14 Introduction
Cultural Issues
Mental disorders are defined in relation to cultural, social, and familial norms and values.
Culture provides interpretive frameworks that  shape the experience and expression of the
symptoms, signs, and behaviors that are criter ia for diagnosis. Culture is transmitted, re-
vised, and recreated within the family and other social systems and institutions. Diagnostic
assessment must therefore consider whether an individual’s experiences, symptoms, and
behaviors differ from sociocultural norms and lead to difficult ies in adaptation in the cul-
tures of origin and in specific social or familial  contexts. Key aspects of culture relevant to di-
agnostic classification and assessment have been considered in the development of DSM-5.
In Section III, the “Cultural Formulation” contains a detailed discussion of culture and
diagnosis in DSM-5, including tools for in-dep th cultural assessment. In the Appendix, the
“Glossary of Cultural Concepts of Distress ” provides a description of some common cul-
tural syndromes, idioms of distress, and causal explanations  relevant to clinical practice.
The boundaries between normalit y and pathology vary across cultures for specific types
of behaviors. Thresholds of tolerance for spec ific symptoms or behaviors differ across cul-
tures, social settings, and fami lies. Hence, the level at which an experience becomes prob-
lematic or pathological  will differ. The judgment that a given behavior is abnormal and
requires clinical attention depends on cultural norms that are internalized by the individual
and applied by others around them, including family members and clinicians. Awareness of
the significance of culture may correct mistaken  interpretations of ps ychopathology, but cul-
ture may also contribute to vulnerability and suffering (e.g., by amplif ying fears that main-
tain panic disorder or health anxiety). Cultural meanings, habits, and traditions can also