Personality Disorders and Culture. Contemporary Clinical Views (Part B)

This article reviews the basic concepts surrounding the clinical relationships between culture and personality disorders (PDs). Part A of this article, which appeared in Cultural Diversity and Mental Health, Vol. 1, No. 1, pp 3-17 (1995), examined the interpretive/explanatory and pathogenic/pathoplastic roles of culture. Herein, culture's role as a diagnostic/nosological factor is discussed through the use of measurement instruments and the cultural formulation included in DSM-IV (American Psychiatric Association, 1994). In addition to these three roles, some authors would also consider a therapeutic/protective function for culture in PDs. Following a critique of the biological perspective, a research model based on the definition of the cultural profile and the estimation of the cultural distance between clinical examiners and populations is proposed. It is important to reject both biological reductionism and the extremes of cultural determinism, in order to better assess the intraethnic distribution of psychopathology, and interethnic variations represented by the notion of cultural relativism.