Cross-Cultural Differences in Somatic Presentation in Patients With Generalized Anxiety Disorder
Abstract
Little is known about cultural differences in the expression of distress in anxiety disorders. Previous cross-cultural studies of depression have found a greater somatic focus in Asian populations. We examined anxiety symptoms in patients with generalized anxiety disorder (GAD) in urban mental health settings in Nepal (N = 30) and in the United States (N = 23). Participants completed the Beck Anxiety Inventory (BAI). The overall BAI score and somatic and psychological subscales were compared. While there was no difference in total BAI scores, the Nepali group scored higher on the somatic subscale (i.e. "dizziness" and "indigestion," t[df] = -2.63[50], p < 0.05), while the American group scored higher on the psychological subscale (i.e. "scared" and "nervous," t[df] = 3.27[50], p < 0.01). Nepali patients with GAD had higher levels of somatic symptoms and lower levels of psychological symptoms than American patients with GAD. Possible explanations include differences in cultural traditions of describing distress and the mind-body dichotomy.
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This is supported by evidence that some patients are unable to describe cognitive content of their worries and that cross-cultural application of DSM-5 requirement may miss cases.
“This is supported by evidence that some patients are unable to describe the cognitive content of their worries 53 and that cross-cultural application of the DSM-5 requirement may miss cases 54,55 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [54]
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Cross-cultural variations in the prevalence and presentation of anxiety disorders
Marques, L., Robinaugh, D. J., LeBlanc, N. J., & Hinton, D. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.10.122 · Cited by 122 · see citing works
Anxiety and Fear-Related Disorders: Generalized Anxiety Disorder
Rosellini, A. J., & Brown, T. A. (2024) · Tasman’s Psychiatry · doi:10.1007/978-3-030-51366-5_74 · Cited by 1 · see citing works
- Authors
- Hoge, E. A., Tamrakar, S. M., Christian, K. M., Mahara, N., Nepal, M. K., Pollack, M. H., & Simon, N. M.
- Affiliations
- Harvard University (US)
- Tribhuvan University Teaching Hospital (NP)
- Corresponding author
- Hoge, Elizabeth A.
- Christian, Kelly M.
- Pollack, Mark H.
- Simon, Naomi M.
- Venue
- The Journal of Nervous and Mental Disease
- Published
- 2006-12
- Volume
- 194
- Issue
- 12
- Pages
- 962-966
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2026991996
- Cited by
- 84
- References
- 1
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 2 · 2018: 8 · 2017: 7 · 2016: 6 · 2015: 2 · 2014: 6 · 2013: 4 · 2012: 7
- FWCI
- 5.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- generalized anxiety disorder, somatic symptoms, cross-cultural comparison, mind-body dichotomy, Nepal, United States, psychological symptoms, Beck Anxiety Inventory, Asian populations
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Cross-Cultural Comparison, Cultural Characteristics, Ethnicity, Female, Humans, Male, Middle Aged, Nepal, Personality Inventory, Psychiatric Status Rating Scales, Psychophysiology, Somatoform Disorders, United States, Urban Population, Diagnostic and Statistical Manual of Mental Disorders
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