Cultural concepts have four key features in relation to the DSM-S nosology: - There is seldom a one-to—one correspondence of any cultural concept with a DSM diag- nostic entity; the correspondence is more likely to be one-to-many in either direction, included in a single folk concept, and diverse presentations that might be classified by
DSM-5 as variants of a single disorder may be sorted into several distinct concepts by an indigenous diagnostic system.
0 Cultural concepts may apply to a wide range of severity, including presentations that do not meet DSM criteria for any mental disorder. For example, an individual with acute grief or a social predicament may use the same idiom of distress or display the same cultural syndrome as another individual with more severe psychopathology.
0 In common usage, the same cultural term frequently denotes more than one type of cultural concept. A familiar example may be the concept of ”depression,” which may be used to describe a syndrome (e.g., major depressive disorder), an idiom of distress (e.g., as in the common expression “I feel depressed"), or a perceived cause (similar to ”stress").
0 Like culture and DSM itself, cultural concepts may change over time in response to both local and global inﬂuences.
Cultural concepts are important to psychiatric diagnosis for several reasons: ' To avoid misdiagnosis: Cultural variation in symptoms and in explanatory models as- sociated with these cultural concepts may lead clinicians to misjudge the severity of a problem or assign the wrong diagnosis (e.g., unfamiliar spiritual explanations may be misunderstood as psychosis).
0 To obtain useful clinical information: Cultural variations in symptoms and attribu- tions may be associated with particular features of risk, resilience, and outcome.
I To improve clinical rapport and engagement: ”Speaking the language of the patient,” both linguistically and in terms of his or her dominant concepts and metaphors, can re- sult in greater communication and satisfaction, facilitate treatment negotiation, and lead to higher retention and adherence.
0 To improve therapeutic efficacy: Culture inﬂuences the psychological mechanisms of disorder, which need to be understood and addressed to improve clinical efficacy. For example, culturally specific catastrophic cognitions can contribute to smptom escala— tion into panic attacks.
0 To guide clinical research: Locally perceived connections between cultural concepts may help identify patterns of comorbidity and underlying biological substrates.
. To clarify the cultural epidemiology: Cultural concepts of distress are not endorsed uniformly by everyone in a given culture. Distinguishing syndromes, idioms, and ex- planations provides an approach for studying the distribution of cultural features of ill- ness across settings and regions, and over time. It also suggests questions about cultural determinants of risk, course, and outcome in clinical and community settings to en- hance the evidence base of cultural research.
DSM-S includes information on cultural concepts in order to improve the accuracy of diagnosis and the comprehensiveness of clinical assessment. Clinical assessment of indi- viduals presenting with these cultural concepts should determine whether they meet
DSM-5 criteria for a specified disorder or an other specified or unspecified diagnosis. Once the disorder is diagnosed, the cultural terms and explanations should be included in case for- wise be confusing. Individuals whose symptoms do not meet DSM criteria for a specific by—case basis. In addition to the CFI and its supplementary modules, DSM-S contains the in clinical practice: 0 Data in DSM-S criteria and text for specific disorders: The text includes information on cultural variations in prevalence, symptomatology, associated cultural concepts, and other clinical aspects. It is important to emphasize that there is no one-to-one cor- respondence at the categorical level between DSM disorders and cultural concepts. Dif- variation with information elicited by the CFI.
0 Other Conditions That May Be a Focus of Clinical Attention: Some of the clinical con- cerns identified by the CFI may correspond to V codes or Z codes—for example, accul- turation problems, parent—child relational problems, or religious or spiritual problems.