Culture and the anxiety disorders: recommendations for DSM-V

Abstract

Background The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over-specification” of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. Methods Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal applicability of the diagnostic criteria for six anxiety disorders. Results Possible mismatches between the DSM criteria and the local phenomenology of the disorder in specific cultural contexts were found for three anxiety disorders in particular. These involve the unexpectedness and 10-minute crescendo criteria in Panic Disorder; the definition of social anxiety and social reference group in Social Anxiety Disorder; and the priority given to psychological symptoms of worry in Generalized Anxiety Disorder. Limited evidence was found throughout, particularly in terms of neurobiological markers, genetic risk factors, treatment response, and other DSM-V validators that could help clarify the cross-cultural applicability of criteria. Conclusions On the basis of the available data, options and preliminary recommendations for DSM-V are put forth that should be further evaluated and tested.

Culture and Context in Mental Health Diagnosing: Scrutinizing the DSM-5 Revision

“…Alarcón et al 2002;Allik 2006;Ashton and Lee 2005;Becker 2007;Brown and Lewis-Fernández 2011;Escobar and Vega 2006;Hinton and Lewis-Fernández 2011;Kirmayer and Sartorius 2007;Kupfer et al 2002;Lee and Kleinman 2007;Lewis-Fernández et al 2010;Regier et al 2011;Room 2006). During the revision, the cultural expertise reviewed all relevant research published since DSM-IV was released in 1994.…”

“…For instance, as seen above, criteria for Panic Disorder include a note that states that BThe abrupt surge [of a Panic attack] can occur from a calm state or an anxious state.^This note apparently originates from reports showing that the previous requirement that panic attacks should Bcome out of nowhere^had to be re-thought from a cross-cultural perspective (eg. Lewis-Fernández et al 2010). Adding to the complexity, the manual also comments upon the imbalance of contextualising only some conditions and not all.…”

A critical engagement with the DSM-5 and psychiatric diagnosis

“…The first difficulty in attempting to answer the question of epidemiological variability is that cross-cultural comparative studies are plagued by problems regarding sampling, accessibility of populations, and reliability and validity of diagnoses (Hinton & Lewis-Fernández, 2011;Joyce, 2008;Olatawura, 200l). For example, a review of the literature since 1994 on cultural or race/ethnicity-related factors that may limit the universal applicability of the diagnostic criteria for anxiety disorders revealed mismatches between the DSM criteria and the local phenomenology in specific cultural contexts (Lewis-Fernández et al, 2010). Rossier, Ouedraogo, Dahourou, Verardi, and De Stadelhofen (2013) also point to the difficulty, when conducting research in Africa, of assessing measurement equivalence.…”

Cognitive-Behavioral Therapy of Obsessive-Compulsive Disorder in Children and Adolescents

“…The prevalence of OCD in children and adolescents has been reported between 0.5 and 3% [33,34]. In a recent study, in 16 European countries, median prevalence of OCD was found 0.7% [35].…”