Ivan Karp (1985) argues that "culture-bound syndromes" are tied to the culture that presents the condition and therefore are supported by the culture. This creates some conceptual problems for the genesis of the “culture-bound syndromes” advocated by Hahn (1985). The main intangible problem with Hahn's (1985) argument is that not all diseases have a biological basis. Rather, they often manifest themselves psychiatrically in different cultural contexts. Although some of them may present some physical symptoms, they are mostly culturally established with psychological symptoms. Such examples might include Koro, Peito aberto and Hikikomori (Thousand