Culture and Psychiatric Diagnosis

Abstract

Since the publication of DSM-IV in 1994, a number of components related to psychiatric diagnosis have come under criticism for their inaccuracies and inadequacies. Neurobiologists and anthropologists have particularly criticized the rigidity of DSM-IV diagnostic criteria that appear to exclude whole classes of alternate illness presentations as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis –composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress—as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning.

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial

“…The field trial was designed by cultural psychiatry experts through the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) [18]. The New York State Psychiatric Institute (NYSPI) and Columbia University Department of Psychiatry formed a single site and coordinated logistics for all sites.…”

“…The OCF has been the most widely-used framework for introducing cultural competence to psychiatric trainees, with publications in over ten languages from six clinics around the world developing practice guidelines [16, 17]. For DSM-5, the OCF was revised into the Cultural Formulation Interview (CFI) by an international consortium to create a standardized interview of sixteen questions with guidelines [18]. An earlier draft of the CFI was tested in an international field trial for feasibility, acceptability, and clinical utility among patients and clinicians, and revised for DSM-5 based on their feedback [19].…”

Hoarding symptoms among psychiatric outpatients: confirmatory factor analysis and psychometric properties of the Saving Inventory – Revised (SI-R)

“…[16–19]). There is growing evidence that cultural differences exist in comprehending, interpreting, and responding to the language written in describing psychiatric symptoms [20]. Manifestation of psychiatric symptoms may also vary across cultures [20].…”

Global Mental Health and systems of diagnostic classification: clinical and cultural perspectives

“…Broader because it encompasses a multitude of variables giving shape to identity, social habits, religious beliefs, help-seeking patterns and what many people from many quarters call "environment"(61); and it is more specific because, by precisely defining those variables, it is also characterizing different sets or groups of people on the basis of geographic, ethnic, religious and epigenetic considerations (62). How the patient and their relatives perceive or explain disease and disease-induced suffering, and how their beliefs generate attitudes of empathy or disdain, of compassion or fear are distinctive socio-cultural features of any diagnosis (63). In short, the clinical perspective tends to find the similarities of homogeneity whereas the socio-cultural perspective accentuates the many shades of heterogeneity.…”

“…First of all, the implementation of an objective approach requires adequate policies and resources beginning with a genuine integration of the work of primary care providers and mental health professionals through the constitution of multidisciplinary, democratized teams open to the active participation of the patients themselves and their families (31,75,88). All of this entails respect for the human dignity and the cultural background of the individual patient and his/her surroundings, making it possible a comprehensive, realistic and pragmatic clinical management and reasonable outcome-oriented follow up (63,70,89).…”