750 Cultural Formulation
sources, and developmental and current chal lenges, conflicts, or predicaments. For im-
migrants and racial or ethnic minorities, th e degree and kinds of involvement with both
the culture of origin and the ho st culture or majority cultur e should be noted separately.
Language abilities, preferences,  and patterns of use are relevant for identifying difficul-
ties with access to care, social integration, and the need fo r an interprete r. Other clini-
cally relevant aspects of identity may in clude religious affiliation, socioeconomic
background, personal and family places of  birth and growing up, migrant status, and
sexual orientation.
•Cultural conceptualizations of distress:  Describe the cultural constructs that influence
how the individual experiences, understands, and communicates his or her symptoms
or problems to others. These constructs may include cultural syndromes, idioms of dis-
tress, and explanatory models or perceived causes. The level of severity and meaning of
the distressing experiences shou ld be assessed in relation to the norms of the individ-
ual’s cultural reference groups. Assessment of coping and help-seeking patterns should
consider the use of profession al as well as traditional, alternative, or complementary
sources of care.
•Psychosocial stressors and cultural feat ures of vulnerability and resilience:  Identify
key stressors and supports in the individual ’s social environment (which may include
both local and distant events) and the role of religion, family, and other social networks
(e.g., friends, neighb ors, coworkers) in providing emotional, instrumental, and infor-
mational support. Social stressors and social  supports vary with cultural interpreta-
tions of events, family structure, developm ental tasks, and social context. Levels of