When culture informs the illness: 3 cultural psychiatric disorders you may not know

By Jules Murtha | Medically reviewed by Amanda Zeglis, DO, MBA
Published July 29, 2022

Key Takeaways

  • Clinical lycanthropy is a disorder characterized by the delusion that the patient will shapeshift into a wolf.

  • Kufungisisa is a Sub-Saharan African-based condition in which the patient “thinks too much,” while Khyâl attacks among Cambodians are known as “wind attacks” and have similar characteristics as anxiety.

  • Depending on the culture, doctors may treat lycanthropy, Kufungisisa, and Khyâl attacks with medications and other biomedical or psychological tools, patient-centered care, spiritual practices, community support, and coining.

Psychiatric disorders don’t exist in a vacuum. In fact, they are informed by culture, and certain symptoms can hold cultural significance.

To give you a closer look at how some culturally specific psychiatric disorders manifest, we’ve gathered a list of three for you to familiarize yourself with. Not only will you be able to recognize their symptoms, but you’ll also have an idea of how to treat them.


The first on our list is clinical lycanthropy: A syndrome marked by the delusion that the patient can—and will—transform into a wolf.

According to a study published by Frontiers in Psychiatry, lycanthropy sits at the underexplored intersection of neuroscience and culture.[]

With its origins dating back to Antiquity, lycanthropy may be informed by Western folklore and mythology regarding wolves.

In Greek mythology, for instance, Zeus turns the king of Arcadia, Lycaon, into a wolf. Current popular media still portrays the metamorphosis of humans into wolves. Think: Teen Wolf and Twilight.

Clinical lycanthropy (and a related disorder, kyanthropy, the delusion one will turn into a dog) is rare, with only 38 cases identified between 1970 and 2020. Evidence shows that those who have lycanthropy tend to present other psychotic and schizoaffective disorders, such as schizophrenia, bipolar disorder, and psychotic depression.

For treatment, physicians can rely on antipsychotics, antidepressants, or mood regulators in combination with cognitive behavioral therapy (CBT) to effectively address clinical lycanthropy and any other underlying psychotic disorders with a patient-centered approach.


The second cultural psychiatric disorder on our list is Kufungisisa, which has roots in Zimbabwe and is characterized by the act of “thinking too much.” Similar conditions can be located in other parts of Sub-Saharan Africa as well.

As mentioned in an article in Culture, Medicine, and Psychiatry, Kufungisisa captures the ways in which some individuals express their distress when supernatural or social circumstances arise.[]

Kufungisisa could lead to pain in the heart, also known as moyo unorwadza. Spiritual factors play a significant role in the development of this mental illness, often involving ancestral spirits or bewitchment.

Another reported cause of excessive thinking is trauma.

Some patients in Uganda who bear an HIV diagnosis use the phrase kufungisisa kwe njodzi, which translates to “thinking too much due to traumatic experience.”

Somatic symptoms associated with Kufungisisa may include body aches, insomnia, and lack of appetite. Rumination is characteristic, as are psychological symptoms of anger, fatigue, hopelessness, burnout, and grief. Individuals with a severe case could experience hallucinations, suicidal thoughts, and substance abuse.

To treat Kufungisisa (or similar illnesses in the region), doctors can implement various biomedical, spiritual, or religious strategies, alongside community support. The choice depends on what purportedly caused the condition in that patient and that individual’s cultural context.

Khyâl attacks

Third on our list of culturally specific psychiatric conditions to learn about is known among Cambodians as a Khyâl attack.

Khyâl attacks, according to The SAGE Encyclopedia of Abnormal and Clinical Psychology, are also known as “wind” attacks.[] This is because those who experience them consider Khyâl to be a wind-like substance that, in a healthy state, flows freely through the body and exits by various means—through the extremities, the eyes, the ears, the GI tract, and other locations.

A surge of Khyâl in its escape, or blockage of the escape, can lead to symptoms of an attack.

If Khyâl surges upward in the body (along with blood), it can cause symptoms such as dizziness, tinnitus, shortness of breath, nausea, and palpitations. Khyâl attacks look very similar to what Westerners would call anxiety (or panic) attacks.

Cambodians report that stress, anxiety, worry, weather changes, entering crowded areas, and being startled are usually what triggers Khyâl attacks.

Patients treat their Khyâl attacks with an approach known as coining. Coining involves rubbing the fingertip with a substance that contains camphor and menthol, similar to the consistency of petroleum jelly. After dragging the fingertip along the skin, the patient then grasps a coin and pushes the edge lightly against the skin in an outward direction, leaving visible lines. The coin-dragging is said to free up the blockages and help the Khyâl flow properly.

Similar practices occur in Chinese culture with gua sha, alongside other comparable elements being adapted in modern American culture with cupping techniques.

What this means for you

Culture plays an important role in psychiatric disorders around the world. In the global West, clinical lycanthropy is a rare disorder in which the afflicted patient believes they will transform into a wolf. Narrative and patient-centered care, as well as the use of antipsychotics and CBT, may be effective in treatment. Kufungisisa, a condition identified in Sub-Saharan African communities, is what’s known as “thinking too much.” Its symptoms are treated with medicinal, spiritual, and social support. Finally, attacks of Khyâl (“wind”) among Cambodians have similar features of anxiety attacks. They are commonly treated with a ritual called coining. Taking the opportunity to identify and understand the cultural background of patients can improve awareness, alongside aid in informing diagnosis and treatment choices.

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