Disordered Personalities 2ed

Disordered Personalities — Setond Edition
Personality & Culture
While the DSM-IV is prepared and published by the American
Psychiatric Association, it is used by clinicians for ethnically diverse
populations within the United States as well as in other countries. A
number of features in the DSM-IV specifically address cultural aspects:
• a section outlining cultural factors (where applicable) in the description
of the disorder that accompanies the diagnostic criteria; this is generally
included with age and gender-specific considerations
• an outline for cultural formulation which assists clinicians in more
accurately assessing the impact of an illness within the individual’s cultural
context (this appears in Appendix I)
• a glossary of culture-bound syndromes (also in Appendix I)
Personality disorder criteria in particular can be difficult to apply across
cultural situations. Concepts of self, coping mechanisms and modes
of emotional expression vary considerably between cultures. However,
the WHO has emphasized the similarity in psychiatric illnesses between
cultures and that diagnostic constructs are applicable regardless of
culture. The increasing amount of information about genetic
contributions to psychiatric disorders supports this view. Paris (1991)
reported on the WHO multi-site investigation of personality disorder
diagnoses on four continents. The findings suggest that the majority of
personality diagnoses made would be applicable in all centers.
Epidemiologic studies have consistently shown the prevalence of Axis
II conditions across populations to be in the range of 1 - 3% (for each
diagnosis). Accordingly, cultural factors have not been consistently
shown to have a dominant role in the etiology of personality disorders.
As noted above, the DSM-IV and the ICD-10 do not have a complete
overlap in their cataloging of personality disorders, suggesting that
cultural factors affect the determination of an “ideal personality.” Foulks
(1996) states that the major issue for clinicians having to make diagnoses
across cultures is differentiating between the ideal personality type,
the typical personality type and the atypical personality from the
standpoint of cultural functionality. Culture, a pervasive environmental
factor, does influence which traits are adaptive in a certain milieu.
While some of these styles may not ultimately be desirable, they assist
functionality. Individuals may have done well with their personality
characteristics in their own culture, but encountered difficulties upon
relocating to a society that does not value the expression or suppression
of certain behaviors to the same degree.
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