Abstract
This chapter examines the assessment of somatization with Asian-American clients, who have been traditionally identified as a group that is more likely to present with somatic symptoms as indicators of emotional distress. Somatization refers to physical symptoms that are often manifestations of psychological and emotional distress. In this chapter, we discuss what somatization is, why it occurs among Asian-American clients, and what clinicians can do to assess this symptom presentation. We examine three clusters of somatization: somatoform disorders, culturally bound somatic syndromes, and somatic symptoms. We discuss possible reasons Asian-Americans somaticize including a conceptualization of mind and body as integrated, stigma associated with mental health, and culturally sanctioned values regarding emotional expression. We then examine how to work with clients with these presentations and review assessments created specifically for Asian-American populations as well as more general assessments of somatization normed with Asian-American samples. Finally, we discuss implications for practice and research so as to further develop culturally appropriate assessments and interventions with Asian-American clients.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Akutsu, P. D. (1997). Mental health care delivery to Asian Americans: Review of the literature. In E. Lee (Ed.), Working with Asian Americans: A guide for clinicians (pp. 464–476). New York, NY: Guilford Press.
Akutsu, P. D., & Chu, J. P. (2006). Clinical problems that initiate professional help-seeking behaviors from Asian Americans. Professional Psychology: Research and Practice, 37, 407–415. doi:10.1037/0735-7028.37.4.407.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
Chang, D. F., Myers, H. F., Yeung, A., Zhang, Y., Zhao, J., & Yu, S. (2005). Shenjing shuairuo and the DSM-IV: Diagnosis, distress, and disability in a Chinese primary care setting. Transcultural Psychiatry, 42, 204–218. doi:10.1177/1363461505052660.
Chen, W.-Y. (2010). Exposure to community violence and adolescents’ internalizing behaviors among African American and Asian American adolescents. Journal of Youth Adolescence, 39, 403–413. doi:10.1007/s10964-009-9427-7.
Collier, A. F., Munger, M., & Moua, Y. K. (2012). Hmong mental health needs assessment: A community-based partnership in a small Mid-Western community. American Journal of Community Psychology, 49, 73–86. doi:10.1007/s10464-011-9436-z.
Derogatis, L. R., & Unger, R. (2010). Symptom checklist-90-revised. Corsini encyclopedia of psychology (Vol. 1–2). Hoboken, NJ: John Wiley.
Dinh, T. Q., Yamada, A. M., & Yee, B. W. K. (2009). A culturally relevant conceptualization of depression: An empirical examination of the factorial structure of the Vietnamese Depression Scale. International Journal of Social Psychiatry, 55, 496–505.
Hinton, D., Ba, P., Peou, S., & Um, K. (2000). Panic disorder among Cambodian refugees attending a psychiatric clinic: Prevalence and subtypes. General Hospital Psychiatry, 22, 437–444.
Hinton, D. E., Pich, V., Chhean, D., Safren, S. A., & Pollack, M. H. (2006). Somatic-focused therapy for traumatized refugees: Treating posttraumatic stress disorder and comorbid neck-focused panic attacks among Cambodian refugees. Psychotherapy: Theory, Research, Practice, Training, 43, 491–505.
Hinton, D., Um, K., & Ba, P. (2001). Kyol goeu (‘wind overload’) Part I: A cultural syndrome of orthostatic panic among Khmer refugees. Transcultural Psychiatry, 38, 403–432. doi:10.1177/136346150103800401.
Hsu, L. K. G., & Folstein, M. (1997). Somatoform disorders in Caucasian and Chinese Americans. The Journal of Nervous & Mental Disease, 185, 382–387. doi:10.1097/00005053-199706000-00004.
Hwang, W.-C. (2006). The psychotherapy adaption and modification framework: Application to Asian Americans. American Psychologist, 61, 702–715. doi:10.1037/0003-066X.61.7.702.
