Ataque de Nervious

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Cult Med Psychiatry (2010) 34:219–243
DOI 10.1007/s11013-010-9177-8
ORIGINAL PAPER

Association of Trauma-Related Disorders
and Dissociation with Four Idioms of Distress
Among Latino Psychiatric Outpatients
´
Roberto Lewis-Fernandez • Magdaliz Gorritz •
´
Greer A. Raggio • Clara Pelaez • Henian Chen •
Peter J. Guarnaccia

Published online: 23 April 2010
Ó Springer Science+Business Media, LLC 2010

Abstract Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong ‘nexus’ of associations between dissociation and three of the idioms: currently being ´

R. Lewis-Fernandez (&) Á M. Gorritz Á G. A. Raggio
New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA e-mail: rlewis@nyspi.cpmc.columbia.edu
´
R. Lewis-Fernandez
Department of Psychiatry, Columbia College of Physicians & Surgeons, New York, NY, USA ´
C. Pelaez
Hospital Puerta de Hierro, Madrid, Spain
H. Chen
Department of Biostatistics, Winthrop University Hospital, Stony Brook University Medical School, Stony Brook, NY, USA
P. J. Guarnaccia
Institute for Health, Health Care Policy & Aging Research, Rutgers University, New Brunswick, NJ, USA

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Cult Med Psychiatry (2010) 34:219–243

ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses.

Keywords Idioms of distress Á Ataque de nervios Á Dissociation Á Trauma Á Posttraumatic stress disorder Á Altered perceptions Á Latinos

Introduction
Research on the empirical relationship between popular categories of mental and emotional suffering—idioms of distress (Nichter 1981)—and DSM-defined psychiatric disorders has become increasingly precise in recent years. Three research approaches have dominated the field. The first approach involves amassing large community-based samples with sufficient statistical power to examine the independent effects of a series of indicators—such as language fluency, ethnonational origin or use of religious or spiritual sources of care—on the presence of the idioms and on their association with psychiatric disorders (Guarnaccia et al. 1993, ´

2005, 2010; Lewis-Fernandez et al. 2009; Salgado de Snyder et al. 2000; Takeuchi et al. 2002). The second approach entails classifying clinical samples of mental health or general medicine patients who endorse the idiom on the basis of their psychiatric symptoms and disorders in order to clarify the conceptual...
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