Personality disorders and culture in DSM-IV: A critique

A brief history is presented of the suggestions on personality disorders (PDs) made by the NIMH-sponsored Culture and Diagnosis Group to APA's DSM-IV Task Force. A quantitative analysis of the level of acceptance of such suggestions In the final version of DSM-IV shows that, overall, only 27.5% of them were included. This figure increases to 51% for texts specifically related to 10 PD types. Paranoid and schizoid PD texts included most of the Group's recommendations whereas those for narcissistic, histrionic, and avoidant were almost totally ignored. Conceptually, very Important notions such as a cultural dimension, self-image, acculturation, contextualization, exclusionary criteria, and differential diagnosis were omitted. The uneven presence of culture in the PDs section of DSM-IV calls for renewed efforts to increase research, clinical observations, and theoretical discussions in order to make the cultural perspective more visible and relevant in the national mental health debate.