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The case of th e Barking Man WP 9( I) :82-88, 1991) raises on ce aga in th e qu estion wh ether some mental disorders are "Cult u re Bound Syndromes " or a re merely cultu ral manifestations of basi c mental disorders wh ich plague humankind wh erever th ey live. Bernst ein and Gaw ( I) have recently made a com pe lling a rg ument for th e form er pos ition using the example of Koro. Kor o affects a variet y of e thnic groups throughout Southeast Asia a nd is characte rized by a n acut e, morbid panic accompanied by t he idea that th e penis is retract ing and will disappear, a t wh ich time, th e patient fears, he will di e. The di sorder is widespread, affe cting man y people, and has been preval ent in th e region for ge nera tio ns. As Bern st ein, Gaw, and th e numerous responses to th eir art icle have discu ssed (2,3), Kor o is not easy to pigeonhole in th e DSM-III -R. Panic disorder, bod y dysm orphic disorder, delusional di sorder are all possibi liti es but each requires additional essent ia l cri teria to accommodat e th e symptoms of Koro . Thus, Am eri can psychi atrist s deb at e whether Koro is an a nxie ty disorder, a soma toform disorder, or a psych oti c di sorder. South-East Asians on th e other hand are convince d that Koro is sim ply, Koro, a di sorder that occurs so rarely in th e U .S. th at it has not deserved a place as a di agnosis in th e DSM-Ill-R . Whereas , anorexia nervosa, a disorder exceed ing ly rare in Sou th -East Asia , but com monly encoun te red in th e United States rat es a place. The DSM's a ppa re n tly include those cult ure -bound syndromes found com mo nly in th e Un it ed States, but not those from other diverse cult u res of th e world, a nd in the minorit y populations in th e United States . In all fairness to th e develop ers of th e DSM's, th eir intent has been to cre ate ca te gories based on th e ph enomenology of those mental di sord ers encoun te red by Am erican psychiatrists. They never proposed th at this classification sho uld be applied elsewhe re . Nevertheless, th e DSM-III-R has by now become int ernat ion al (4) , a nd has been translated in to Chinese, Japanese, Danish , Dutch , Finnis h, French, Ge rman, Greek, Ita lia n, Spanish, Po rtugese, Swedish, Norwegian , Ru ssian , and has been ex te nsive ly eva lua ted for its use in many societi es aro und th e world and within th e United States. The W.H.O. International Pilot Study of Schizophrenia (IPSS) a nd th e N.I.M.H., Epidemiological Catchmen t Ar ea Program (E .C.A.P.) (5) are such attempts, and are bas ed on th e assum pt ion that m ental health probl ems a re st r ikin gly similar across cult u re s. The W.H.O.' s International Pilot Study of Schizoph reni a (IPSS) att empted to syst ematically verify this assum ption by utili zin g the Present State Examinat ion (PSE) on hospitalized psychotic patients in seven di fferen t nat ion s across th e world . Resea rch psychiatrists from India , Nigeri a , Co lum bia, Denma rk,

Cultural Diversity and the DSM-III-R: Can a Barking Man be Diagnosed?