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Idioms of Distress Among Spanish-Speaking Cultures

In Session With Glòria Durà-Vilà, MD, MRCPsych, MSc:

Idioms of Distress Among Spanish-Speaking Cultures


April 9, 2012

Glòria Durà- Vilà, MD, MRCPsych, MSc


Consultant Child and Adolescent Psychiatrist, Surrey and Borders Partnership NHS Foundation Trust, UK; Visiting Lecturer, Department of Mental Health Sciences, University College London


First published in Psychiatry Weekly, Volume 7, Issue 7, on April 9, 2012


Q: How can descriptions of mental distress vary among some Spanish-speaking cultures?

A: Susto, nervios, and ataque de nervios—“fright,” “nerves,” and “attack of nerves”—are idioms of distress widely experienced among Hispanic Americans; they are often associated with psychiatric disorders, especially mood and anxiety disorders. We undertook a population survey in four adult education centers in Spain using hypothetical case vignettes of individuals suffering from these idioms of distress. This is, to our knowledge, the first study to explore these idioms in a population resident in Spain. The aims of the study were to investigate understanding of these idioms of distress, and attitudes toward help-seeking, among indigenous Spanish and Hispanic American residents in Spain.

We found that the idioms ataque de nervios and nervios were recognized by the majority of the Hispanic American and Spanish participants. However, though susto was recognized by half of the Hispanic Americans, it was only infrequently recognized by the Spanish group. In fact, Hispanic Americans had statistically significantly higher levels of use of the three idioms than Spanish people. Findings from the regression analysis showed that being Hispanic American and having lower educational attainment were associated with greater use of susto.

Q: Did the Spanish and Hispanic American groups vary in their recommendations of help-seeking for the idioms of distress?

A: Hispanic Americans were found to have statistically significantly higher levels of medical help-seeking behavior—seeing a psychiatrist or psychologist—than Spanish people (for ataques and nervios). In contrast, those born in Spain relied significantly more on non-medical sources of support, such as family and friends, than Hispanic Americans. This difference might arise simply because the immigrant participants had fewer family and friends near them and were less inclined to think about them as an immediate source of support for the characters of the vignettes. Despite the differences found amongst ethnic groups regarding non-medical sources of help, these sources were indeed widely used across groups: the help of relatives and friends was recommended by over half of the participants. The most frequently recommended medical help-seeking behavior was seeing a psychiatrist or a psychologist, highlighting the psychological—rather than physical—nature of the complaints.

Interestingly, the study has found a complex fit between the use of the idioms of distress and help-seeking. It suggests that people hold multiple models of distress and disorder in their minds. It is essential that efforts be made by mental health professionals to carefully explore the patient’s own understanding of their symptoms and their wider social and cultural context, thereby gaining insight into the subjective experience of illness.


Disclosure: Dr. Durà-Vilà reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.


1. Durà-Vilà G, Hodes M. Cross-cultural study of idioms of distress among Spanish nationals and Hispanic American migrants: susto, nervios and ataque de nervios. Soc Psychiatry Psychiatr Epidemiol. 2012 Jan 24 [Epub ahead of print]