Cultural Formulation 759
problem or assign the wrong diagnosis (e.g., unfamiliar spiritual explanations may be
misunderstood as psychosis).
•To obtain useful clinical information:  Cultural variations in symptoms and attribu-
tions may be associated with particular fe atures of risk, res ilience, and outcome.
•To improve clinical rapport and engagement:  “Speaking the language of the patient,”
both linguistically and in terms of his or her dominant concepts and metaphors, can re-
sult in greater communication and satisfac tion, facilitate treatment negotiation, and
lead to higher rete ntion and adherence.
•To improve therapeutic efficacy:  Culture influences the psychological mechanisms of
disorder, which need to be understood and addressed to improve clinical efficacy. For
example, culturally specific catastrophic co gnitions can contribute to symptom escala-
tion into panic attacks.
•To guide clinical research:  Locally perceived connections  between cultural concepts
may help identify patterns of comorbidity and underlying biological substrates.
•To clarify the cu ltural epidemiology:  Cultural concepts of distress are not endorsed
uniformly by everyone in a given culture. Distinguishing syndromes, idioms, and ex-
planations provides an approach for studying the distribution of cultural features of ill-
ness across settings and regions, and over time. It also suggests qu estions about cultural
determinants of risk, course, and outcome in clinical and community settings to en-
hance the evidence base of cultural research.
DSM-5 includes information on cultural conc epts in order to improve the accuracy of
diagnosis and the comprehensiveness of clinical assessment. Clinical assessment of indi-
viduals presenting with thes e cultural concepts should determine whether they meet
DSM-5 criteria for a spec ified disorder or an other specified or unspecified  diagnosis. Once the