Isaac, M., Janca, A., Burke, K. C., Costa e Silva, J. A., Acuda, S. W., Altamura, A. C., … Tacchini, G. (1995). Medically unexplained somatic symptoms in different cultures: A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders. Psychotherapy and Psychosomatics, 64, 88–93.
Isaac, M., Janca, A., & Orley, J. (1996). Somatization—A culture-bound or universal syndrome? Journal of Mental Health, 5, 219–222.
Kalibatseva, Z., & Leong, F. T. (2011). Depression among Asian Americans: Review and recommendations. Depression Research and Treatment, 2011, 9. doi:10.1155/2011/320902.
Kim, B. S. K. (2007). Acculturation and enculturation. In F. T. L. Leong et al. (Eds.), Handbook of Asian American psychology (pp. 141–158). Thousand Oaks, CA: Sage.
Kim, B. S. K. (2011). Counseling & diversity: Counseling Asian Americans. Belmont, CA: Brooks/Cole.
Kinzie, D., Manson, S. M., Vinh, D. T., Tolan, N. T., Anh, B., & Pho, T. N. (1982). Development and validation of a Vietnamese-language depression rating scale. American Journal of Psychiatry, 139, 1276–1281.
Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60, 420–430.
Kleinman, A., & Kleinman, J. (1985). Somatization: The interconnections in Chinese society among culture, depressive experiences, and the meanings of pain. In A. Kleinman & B. J. Good (Eds.), Culture and depression: Studies in the anthropology and cross-cultural psychiatry of affect and disorder (pp. 429–490). Berkeley, CA: University of California Press.
Koh, K. B. (1998). Perceived stress, psychopathology, and family support in Korean immigrants and nonimmigrants. Yonsei Medical Journal, 39, 214–221.
Kroll, J., Habenicht, M., Mackenzie, T., Yang, M., Chan, S., Vang, T., … Cabugao, R. (1989). Depression and posttraumatic stress disorder in Southeast Asian refugees. American Journal of Psychiatry, 146, 1592–1597.
Lau, A. W., & Kinoshita, L. M. (2006). Cognitive–behavioral therapy with culturally diverse older adults. In P. A. Hays & G. Y. Iwamasa (Eds.), Culturally responsive cognitive–behavioral therapy: Assessment, practice, and supervision (pp. 179–198). Washington, DC: American Psychological Association.
Lee, S. (1997). A Chinese perspective of somatoform disorders. Journal of Psychosomatic Research, 43, 115–119. doi:10.1016/S0022-3999(97)00037-8.
Lee, S., & Kleinman, A. (2007). Are somatoform disorders changing with time? The case of neurasthenia in China. Psychosomatic Medicine, 69, 846–849. doi:10.1097/PSY.0b013e31815b0092.
Lee, M. H., Lee, H. Y., Min, S. K., Kim, K. H., Kim, S. Y., Song, D. H., et al. (1986). Development of Korean version of the NIMH diagnostic interview schedule and its validity test—Kangwha psychiatric epidemiological survey. Neuropsychiatry, 25, 300–313.
Lee, J., Lei, A., & Sue, S. (2001). The current state of mental health research on Asian Americans. Journal of Human Behavior in the Social Environment, 3, 159–178.
Leong, F. T. L., & Lau, A. S. L. (2001). Barriers to providing effective mental health services to Asian Americans. Mental Health Services Research, 3, 201–214. doi:10.1023/A:1013177014788.
Lin, K.-M. (1983). Hwa-byung: A Korean culture-bound syndrome? American Journal of Psychiatry, 140, 105–107.
Lin, E. H. B., Carter, W. B., & Kleinman, A. M. (1985). An exploration of somatization among Asian refugees and immigrants in primary care. American Journal of Public Health, 75, 1080–1084.
Ma, P.-W. W., Shea, M., & Yeh, C. J. (2012). Promoting mental health in Asian immigrants. In E. Vera (Ed.), The Oxford handbook of prevention in counseling psychology (pp. 439–454). New York, NY: Oxford University Press.
