Differences across cultural and ethnic groups exist in terms of how these groups react to pain and respond to painful stimuli (Chaplin, 1997; DSM-IV, 1994, p. 460). For example, Jewish patients tend to show pain more openly than Asian clients do. The reason for this difference in the expression of pain is that Asians "in general are taught self-restraint and may be more reluctant to express pain" (Castillo, 1997, p. 196). The DSM-IV (1994) suggests that cultural variants in the evaluation and treatment of patients with Pain Disorder might be of limited utility because of the great deal of individual differences in the expression of pain across cultures. Another reason for this limitation is that it is extremely difficult to assess the severity of pain with objectivity (Castillo, 1997), which might prevent clinicians from distinguishing pain with sufficient medical justification from pain suggesting either Pain Disorder or culturally related pain in a given culture.
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