Culture in DSM and ICD Flashcards
Culture in DSM and ICD
Culture and cultural sensitivity and ethnocentric
Culture is the collective beliefs and attitudes and social norms, of a people of a specific area for example a religion or behaviors shared and passed down from Generation to generation
Ethnocentric is when a studies results cannot be applied to different cultures due to cultural differences
therefore a lack of cultural representation in the sample
Cultural sensitivity is the awareness and appreciation of the values norms and beliefs characteristic of a culture with is what not ones own
acompanyed by a willingness to adapt ones behavior accordingly
This is important in diagnosis as different cultures may exhibit or explain certain symptoms in different ways, therefore it is important to be aware of these cultures and their differences to accurately diagnose disorders
Culture in DSM and ICD
DSM V and culture
The DSM V has made different efforts to be culturally sensitive in the creation of its classification system
• It does alert mental health practitioners to not make a diagnosis of mental health without considering the cultural variables, potentially affecting the assessment and diagnosis of such disorders
• The DSM provides guidelines for assessing information about cultural features and individuals mental health problems
• and how these features relate to a social and cultural, context and history
This includes three main aims
• To include culture-related diagnostic issues across most disorders in the dsm v
• To include cultural information to create framework for assessing information about cultural features of individuals mental health problems
• And cultural formulation interviews which are used to obtain information during mental health assessments about the impact of Culture on key aspects of the individual’s clinical presentation and care
Culture in DSM and ICD
ICD 10 and culture
The icd-10 does not mention the need to regard cultural variables when diagnosing people with mental disorders
it however does include a section and cultures specific disorders (as does the DSM)
but it says it is less needed in recent years so it is said to be less relevant in diagnosis
Culture in DSM and ICD
DSM and ICD overview
Both systems consider socio-economic and psychosocial circumstances that may affect diagnosis
but only the DSM-5 considers cultural variables before diagnosis
It aims to combat issues related with cultural diagnosis, framework for assessing cultural features via cultural formulation, in a cultural formulation interview to assess the impact of Culture on key aspects of individuals clinical presentation and care
Where has both include a section on cultural specific disorders however the ICD claims that it is less needed in diagnosis in recent years
Overall the DSM V is more culturally sensitive as it makes practitioners aware of the need to consider cultural variables affects on symptoms for accurate diagnosis and assessment
Culture in DSM and ICD
Scientific model
(Culture doesnt affect diagnosis)
The scientific model claims that culture does not affect diagnosis
• DSM is Made in the USA and is used in other cultures
• though this model is a valid if mental health disorders are defined with specific features and symptoms
for example depression is the same worldwide
• therefore culture would not affect diagnosis as they would use a scientific model to diagnose mental health disorders scientifically in a scientific way
Culture in DSM and ICD
Scientific model support
Lee 2006
Lee 2006
Conducted A Study in South Korea to see if the DSM IV TR was valid in non-western cultures for diagnosis
and it was for ADHD
meaning that culture may not affect diagnosis at all as South Korea has a completely different culture to the Western world
and by the valid diagnosis from the DSM-IV-TR suggests that culture did not play a factor in it
meaning Lee 2006 is evidence to support the Scientific model
Culture in DSM and ICD
Spiritual model
Culture does affect diagnosis
The spiritual model suggests that culture does affect diagnosis
some studies show culture could affect diagnosis
and the DSM is a diagnostic tool for Western cultures, and therefore is useful for diagnosing things in western cultures
however it does note certain aspects of other cultures
meaning that it suggests that it could be adapted to other cultures making it valid in multiple cultures
so yay
Culture in DSM and ICD
evidence for Spiritual model
Evrard 2014 (☆SZ)
Evrard 2014
The study States that’s hearing voices in western cultures signifies schizophrenic symptoms