Maffini, C. S., Wong, Y. J., & Shin, M. (2011). The potential impact of violent victimization on somatic symptoms among Asian American adolescents: A national longitudinal study. Asian American Journal of Psychology, 2, 157–167. doi:10.1037/a0024920.
Mak, W. W. S., Cheung, F. M., & Leung, F. (2012). Somatoform disorders in Asians. In E. C. Chang (Ed.), Handbook of adult psychopathology in Asians: Theory, diagnosis, and treatment (pp. 179–202). New York, NY: Oxford University Press.
Mak, W. W. S., & Zane, N. W. S. (2004). The phenomenon of somatization among community Chinese Americans. Social Psychiatry & Psychiatric Epidemiology, 39, 967–974. doi:10.1007/s00127-004-0827-4.
Mayou, R., Kirmayer, L. J., Simon, G., Kroenke, K., & Sharpe, M. (2005). Somatoform disorders: Time for a new approach in DSM-V. American Journal of Psychiatry, 162, 847–855. doi:10.1176/appi.ajp.162.5.847.
Mollica, R. F., Wyshak, G., de Marneffe, D., Khuon, F., & Lavelle, J. (1987). Indochinese versions of the Hopikins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. American Journal of Psychiatry, 144, 497–500.
Mouanoutoua, V. L., & Brown, L. G. (1995). Hopkins Symptom Checklist—25, Hmong Version: A screening instrument for psychological distress. Journal of Personality Assessment, 64, 376–383.
Nishio, K., & Bilmes, M. (1987). Psychotherapy with Southeast Asian Americans clients. Professional Psychology: Research and Practice, 18, 342–346.
Pang, K. Y. C. (1990). Hwabyung: The construction of a Korean popular illness among Korean elderly immigrant women in the United States. Culture, Medicine and Psychiatry, 14, 495–512.
Pang, K. Y. C. (2000). Symptom expression and somatization among elderly Korean immigrants. Journal of Clinical Geropsychology, 6, 199–212. doi:10.1023/A:1009541200013.
Pang, K. Y., & Lee, M. H. (1994). Prevalence of depression and somatic symptoms among Korean elderly immigrants. Yonsei Medical Journal, 35, 155–161.
Pew Research Center. (2012). The rise of Asian Americans. Retrieved from http://www.pewsocialtrends.org/2012/06/19/the-rise-of-asian-americans/
Phan, T., Steel, Z., & Silove, D. (2004). An ethnographically derived measure of anxiety, depression, and somatization: The Phan Vietnamese Psychiatric Scale. Transcultural Psychiatry, 41, 200–232. doi:10.1177/1363461504043565.
Reuber, M., & Elger, C. E. (2003). Psychogenic nonepileptic seizures: Review and update. Epilepsy & Behavior, 4, 205–216. doi:10.1016/S1525-5050(03)00104-5.
Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). The NIMH Diagnostic Interview Schedule: Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389. doi:10.1001/archpsyc.1981.01780290015001.
Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., et al. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117, 300–313. doi:10.1037/0021-843X.117.2.300.
Schwartz, P. Y. (2002). Why is neurasthenia important in Asian cultures? Western Journal of Medicine, 176, 257–258.
Simon, G. E., VonKorff, M., Piccinelli, M., Fullerton, C., & Ormel, J. (1999). An international study of the relation between somatic symptoms and depression. The New England Journal of Medicine, 341, 1329–1335.
Smith, R. C., Gardiner, J. C., Lyles, J. S., Sirbu, C., Dwamena, F. C., Hodges, A., … Goddeeris, J. (2005). Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms. Psychosomatic Medicine, 67, 123–129. doi:10.1097/01.psy.0000149279.10978.3e
Stewart, S. M., Lee, P. W. H., & Tao, R. (2010). Psychiatric disorders in the Chinese. In M. H. Bond (Ed.), Oxford handbook of Chinese psychology. New York, NY: Oxford University Press.
