Falling-out: A diagnostic and treatment problem viewed from a transcultural perspective

Culture and Conversion Disorder: Implications for DSM-5

“…A similar, but more circumscribed, set of symptoms also characterizes the Haitian syndrome of indisposition (Weidman, 1979;Philippe & Romain, 1979). Weidman (1979) reports that 23% of Bahamian and 10% of Southern African American households (out of samples of "approximately 100 per ethnic group" -further details are not provided) reported one or more members as suffering from falling-out spells, though the level of pathology associated with these presentations was not assessed.…”

“…A similar, but more circumscribed, set of symptoms also characterizes the Haitian syndrome of indisposition (Weidman, 1979;Philippe & Romain, 1979). Weidman (1979) reports that 23% of Bahamian and 10% of Southern African American households (out of samples of "approximately 100 per ethnic group" -further details are not provided) reported one or more members as suffering from falling-out spells, though the level of pathology associated with these presentations was not assessed. It is noteworthy that some Bahamian and Southern African American respondents apply the term seizures to describe falling-out episodes, and that the phenomenon is often misdiagnosed (despite a normal EEG) as idiopathic epilepsy when these individuals present in neurological settings (Weidman, 1979).…”

“…Weidman (1979) reports that 23% of Bahamian and 10% of Southern African American households (out of samples of "approximately 100 per ethnic group" -further details are not provided) reported one or more members as suffering from falling-out spells, though the level of pathology associated with these presentations was not assessed. It is noteworthy that some Bahamian and Southern African American respondents apply the term seizures to describe falling-out episodes, and that the phenomenon is often misdiagnosed (despite a normal EEG) as idiopathic epilepsy when these individuals present in neurological settings (Weidman, 1979). Excessive movement of the limbs, head, and trunk seem to be more common in PNES than in falling-out, which tends to be characterized by fainting and a loss of motor activity (Reuber, 2008;Weidman, 1979).…”

“…Several cultural syndromes have features resembling pseudoneurological symptoms, particularly PNES. These include ataque de nervios (attack of nerves) in Latinos (Guarnaccia, Canino, Rubio-Stipec, & Bravo, 1993;Lewis-Fernández et al, 2007); the related syndromes of falling-out, blacking-out, and indisposition in Caribbeans of African descent and Southern African Americans (Weidman, 1979;Philippe, & Romain, 1979); and kyol goeu in Cambodians (Hinton, Um, & Ba, 2001a). Unlike most Western cases of PNES, however, these syndromes may be regarded as explicable and acceptable expressions of intense distress, rather than pathological per se, particularly when they occur occasionally and in culturally appropriate situations, such as funerals.…”

“…Another cultural syndrome that has much in common with non-epileptic attack disorder is the syndrome of falling-out (or blacking-out) typically reported by individuals of Bahamian or Southern African American descent, which is characterized by similar symptoms of collapse, blindness, paralysis, and/or loss of consciousness, often preceded by dizziness or "swimming" sensations in the head (Weidman, 1979). A similar, but more circumscribed, set of symptoms also characterizes the Haitian syndrome of indisposition (Weidman, 1979;Philippe & Romain, 1979).…”