Djinnati syndrome: Symptoms and prevalence in rural population of Baluchistan (southeast of Iran) Nour Mohammad Bakhshani a, *, Nasrin Hosseinbore b , Mohsen Kianpoor c a Research Center for Children and Adolescents’ Health, Zahedan University of Medical Sciences, Baharan Psychiatric Center, Zahedan, Islamic Republic of Iran b Marvedasht Center of Sciences and Research, Azad University, Marvedasht, Shiraz, Islamic Republic of Iran c Zahedan University of Medical Sciences, Baharan Psychiatric Center, Zahedan, Islamic Republic of Iran 1. Introduction The world in which we live has changed in many ways and understanding the psychological disorders requires local psycho- logical studies. Without awareness of the psychology of people in their cultural context, we will not be able to understand the ideology and the reason behind people’s actions (Bhawuk, 2011). Therefore, psychotherapeutic approaches should consider patients’ social, ethnic and cultural background. Providing cross- cultural psychotherapy is the major concern of the therapists who tend to treat patients with diverse backgrounds (Tseng and Streltzer, 2004) Obviously, considering cultural factors in assessing people with mental disorders and understanding their subjective experiences must be followed by accurate diagnosis, access to appropriate care, and effective treatment (Lim, 2006). If culture- bound syndromes are not studied, discussing and commenting on cultural explanations of diseases will remain incomplete. Culture- bound syndromes can be assessed as a cluster of symptoms and behaviors that are regarded as a disorder in the culture of a group, and usually affect the subject who belongs to that group (American Psychiatric Association, 2000; Spiegel et al., 2011). According to DSM-IV (American Psychiatric Association, 2000) a culture-bound syndrome is considered as a pattern specific to a location (culture), and a repetition of an abnormal behavior and troubling experience that may or may not depend on a particular DSM-IV diagnostic category. Most of these syndromes have been initially reported as problems specific to a particular culture or have a geographical origin (Shiraev and Levy, 2004). Many culture-bound syndromes are considered as dissociative disorders. Some examples of culture-bound syndromes/dissociative disorders include amok, bebainan, latah, pibloktoq, ataque de nervios and possession, shin- byung, enchantment, lack of spirit, and Zar (Gold et al., 2006; Spiegel et al., 2011). The main feature of dissociative disorders is a disruption in the ‘‘usually integrated functions of consciousness, memory, identity or perception of the environment. This rupture may occur suddenly or gradually, and it may be transient or Asian Journal of Psychiatry 6 (2013) 566–570 A R T I C L E I N F O Article history: Received 2 March 2013 Received in revised form 27 August 2013 Accepted 2 September 2013 Keywords: Djinnati Possession Culture-bound syndromes A B S T R A C T Objective: The present study describes ‘‘Djinnati,’’ a culture-bound syndrome and examines its prevalence and demographic attributes such as age, gender and education level in the rural population of Baluchistan in southeast Iran. Method: In this cross-sectional study, the participants (n = 4129) were recruited from people living in rural areas of Baluchistan (southeast Iran) by multistage sampling. The data were collected through interviews with local healers, health care personnel, family health records, interview patients suspected with the disorder and their relatives. We administered the dissociative experiences scale. Results: Prevalence of Djinnati syndrome was about 0.5% in the studied population and 1.03% in women. All patients who experienced episodic symptoms of Djinnati were female. The most common reported symptoms were altered consciousness and memory, muteness, laughing, crying, incomprehensible speech and hallucination that have been attributed to a foreign entity called ‘‘Djinn.’’ In addition loss of speech or change in speech rhythm and tone of voice was observed in a subgroup. In one case, speaking in a different language during the attack was reported. There was partial and rarely complete amnesia during the attack. Attacks usually lasted from 30 min to 2 h. Discussion: It is suggested that future studies explore prevalence of Djinnati syndrome in women and explore predisposing, precipitating, and maintaining factors. It is further suggested that a comprehen- sive pathology model should integrate the data related to socio-cultural context in order to prevent and treat this syndrome. ß 2013 Elsevier B.V. All rights reserved. * Corresponding author. Tel.: +98 5414522636; fax: +98 5414522636. E-mail addresses: nmbs14@yahoo.com, bakhsha@yahoo.com (N.M. Bakhshani). Contents lists available at ScienceDirect Asian Journal of Psychiatry jo u rn al h om epag e: ww w.els evier.c o m/lo cat e/ajp 1876-2018/$ – see front matter ß 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2013.09.012