whereas in other cultures it may be perceived as this person’s being possessed by spirits and therefore looked within a positive and celebrative light unlike in western cultures
• therefore cultural blindness may be an issue as some cultures may jump to conclusions on mental health without Consulting possible cultural variations and attitudes to certain symptoms
Therefore meaning that Evrard 2014 supports the spiritual model of diagnosis
Culture in DSM and ICD
Cultural differences in SZ diagnosis
• ideas that are deemed delusional in one culture are seen as normal in another for example whichcraft
• in some cultures visual off auditory hallucinations and delusions with religious content such as listening to God’s voice are deemed as part of the religious experience and not as a symptom of schizophrenia
• assessment of disorganized speech may be difficult by linguistic variation in narrative Styles across cultures
and it may be just how someone speaks normally
therefore meaning that a false diagnosis may be made
• assessment of affect requires sensitivity this is two differences in Styles emotional expression, eye contact, body language etc as it may vary across cultures
meaning for each culture the assessment of SZ should be adapted to not Deem normal behaviour for them to be seen as SZ symptoms to the Clinician
Culture in DSM and ICD
Study supports SZ cultural differences
Myers 2010
Myers 2010
Found that in the case of studying using the recovery model, that efforts to empower citizens (treatments)
increased stress if they would diagnosed with schizophrenia if their lives were already stressed
This means that cultural differences in for example work patterns can lead to different reactions to treatment
so treatments for schizophrenia should be individualized to each culture and not standardized
so Myers 2010 supports Cultural factors/diff affecting SZ diagnosis and treatment
by suggesting this
Culture in DSM and ICD
Studdy supporting cultural differences/factors effecting the diagnosis/treatment of SZ
Luhrmen et al (2015)
Luhrmen Et Al (2015)
Found that in the USA hearing voices is considered negative
whereas an India and Ghana it is seen as positive
therefore experiences of mental disorders are different across Cultures
And if a patient’s culture is different to the clinicians culture then what they say about the disorder to the clinician may affect the diagnosis
as what the patient says and is normal in their culture
maybe seen to The clinician as symptoms of schizophrenia
and then resulting in a false diagnosis
therefore challenging the validity of diagnosis itself (as its affected by Culture)
Meaning that overall Luhrmen Et Al 2015 supports the idea that culture affects the diagnosis of SZ
Culture in DSM and ICD
Support for culture affecting SZ diagnosis
Kulhara et al 2009
Kulhara Et Al 2009
Found that when reviewing various studies that a developing country
there are more people likely to have a good outcome/outlook of schizophrenia than bad outcomes (opposite of Developed cultures)
This is deemed as favorable outcome hypothesis in developing countries
but also said that Culture shouldn’t be used to explain variants in outcomes but other factors should be explored in research
Kulhara et al’s research supports Cultural effect if SZ diagnosis but they do not
Culture in DSM and ICD
Cultural differences in the definition of learning disorders may be difficult to diagnose
Cultural differences in the definitions of learning disorders may be difficult to diagnose because of the different views on it
as some cultures may see it as shameful or deny it
while others were more likely to aid people with learning disorders
different definitions mean that one coaches may find someone has a learning disorder from certain symptoms while another will Deny it
Culture in DSM and ICD
Cultural differences make the diagnosis of alcohol related disorders difficult
Cultural differences make her diagnosis of alcohol-related disorders difficult because some cultures are more stressed due to isolation and discrimination
so they may take more alcohol and have a higher intolerance to it
therefore it may be difficult to diagnose them with substance abuse as that culture may use on average a lot more alcohol than the clinicians culture
therefore meaning that the clinician is more likely to diagnose them with Alcohol abuse when the amount they are consuming is normal for the culture
Showing Cultural difficultys in its diagnosis
Culture in DSM and ICD
Culture does affect diagnosis
Rastafarian’s use of Neologisms (New Words) ☆
