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Falling-out is a culture-bound syndrome that is characterized by a "sudden collapse, which sometimes occurs without warning but sometimes is preceded by feelings of dizziness or “swimming” in the head."

Falling-out
Falling-out is listed in the culture-bound syndrome section in the DSM-IV TR.

''"Falling out is conceptualized as a dissociative reaction that is associated with constricted consciousness and designed to cope with anxiety. The most common descriptions note a sudden collapse or fainting spell that may be preceded by dizziness or “swimming in the head.” The syndrome may occur with or without warning. Individuals who report falling out indicate an awareness of their surroundings, although some report an inability to move. Some individuals claim they are unable to see, although their eyes are open and there is no indication of physical impairment. An analysis of emergency services data from Miami suggests that the syndrome is not the result of chronic organic illness (it can be differentiated from illnesses such as epilepsy) but a psychological reaction to specific stressors. Falling out is not treated as an illness until or unless it becomes disabling. Falling out is viewed as a reasonable response when attending a funeral or receiving shocking news, and it has been described as common in stressful school situations and very hot weather. Episodes of such behavior have been noted during religious services and ceremonies. Falling out is reportedly tolerated in the context of intense anger, rage, or fear. Falling out episodes prevent the individual from completing an undesirable or harmful act in response to intense anger. In the context of trauma, episodes may become chronic and thus debilitating because they interfere with employment and life functioning. Finally, falling out has also been noted in the context of inner-city life, particularly when multiple stressors such as overcrowding, high crime, and financial concerns are present."''

-Vetta L. Sanders Thompson CULTURE-BOUND SYNDROMES: FALLING OUT, BLACKING OUT http://www.learnmax.in/Multicultural-Psychology/350.html

Cultural Information
Falling-out is typically seen primarily in the southern United States and the Caribbean. It is known as "blacking-out" by Bahamians and "indisposition" by Haitians. It is considered a significant health problem for black Americans, Bahamians, and Haitians who live in urban cities in the southern United States.

Causes/Triggers
Falling-out is seen as a normal response (especially in the African American community) when one receives shocking news, participates in religious ceremonies, when attending a funeral, in very hot weather, or even when experiencing stressful school situations. The onset of this syndrome could even be caused by inner-city life, especially overcrowding and financial concerns. It can also be result of stressful or traumatic events such as robberies, etc.

Symptoms
This syndrome often occurs with no warning, however, a few reports state that some individuals experience head “swimming” and dizziness. The individual then collapses and appears to be in an unconscious state. While experiencing this “unconsciousness,” the person is not able to see or move but they are still completely aware of their surroundings because they can still hear. Even though the individual collapses, there are only few reports of salivation, tongue biting, and bowel or bladder incontinence. The episode may last a few minutes to a few hours.

Diagnosis/Treatment
The syndrome appears to be dissociation in the form of a constricted state of consciousness. Medical professionals should rule out diseases such as PTSD, anxiety, somatoform disorders, dissociative disorders, malingering, epilepsy, and narcolepsy before diagnosing a patient with falling-out. People who experience falling-out may be misdiagnosed as epileptic or hysteric. It could also possibly be considered a defense mechanism in response to fear, anger, etc. The syndrome is not treated as an illness unless it becomes disabling to the individual because it is seen as a psychological response to some sort of psychological reaction to stress.