This part refers to Part E of the DSM V Cultural Formulation – Overall Cultural Assessment for Diagnosis and Care
The overall assessment needs to be integrated to present the key issues from the previous sections. It is important to identify what cultural or ethnic factors might predispose the client to their current problem.
Making a cross-cultural diagnosis is challenging given the complex variables involved – in particular, the possibility of culture-bound syndromes. However a rigorous cultural formulation will assist clinicians and clinical teams to establish a competent differential diagnosis, and a culturally congruent treatment plan.
The treatment plan may involve culturally specific elements (such as a traditional healer, family involvement), appropriate application of ethno-pharmacological principles, the engagement of interpreters and/or cultural advisors, and the use of culturally appropriate services or cultural consultants/culturally competent teams.
Issues to consider in developing the formulation:
- What is psychopathological and what is cultural?
- Many psychiatric disorders such as mood, anxiety, conduct, adjustment, somatoform, dissociative and personality disorders can present differently across cultures.
- Presentation of psychotic, bipolar and substance abuse disorders may vary less so.
- Delusions must be incongruent with culturally held beliefs and values.
Issues to consider when integrating the information:
- The narrative of cultural factors needs to reflect the client’s worldview, their explanatory model of the illness/disorder and their expectations.
- How the cultural formulation will affect management.
- Whether the type of treatment recommended is congruent with, and appropriate to, the client’s cultural experience.
- Whether to include psychopharmacological interventions as well as psychotherapeutic frameworks, the family (or not), the participation of religious and community elders and the engagement of an interpreter or a cultural case worker.
Inattention to any of these factors can result in non-adherence or premature termination of treatment as well as client dissatisfaction.