Cultural Factors in Clinical Assessment

Misdiagnosis, overestimation, underestimation, or neglect of psychopathology are frequent problems when clinician and patient come from different cultures. Although national differences in diagnostic categories remain, international efforts over the last decade have facilitated the development of diagnostic categories and criteria with cross-cultural reliability. Special theoretical issues concerning cross-cultural psychopathology include culture-bound syndromes, variable distribution of psychopathology across cultures, and cultural distinctions between belief and delusion and between trance and hallucination. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) has not been adequately assessed from a cross-cultural perspective, its apparent achievements and failures are briefly reviewed. Finally, suggestions are offered for educating clinicians about cross-cultural conceptual issues and teaching the clinical skills necessary for cross-cultural work.