Sue, S. (2006). Cultural competency: From philosophy to research and practice. Journal of Community Psychology, 34, 237–245.
Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons.
Sue, S., Sue, D. W., Sue, L., & Takeuchi, D. T. (1995). Psychopathology among Asian Americans: A model minority? Cultural Diversity and Mental Health, 1, 39–51.
Tseng, W.-S. (2006). From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes. Transcultural Psychiatry, 43, 554–576. doi:10.1177/1363461506070781.
Tsui, P., & Schultz, G. L. (1985). Failure of rapport: Why psychotherapeutic engagement fails in the treatment of Asian clients. American Journal of Orthopsychiatry, 55, 561–569.
Tsung, Y. L. (1989). Neurasthenia revisited: Its place in modern psychiatry. Culture, Medicine and Psychiatry, 13, 105–129.
U.S. Census Bureau. (2010). The Asian populations: 2010. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf
U.S. Department of Health and Human Services. (2001). Mental health: Culture, race and ethnicity—A supplement to mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of Surgeon General.
Westermeyer, J., Bouafuely, M., Neider, J., & Callies, A. (1989). Somatization among refugees: An epidemiologic study. Psychosomatics, 30, 34–43.
Westermeyer, J., & Her, C. (2007). Western psychiatry and difficulty: Understanding and treating Hmong refugees. In J. P. Wilson & C. C. S.-K. Tang (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 371–393). New York, NY: Springer Science.
Willgerodt, M. A., & Thompson, E. A. (2006). Ethnic and generational influences on emotional distress and risk behaviors among Chinese and Filipino American adolescents. Research in Nursing & Health, 29, 311–324.
Wong, Y. J., Maffini, C. S., & Shin, M. (2014). The racial-cultural framework: A framework for addressing suicide-related outcomes in communities of color. The Counseling Psychologist, 42, 15–34. doi:10.1177/0011000012470568.
Wong, Y. J., Tran, K. K., Kim, S. H., Van Horn Kerne, V., & Calfa, N. A. (2010). Asian Americans lay beliefs about depression. Journal of Clinical Psychology, 66, 317–332.
Xu, Y. X. (1994). About ICD-10. Journal of Clinical Psychology in Medical Settings, 4, 224–226 (in Chinese).
Yang, L. H., & WonPat-Boria, A. J. (2007). Psychopathology among Asian-Americans. In F. T. L. Leong, A. G. Inman, A. Ebreo, L. H. Yang, L. M. Kinoshita, & M. Fu (Eds.), Handbook of Asian American psychology (2nd ed., pp. 379–405). Thousand Oaks, CA: Sage.
Yeung, A., Chang, D., Gresham, R. L., Nierenberg, A. A., & Fava, M. (2004). Illness beliefs of depressed Chinese American patients in primary care. The Journal of Nervous and Mental Disease, 192, 324–327.
Yi, K. Y. (2000). Shin-byung (divine illness) in a Korean woman. Culture, Medicine and Psychiatry, 24, 471–486.
Ying, Y. W. (1988). Depressive symptomatology among Chinese‐Americans as measured by the CES‐D. Journal of Clinical Psychology, 44, 739–746.
Zheng, Y.-P., Lin, K.-M., Takeuchi, D., Kurasaki, K. S., Wang, Y., & Cheung, F. (1997). An epidemiological study of neurasthenia in Chinese-Americans in Los Angeles. Comprehensive Psychiatry, 38, 249–259.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Maffini, C.S., Wong, Y.J. (2014). Assessing Somatization with Asian American Clients. In: Benuto, L., Thaler, N., Leany, B. (eds) Guide to Psychological Assessment with Asians. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0796-0_22
Download citation
DOI: https://doi.org/10.1007/978-1-4939-0796-0_22
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-0795-3
Online ISBN: 978-1-4939-0796-0
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)