Module 4 – Part 2 – Idioms of distress

The technical term idiom of distress refers to the varieties of ways people express their distress in a clinical setting. In the early 1980s, the anthropologist Mark Nichter (1981) introduced the concept of “idioms of distress,” and since then it has experienced a growing importance in disciplines that aim at understanding the doctor/ physician/ health care worker-patient relationship. Meanwhile it has also been included in the DSM-V.

„In any given culture, a variety of ways exist to express distress. Expressive modes are culturally constituted in the sense that they initiate particular types of interaction and are associated with culturally pervasive values, norms, generative themes, and health concerns“. (Nichter 1981, 379)

Every patient, independently of his or her origin, uses idioms of distress. Physicians need to direct their attention to them in order to understand the condition of his or her patient.

Aside from that, idioms of distress have a cultural component and depend on the context. Superficially compared, people with different cultures show both similarities and differences in the manner of expressing their distress, in their idioms of distress; also within one culture there is a wide range of expression.

Two important questions need to be considered (cf. Nichter 2010):


Who is expressing distress?

Personal history Experience of war, persecution, flight, living in a refugee camp
Place of origin  
Social status and self-image Rich or poor; well respected business men, farmer, student, vulnerable group (i.e. gay people)
Religion and moral principles ·         Protestant, Catholic, Muslim, Jewish, Atheist

·         Very conservative, very liberal


In which context does a person express distress?

At home, in a safe place  In front of family or friends
In a semi-public context In front of a pharmacist
In the hospital or doctoral practice In front of a physician or a nurse


 For further information you may watch the following video on Youtube:

‪Dr. Laurence Kirmayer; Lecture: “Cultural Psychiatry: Lecture #2 Somatization and Bodily Idioms of Distress” []