Posttraumatic stress and somatization in Iraqi Shiite refugees: Clinicians' judgments

Lindsay K. Olden (2007)

Refugees are known to suffer extensive psychological distress owing to the sociocultural and sociopolitical nature of their life experiences (Jamil, Hakim-Larson, Farrog, Kafaji, Duqum, & Jamil, 2002; Weine et al., 1998). While the presence of psychological distress in this population is clear (Mollica et al., 1998), its symptomatic presentation is not. Furthermore, the presentation of distress by more recent refugees, such as Iraqis, is even less understood. At present, posttraumatic stress disorder (PTSD) and somatization are common symptom patterns within refugee populations (Erickson & Al-Timimi, 2001; Huynh & Roysircar, 2006). Despite the known association between refugees and the likelihood of these disorders, misdiagnosis may still occur owing to unfamiliar cultural variables in symptom presentation and assessment biases of service providers (Marsella, Friedman, Gerrity, & Scurfield, 1996). Thus, the combination of cultural factors in mental health and newly developing refugee groups in the U.S. requires research. The present study examined service providers' diagnosis of psychological symptomatology of Iraqi Shiite refugees. Service providers at refugee resettlement organizations participated in an online survey. Survey data were examined to study the prevalence rates of PTSD and somatization symptoms of Iraqi Shiite refugees and the relationship between PTSD and somatization. PTSD (50-75% of cases) and somatization (25-50% of cases) were diagnosed in this population. Additionally, it was found that these disorders co-occurred (50-75% of cases). Despite high rates of reporting, it is possible that PTSD and somatization may have even been under-diagnosed because Iraqi refugees did not meet the full criteria of the DSM-IV-TR (American Psychiatric Association, 2000). In particular, it was found that Iraqi refugees often did not present with 2 of the criteria necessary for the diagnosis of somatization disorder, while they did present with symptoms in all DSM categories necessary for the diagnosis of PTSD. Additionally, Iraqi refugees were found to have significant life functioning problems (50-75% of cases). The combination of these results and the known literature on refugee populations were used to propose the addition of somatization and life functioning problems to the current set of 5 criteria for PTSD when working with culturally diverse refugees.