Differentiation of Zaghrouta, Ululation to Express Joy in the Middle East, from Movement Disorders and Other Conditions

Introduction: Clinicians are trained to elicit symptoms and signs to formulate a differential diagnosis. Ruling out treatable diseases is crucial. Movement disorders specialists interpret observable behaviors as indicators of potential pathological processes. Movement disorders specialists must be able to identify symptoms and signs of organic disorders as well as actions that represent normal behaviors in healthy members of specific ethnic and cultural groups. The goal of this presentation is to describe zaghrouta, a manifestation of joy in the Middle East and other cultures, and to differentiate this normal expression of feelings from movement disorders, exaggerated startle responses, and functional disorders. Case Presentation: A 29-year-old Egyptian woman observed the performance of zaghrouta frequently for happy events in her family, neighborhood, and community since early childhood as long as she can remember. Ten years ago she herself first performed zaghrouta at the engagement party of her friend. Since then she has performed zaghrouta five or six times a year to express happiness for cheerful events. Conclusions: Zaghrouta may resemble pathological behaviors seen in movement disorders such as tardive dyskinesia, focal seizures, psychiatric manifestations such as catatonia in schizophrenia, tics in the syndrome of Gilles de la Tourette, and functional disorders. Therefore, clinicians around the world must be able to differentiate this normal behavior to express emotions from abnormal behaviors indicating pathology.