Psychiatric symptoms and diagnoses

Early research describing the psychiatric status of refugee survivors, especially those who had been tortured, refrained from the use of psychiatric diagnoses because of a prevailing perception that the observed symptomatology was a normal response to horrific life experiences. (,!4) Similarly, many medical anthropologists believed that Western psychiatric diagnostic classifications were not relevant to the assessment of suffering in non-Western populations. (l5) Despite these reservations, the emergence of standardized diagnostic criteria for major depression and post-traumatic stress disorder ( PTSD) have allowed for the cultural validity of these diagnoses to be tested in a number of refugee settings. Observations since Kinzie et a/.(!6) and Mollica et al.(U) first diagnosed PTSD in Cambodian refugees, have made the cultural validity of PTSD seem almost certain. However, this reality does not negate the importance of culture-specific symptoms related to trauma that are independent of PTSD criteria. Recent large-scale epidemiological studies of refugee populations have confirmed the high prevalence of major depression and PTSD in Western (e.g. Bosnian (18)) and non-Western (e.g. Cambodian (!.9) and Bhutanese(29)) refugee communities. These findings are consistent with the high prevalence of psychiatric disorders found in refugee patients in clinical treatment in countries of resettlement. Clinical evidence is also emerging identifying head injury as causing significant psychopathology in refugee survivors.

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