cultures has defined new mixed, multiple, or hybrid ethnic identities.
Culture, race, and ethnicity are related to economic inequities, racism, and discrimina-
tion that result in health disparities. Cultural , ethnic, and racial identities can be sources of
strength and group support that enhance resilie nce, but they may also lead to psycholog-
ical, interpersonal, and intergen erational conflict or difficultie s in adaptation that require
diagnostic assessment.
Outline for Cultural Formulation
The Outline for Cultural Formulation introduc ed in DSM-IV provided  a framework for as-
sessing information about cultural features of an individu al’s mental health problem and
how it relates to a social and cultural context and history. DS M-5 not only includes an up-
dated version of the Outline but also presents  an approach to assessment, using the Cul-
tural Formulation Interview (CFI), which has been field-tested for diagnostic usefulness
among clinicians and for acceptability among patients.
The revised Outline for Cultur al Formulation calls for syst ematic assessment of the fol-
lowing categories:
•Cultural identity of the individual:  Describe the individual’s racial, ethnic, or cultural
reference groups that may influence his or he r relationships with others, access to re-