Introduction: Anxiety disorders are among the most prevalent psychiatric conditions worldwide. However, their manifestations are shaped by cultural context. In India, patients often present with somatic and socially embedded symptoms, raising concerns about the validity of Western-derived diagnostic scales.


Purpose: This study examined whether standardised tools for generalised anxiety disorder (GAD) and panic disorder (PD) adequately capture culturally relevant symptom expressions in Indian populations and considered the need for decolonising diagnostic practices.


Method: A mixed-methods design was employed. Standardised anxiety measures, including HAM-A, BAI, GAD-7, and PDSS, were reviewed. A retrospective analysis of 100 case records was undertaken to identify reported symptoms. Additionally, 10 semi-structured interviews were conducted in Kannada with patients diagnosed with GAD or PD to elicit idioms of distress. Descriptive statistics and thematic analysis were applied.


Results: Standardised scales captured 21 domains of anxiety and 15 domains of panic symptoms. 352 different symptom descriptions were found in case records, with somatic complaints like "burning in the neck", "shivering", and "crawling sensations" predominating. Interviews validated distressing expressions in colloquial Kannada that resonated with the culture. Indian patients reported greater physical and socially contextualised manifestations and fewer cognitive symptoms (such as depersonalisation) than Western patients.


Conclusions: The cultural subtleties of anxiety presentations in India are not well reflected by Western diagnostic techniques. Accurate screening, diagnosis, and treatment planning depend on decolonising mental health diagnostics through the creation of indigenous, culturally grounded tools. These methods question the widespread use of Western psychiatric classifications and enhance patient-centered care.