Skip to main content

Assessing Somatization with Asian American Clients

  • Chapter
  • First Online:
Guide to Psychological Assessment with Asians

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R., & Unger, R. (2010). Symptom checklist-90-revised. Corsini encyclopedia of psychology (Vol. 1–2). Hoboken, NJ: John Wiley.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Isaac, M., Janca, A., & Orley, J. (1996). Somatization—A culture-bound or universal syndrome? Journal of Mental Health, 5, 219–222.

    Article  Google Scholar 

  • Kalibatseva, Z., & Leong, F. T. (2011). Depression among Asian Americans: Review and recommendations. Depression Research and Treatment, 2011, 9. doi:10.1155/2011/320902.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • Kim, B. S. K. (2011). Counseling & diversity: Counseling Asian Americans. Belmont, CA: Brooks/Cole.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60, 420–430.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Koh, K. B. (1998). Perceived stress, psychopathology, and family support in Korean immigrants and nonimmigrants. Yonsei Medical Journal, 39, 214–221.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Lee, S. (1997). A Chinese perspective of somatoform disorders. Journal of Psychosomatic Research, 43, 115–119. doi:10.1016/S0022-3999(97)00037-8.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Lin, K.-M. (1983). Hwa-byung: A Korean culture-bound syndrome? American Journal of Psychiatry, 140, 105–107.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Nishio, K., & Bilmes, M. (1987). Psychotherapy with Southeast Asian Americans clients. Professional Psychology: Research and Practice, 18, 342–346.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Pang, K. Y., & Lee, M. H. (1994). Prevalence of depression and somatic symptoms among Korean elderly immigrants. Yonsei Medical Journal, 35, 155–161.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Schwartz, P. Y. (2002). Why is neurasthenia important in Asian cultures? Western Journal of Medicine, 176, 257–258.

    PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Sue, S. (2006). Cultural competency: From philosophy to research and practice. Journal of Community Psychology, 34, 237–245.

    Article  Google Scholar 

  • Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: John Wiley & Sons.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Tsung, Y. L. (1989). Neurasthenia revisited: Its place in modern psychiatry. Culture, Medicine and Psychiatry, 13, 105–129.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • Westermeyer, J., Bouafuely, M., Neider, J., & Callies, A. (1989). Somatization among refugees: An epidemiologic study. Psychosomatics, 30, 34–43.

    Article  PubMed  Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Xu, Y. X. (1994). About ICD-10. Journal of Clinical Psychology in Medical Settings, 4, 224–226 (in Chinese).

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Yi, K. Y. (2000). Shin-byung (divine illness) in a Korean woman. Culture, Medicine and Psychiatry, 24, 471–486.

    Article  Google Scholar 

  • Ying, Y. W. (1988). Depressive symptomatology among Chinese‐Americans as measured by the CES‐D. Journal of Clinical Psychology, 44, 739–746.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cara S. Maffini M.A. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints 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

Publish with us

Policies and ethics