived human rights violations and extensive trauma during the Pol Pot regime, represent an illustrative case in point. , Kleinman Nicasio Salem Singer W-S. Humility can thus lead to more nuanced, appropriate, and holistic definitions of trauma reactions so that all reactions are not pathologized (51). Hall Finally, diagnosing PTSD or other trauma reactions across cultures can be complicated by the failure to account for ongoing stressors (3436). : KE A Benish J Thomas : Thinking too much: A systematic review of a common idiom of distress, Idioms of distress among trauma survivors: subtypes and clinical utility. NK Rather than engage in one-way psychoeducation about mental health from a Western psychiatric perspective, a culturally informed perspective is comprehensive in that it elicits idioms of distress, cultural syndromes, and illness beliefs. A et al. J : The cultural context of clinical assessment. , , BA I Post-traumatic stress disorder -- Social aspects, Psychic trauma -- Social aspects. Similarly, encounters with assessors from different cultural backgrounds, or within contexts of uncertainty (e.g., refugees and asylum seekers), may evoke defensiveness, which could be misjudged as paranoia or uncooperativeness. : Somatic symptoms mediate the relationship between trauma during the Arab Spring and quality of life among Tunisians. Weboverviewwillhighlightseveralculture-relatedchallengesinthisfield.Mostofthe studies in the field of culture, trauma and dissociation have examined the occurrence of dissociative A BA It is our hope that this book and its suc- Part III examines trauma and cultural JP Therefore, idioms of distress can be useful stand-alone diagnostic categories within some cultural groups. Kredlow WebCultural trauma occurs when members of a collectivity feel they have been subjected to a horrendous event that leaves indelible marks upon their group consciousness, marking Altogether, comprehensive trauma assessment includes universal and culturally relevant trauma reactions. J : Preparing instruments for transcultural research: use of the translation monitoring form with Nepali-speaking Bhutanese refugees. AV de Jong , MJD Ottomeyer 1995. WA For example, some cultural groups may believe that a trauma occurred because supernatural forces punished them or their community for a transgression or a trauma occurred as part of their karma (29, 30). The practical usefulness of idioms in psychological assessment is the shared language they provide to describe suffering. , Cultural humility is a process of self-reflection and critique to redress power imbalances that exist between health professionals and patients to develop a mutually beneficial relationship (50). Thapa Chen M on August 1, 2022, There are no reviews yet. H , The suggestions that we provide in this article can be used in routine clinical settings. Be the first one to, Beyond trauma : cultural and societal dynamics, Advanced embedding details, examples, and help, Post-traumatic stress disorder -- Social aspects, urn:lcp:beyondtraumacult0000unse:lcpdf:f57f9f04-4032-4085-820b-6f471743b4db, urn:lcp:beyondtraumacult0000unse:epub:aee0721f-590e-4d31-bf74-3f8ad6e947a4, Terms of Service (last updated 12/31/2014). Kohrt : The Thinking a Lot Idiom of Distress and PTSD: An Examination of Their Relationship among Traumatized Cambodian Refugees Using the Thinking a Lot Questionnaire. , J : Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. AS Beyond Trauma, presents a series of conversations with a wide range of people from many different backgrounds and Please cite this article as: Wilde, L (2020). Ethical and Cultural Considerations in Trauma Treatment: WebBeyond Trauma - Kentucky Cabinet for Health and Family Services : Cultural concepts of distress and psychiatric disorders: literature review and research recommendations for global mental health epidemiology, Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. Good , BEYOND TRAUMA - trauma-informed and gender-sensitive Reporting ongoing stressors and adversity can improve confidence in study findings and provide a more nuanced picture of clinical considerations, because PTSD may not be the best diagnosis to capture reactions to current stressors. These methods can take the form of in-depth qualitative interviews, focus groups, or free listing methods that provide an opportunity for the group to list the various reactions associated with a community-defined illness concept. Vietnamese Buddhist Monks/Nuns and Mediums Views on Attribution and Alleviation of Symptoms of Mental Illness. DE , Kulkarni et al. Although trauma exposure is a global phenomenon, trauma reactions vary considerably across cultures. , , C Sharma Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to K-T Beyond Trauma - Kentucky Cabinet for Health and Family Services WebBeyond Trauma: A Healing Journey for Women, a twelve-session curriculum, is designed to help women and girls recover from the effects of trauma in their lives. When available, clinicians can append their assessment batteries with assessments incorporating idioms of distress to assess culturally relevant trauma reactions. , C F Two independent studies with Kalahari bushmen and Vietnamese refugees found that, although intrusion reactions were highly endorsed, the numbing-avoidance reactions were not central trauma reactions; this lower endorsement rate led to significantly underdiagnosing PTSD in these groups (5, 6). Explanatory models of illness refer to a clients or cultural groups viewpoints on the nature of the illness they are experiencing, its perceived causes, and solutions or help-seeking associated with it (28). V , JT discussed in their 2010 Nature article Most People Are Not WEIRD, most psychological research draws from subject pools whose demographic characteristics are westernized, including being more educated, more industrialized, rich, and from democratic nations that do not represent the vast majority of the world, such as individuals from the Global South. GM Omidian Cognitive interviews involve asking members of the community to state the meaning of an item or describe it in their own words. LJ In a study of Cambodian refugees, the idiom thinking a lot was a more prominent trauma reaction than most of the DSM-5 PTSD symptoms (23), which argues for including this idiom within the assessment of trauma reactions for Cambodian refugees. Finally, cultural humility is also consistent with culturally sensitive clinical practice. Frequencies of these reactions provide evidence of their primacy within the symptom presentation of the community. Kessler In the Chinese context, shenjing shuairuo, or neurasthenia, is a syndrome indicated by physical exhaustion, fatigue, weakness, and nonspecific aches and pains that highly overlaps with the Western psychiatric diagnosis of depression (25). : Psychometric validation of the PTSD Checklist-5 among female Filipino migrant workers, DSM-5-based latent PTSD models: Assessing structural relations with GAD in Filipino post-relocatees, Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Western psychiatric diagnoses, such as posttraumatic stress disorder (PTSD), may be limited in capturing the breadth of trauma reactions in cross-cultural contexts. The ethics of practicing with trauma survivors thus Ron Eyers argues that a cultural trauma is a tear in the social fabric, which DE ,
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