of the ceremony vary by region. Some leaders may recommend that the patient first seek the help of a doctor, while others believe that interventions by the doctor, such as using needles for injections, may further agitate the zār, creating more problems for the patient. Those who choose traditional treatment for zār remain in isolation for up to seven days. This syndrome has been reported in North African and Middle Eastern countries, including Ethiopia, Egypt, Iran, and Sudan. Signs and symptoms of zār may include dissociative episodes, unexpected laughing, yelling, or singing, or even patients hitting their heads against a wall. Clients may exhibit apathy and be reclusive. Those under the influence of the zār may refuse to eat or carry out activities of daily living, and may develop an extended interaction with the possessing spirit. The evil eye The "evil eye" is also known as ʿayn al-ḥasūd (عين الحسود)" and "Mal De Ojo", and has been described by a number of sources. It is also described in Mexican culture The late Professor Alan Dundes theorized that belief in the evil eye had a Middle Eastern, Mediterranean, and Indo European pattern of distribution, and was completely unknown in the Americas, Pacific Islands, Asia, and sub-Saharan Africa until the introduction of European and possibly Moorish culture. He based his ideas upon the ancient underlying belief that water represented life and dryness represented death. Dundes suggested that evil caused by the evil eye came from its power to cause living beings to "dry up", specifically referring to infants, lactating mammals, and even young fruit trees. Symptoms included sudden vomiting, diarrhea, and loss of potency in men. Dundes contended that the evil eye dries up liquids, which explained its Middle Eastern and desert origins. This unique syndrome is also mentioned in the DSM-IV TR, Appendix I. The syndrome is also seen in many other Middle Eastern Countries. Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is, unfortunately, common in the Middle East due to the myriad conflicts experienced by people in the region. Diagnostic symptoms for PTSD include recurrent experiencing of the initial traumatic event(s) through flashbacks or recurrent night sweats and nightmares. Those afflicted with post-traumatic stress syndrome often seek to avoid others as well as any stimulus similar to the traumatic occurrence. They may also exhibit increased arousal. Difficulty in falling or staying asleep, unexpected episodic fits of anger, and hypervigilance may