Rastafarian’s use of neologisms (which a new words and plays on English words for example down press into the oppressed etc) is an example of how culture could affect diagnosis
• if a clinician was unaware of this they may see these new words as disorganized thinking
• which is a symptom of schizophrenia maybe leading to a type 1 error or a false diagnosis
• therefore showing how culture can affect diagnosis and it may lead to a misdiagnosis
Culture in DSM and ICD
Culture does affect diagnosis
Culture Bias and the presentation and interpritation of symptoms in the ICD and DSM
The presentation, communication and interpretation of the symptoms and the ICD and the DSM are shaped on language and culture
Culture bias is when a person of one culture could be given a different diagnosis to somebody of another despite showing the same symptoms
• this is due to the use of different languages and different cultural norms in the interpretation of symptoms
• therefore meaning that culture could affect diagnosis as despite showing the same symptoms due to different languages and cultures different diagnosis may be met
Culture in DSM and ICD
Culture affects Diagnosis
Gurland et al 1970
Diff in clinicians training ☆
Gurland Et Al 1970
Showed psychiatrists in New York in the United States of America were more likely to diagnose patients with schizophrenia than those in London
due to cultural differences in the clinicians training and thus their interpretations of symptoms
leading to different diagnosis
therefore meaning that cultural differences are present in diagnosis, as shown in the supporting evidence provided by Gurland et al 1970
Culture in DSM and ICD
Culture doesn’t affect diagnosis
Hilker et al 2018
Heredibilaty of SZ ☆ SZ
Hilker et al 2018
Found that a recent estimate of hereditability of SZ is 79%
this implies a genetic cause of SZ meaning the scientific method is valid at causing SZ not the spiritual model or cultural factors
Showing Hilker et al 2018 is evidence opposing Cultures effect on Diagnosis
Culture in DSM and ICD
Culture doesn’t affect diagnosis
Lin 1996
(sim>diff in symptoms of SZ)
Lin 1996
Finds that symptoms of schizophrenia is similar across all cultures more than it is different
therefore meaning culture would not affect diagnosis due to the similarities across the globe
Showing how Lin 1996 opposes cultures affect on diagnosis of SZ
Culture in DSM and ICD
Culture doesn’t affect diagnosis
Andrade et al 2012
Socio eco in Sau Paulo not culture
alt ☆
Andrade et al 2012
Find high social deprivation associated with substance abuse disorders in Sao Paulo
This shows that economic background affects individual mental disorders
This is therefore evidence to supporting socio-economic factors rather than cultural factors
Andrade et al 2012 is providing an alternative to show that socioeconomic factors may affect diagnosis rather than cultural factors
Culture in DSM and ICD
Certain groups may be prone to certain disorders of a wise known as cultural bias
Support for this: Fernando 1992
Fernando 1992
Identified five key issues from studies of ethnicity and mental health
1) over diagnosis of SZ among West Indian and Asian British for the same symptoms meaning a disproportional number of them was diagnosed
2) exercise of the use of compulsory administration for West Indian British black patients with schizophrenia (was 3x more likely to be hospitalized than white British)
3) most West Indian, African, Asian British were transferred to locked wards
4) an excessive amount of ‘offender’ patients amongst West Indian British going to prison instead of hospital
5) the overuse of Electro convulsive therapy ECT in Afro-Caribbean and Asian British who were more likely to receive ECT than other ethnic groups
These findings don’t suggest that mental illness is more common and ethnic groups but that they are treated biasely in the mental health system
Therefore meaning that this study by Fernando (1992) supports cultural bias which is when certain groups of people are prone to certain disorders or are treated in a bias by the mental health System ‘aiding’ them
Culture in DSM and ICD
Culture affects communication (willingness to be aided)
support: Sue and Sue (1992) ☆
Sue and Sue 1992
found African Americans don’t like to talk about their emotions
and a less likely to admit they have a problem
and if they do admit that they have a problem
they are still less likely to talk to their therapist
Sue and Sue 1992 therefore is showing how cultural differences affect communication between patients and psychiatrists and their willingness to be aided by them
