Social and cultural factors

Social and cultural factors are important determinants of somatization and hypochondriasis. Not only does somatization elicit caretaking behaviour from others, but it secures the sick role for those with legitimate afflictions.(69) This social role with its privileges—avoidance of blame for illness and exemption from social role responsibilities—protects society from the disruptive effects of illness and promotes the return to health and social functioning of its members. Persons who are trapped in difficult relationships or social circumstances may find a face-saving solution in illness. Consequently, persons who are especially vulnerable to psychosocial stressors, such as those of low socioeconomic status, are prone to somatization. Somatization is common in cultures where the stigma attached to mental illness is strong—frequent somatization among Hispanic peoples has been attributed to such factors.

Physicians play an important role in the development and persistence of hypochondriasis. Often they contribute by making alarming statements or ordering anxiety-provoking tests or procedures. Also, when perceived as uncaring or unskilled, their reassurance may be ineffective. When physicians tell hypochondriacal patients there is nothing wrong, they challenge them and contribute to their alienation from the medical system.

Different cultural and ethnic attitudes may also encourage hypochondriacal concerns. According to Baur, (4) the American lifestyle, which emphasizes fitness and attractiveness, fosters preoccupation with health and influences people to see their distress in terms of physical illness. There are, for example, cultural differences in pain threshold, pain tolerance, patterns of arousal, and physiological and behavioural responses to pain. There are also differences in hypochondriacal concerns across cultures; for instance, Kleinman(79 observed that Chinese people who are depressed view themselves as suffering from physical disease.

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