Cultural Obstacles in Emotion Expression among Patients with Somatic Symptom Disorder (SSD) in an Iranian Sample: A Qualitative Study

Document Type : Original Article

Authors

1 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran

2 Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Numerous studies have indicated the role of unexpressed emotions in Somatic Symptoms Disorder (SSD). There are also many studies demonstrating a high prevalence rate of SSD in Iran. Literature suggests that due to cultural issues in Iran, it is difficult directly expressing emotions. Therefore, the issue of emotion expression contributes to a high prevalence of SSD in Iran. To address this issue, the aim of this study was to discover cultural obstacles in emotional expression among patients with SSD in an Iranian sample.
Method:  A qualitative conventional content analysis was conducted on the data collected from 17 individual in depth interviews with SSD patients, and mental health professionals who were recruited throughout a purposive and theoretical sampling. The sample was derived from the statistical population of SSD patients who were referred to mental health professionals at therapeutic centers in Tehran, Iran.
Results: Three themes were emerged as the obstacles of emotion expression in SSD patients in the context of the Iranian culture: 1) Overgenderizing emotions 2) Internalized ban of expressing emotions towards parents and other authorities 3) Difficulties with expressing positive emotions.
Conclusion: It seems that SSD patients in Iran have difficulties directly expressing their emotions, regarding the four aforementioned cultural barriers identified in this study.

Keywords


  1. References

    1. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadocks comprehensive textbook of psychiatry. Philadelphia: Wolters Kluwer; 2017.
    2. Bagayogo IP, Interian A, Escobar JI. Transcultural Aspects of Somatic Symptoms in the Context of Depressive Disorders. Cultural Psychiatry Advances in Psychosomatic Medicine. 2013:64–74.3
    3. Kirmayer LJ, Sartorius N. Cultural models and somatic syndromes. Psychosomatic Medicine. 2007 Nov 1; 69(9):832-40.
    4. Ryder AG, Yang J, Zhu X, Yao S, Yi J, Heine SJ, Bagby RM. The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? Journal of abnormal psychology. 2008 May; 117(2):300.
    5. Pliskin KL. Dysphoria and somatization in Iranian culture. Western Journal of Medicine. 1992 Sep; 157(3):295.
    6. Good MJ, Good BJ. Ritual, the state, and the transformation of emotional discourse in Iranian society. Culture, Medicine and Psychiatry. 1988 Mar 1; 12(1):43-63.
    7. Firoozabadi A, Seifsafari S, Bahredar MJ. P-480-A symptom profile analysis of depression in a sample of iranian patients (Shiraz-2011). European Psychiatry. 2012 Jan 1; 27:1.
    8. Diagnostic and statistical manual of mental disorders DSM-5. Washington: American Psychiatric Association; 2013.
    9. Abdolmohamadi K, Pourmand NS, Moghadam HS, Kheyradin JB. The Somatization Predictions Derived From Personal Characteristics. International Journal of Behavioral Sciences. 2017 Dec 12;11(3):86-9
    10. Harshaw C. Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression. Psychological Bulletin. 2015; 141(2):311–63.
    11. Erkic M, Bailer J, Fenske SC, Schmidt SNL, Trojan J, Schröder A, et al. Impaired emotion processing and a reduction in trust in patients with somatic symptom disorder. Clinical Psychology & Psychotherapy. 2017; 25(1):163–72.
    12. Slavin-Spenny O, Lumley MA, Thakur ER, Nevedal DC, Hijazi AM. Effects of Anger Awareness and Expression Training versus Relaxation Training on Headaches: A Randomized Trial. Annals of Behavioral Medicine. 2013; 46(2):181–92.
    13. Ziadni MS, Carty JN, Doherty HK, Porcerelli JH, Rapport LJ, Schubiner H, et al. A life-stress, emotional awareness, and expression interview for primary care patients with medically unexplained symptoms: A randomized controlled trial. Health Psychology. 2018; 37(3):282–90.
    14. Ansari A. Acculturation and Attitudes toward Psychological Help Seeking among Iranian Americans. California State University, Fullerton; 2017.
    15. Partiali NR. Family conflict, psychological maladjustment, and the mediating roles of sociotropy and coping in Iranian American adolescents. Alliant International University; 2011.
    16. Rouhparvar A. Acculturation, gender, and age as related to somatization in Iranians (Doctoral dissertation, ProQuest Information & Learning).
    17. Noorbala AA, Bagheri Yazdi SA, Asadi Lari M, Mahdavi V, Reza M. Mental health status of individuals fifteen years and older in Tehran-Iran (2009). Iranian journal of psychiatry and clinical psychology. 2011 Feb 15; 16(4):479-83.
    18. Malekian A, Afshar H, Ahamadzadeh G. Cultural Issues in Anxiety Disorders: Some Particularities of the Iranian Culture. International Journal of Body, Mind and Culture. 2013 Nov 5; 1(1):54-8.
    19. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004 Feb 1; 24(2):105-12.
    20. Anoosheh Z, Fathi-Ashtiani A, Ahmadi F, Azadfallah P. Perception of being Overweight in Iranian Women: A Qualitative Study. International Journal of Behavioral Sciences. 2018 Oct 23;12(3):96-101.
    21. Jalali, B. (1996). Iranian Families. In McGoldrick, M.; Giordano, J. and Pearce, J. (Eds.), Ethnicity and Family Therapy, (pp. 347-363). New York, NY:Guilford Publications, Inc.
    22. Simpson PA, Stroh LK. Gender differences: emotional expression and feelings of personal inauthenticity. Journal of Applied psychology. 2004 Aug; 89(4):715.
    23. Novin S, Banerjee R, Dadkhah A, Rieffe C. Self‐reported use of emotional display rules in the Netherlands and Iran: Evidence for sociocultural influence. Social Development. 2009 May; 18(2):397-411.
    24. Ford CV. Somatic symptoms, somatization, and traumatic stress: An overview. Nordic Journal of Psychiatry. 1997 Jan 1; 51(1):5-13.
    25. Joshanloo M, Weijers D. Aversion to happiness across cultures: A review of where and why people are averse to happiness. Journal of happiness studies. 2014 Jun 1; 15(3):717-35.

    Joshanloo M, Weijers D. Aversion to happiness across cultures: A review of where and why people are averse to happiness. Journal of happiness studies. 20