Phobic states presenting as somatic complaints syndromes in Nigeria: socio-cultural factors associated with diagnosis and psychotherapy.

Previous publications have given the impression that phobic states do not exist, or are very rare, in Africa south of the Sahara. This study has shown that this impression is erroneous. One of the explanations for this stems from the fact that African psychiatric patients tend to present with predominantly somatic complaints. These complaints mask the underlying illness making diagnosis very problematic. In an in-depth study of a sample of psychoneurotic patients, in Nigeria, phobic states were found to account for the complaints made by a substantial number of the patients. The type of objects to which fears tend to be bound in African patients are not often the same as those in Western society. This offers another explanation why identification of phobic states might have been missed by the previous writers. The socio-cultural and psychodynamic aspects of this illness in the African are discussed, as well as the effects which such factors may have on the physician-patient relationship, their relevance in diagnosis-making and in successfully implementing psychotherapy for the patients.