Culture in DSM and ICD
Cultural prejudice in diagnosis
Support: Banyard 1996
Banyard 1996
Fines in the UK 25% of patients on psychiatric ward were black but they only make up 5% of the UK population
once there are more likely to be seen by a junior doctor than a full doctor
so Banyard 1996 supports Cultural prejudice in diagnosis
This is a cultural Factor due to the overrepresentation of ethnic groups and psychiatric ward compared to the general population showing a prejudice in diagnosis
as minority groups are higher in diagnosis than other groups compared to their percentage in the general population
Culture in DSM and ICD
Culture creates language barriers
Language differences are a barrier as information may be lost in translation if the patient in clinician do not speak the same language
for example schizophrenia means disorganized mind in Japanese which has a negative connotations therefore meaning there may be negative implications if diagnosed with it
Another example may be that information on symptoms may be lost in translation possibly leading to a false diagnosis which could lead to a negative implication similar to that in Japan
Culture in DSM and ICD
Overcoming bias and diagnosis
DSM V
The DSM V classification must note which features may be affected by culture so a different emphasis can be placed on them
a lower emphasis on symptoms that can be affected by culture
and a higher emphasis on the Universal symptoms
means that the dsm-5 classification system is able to make a more accurate diagnosis
Culture in DSM and ICD
Overcoming bias in diagnosis
DSM IV TR 3 ways to up cultural sensitivity
the DSM IV TR
Attempts to increase the cultural sensitivity of its diagnosis system in 3 ways
1) including in the main body of the manual a discussion of cultural/ ethnic factors for each disorder
2) providing in the appendix a general framework for evaluating the role of culture/ethnicity in diagnosis
3) describing cultural bound symptoms in the appendix
These precautions to increase cultural sensitivity mean that this model of the DSM has a high validity in Cross cultural diagnoses
Culture in DSM and ICD
How SZ diagnosis has changed
+ Flaum et al 1991
• decrease the reliance on first ranked symptoms (i.e hallucinations and delusions) that used to be rated more important in diagnosis, and are often open to interpretations more so than other symptoms
• flaum et al 1991
Found a lack of reliability when using the DSM in regard to first rank symptoms on a similar sample from one culture
so it is highly likely that it’ll be incredibly unreliable in a sample of different cultures
• now there is an increased focus on negative symptoms as they are more objectively measured
E.g. in Flaum et al 1991 (again)
finds
Poverty of speech is more objectively assessed and measured than for example religious delusions
Culture in DSM and ICD
THE ICD’S CROSS CULTURAL POSSITIVES
Make it better to use cross culturaly and cross languages
The ICD-10 is available in many different languages and suits cultural form for that particular group
This helps to reveal inconsistencies, unclear dialogue and overlaps between disorders that where then removed from the ICD
The ICD is now described as a clear simple and logically organized for all cultures to interpret in the same way
Culture in DSM and ICD
Culture bound syndromes
Culture bound symptoms and mental health problems or other illnesses with a set of symptoms found and recognized in only one culture
Lots of psychiatrist reject the idea of this but the most commonly recognised ones are listed on the DSM IV and the ICD-10
e.g.
Penis Panics
In some cultures lads may think their penis will retract into their bodies
ladies may think the same about their breasts
this is also known as genital retraction syndrome (GRS) and is found worldwide but mainly in Africa and Asia
also E.g
Ghost sickness
This is found in native America and is recognized what by the DSM V
people who are preoccupied and/or consumed by the deceased suffer from this
the symptoms include:
a loss of appetite
suffocation feelings
reoccurring nightmares
persuasive feelings of terror
and general weakness
Culture in DSM and ICD
Strengths 1/2
DSM V Universal symptoms focus
The dsm-5 takes into account the cultural issues via acknowledging symptoms/features which differ between cultures and places
and an increase emphasis on what symptoms are accepted universally increasing the validity of diagnosis
Culture in DSM and ICD
Strengths 2/2
DSM V SAYS NO TO FIRST RANK SYMPTOMS
DSM V provides warning for focusing on bizarre symptoms of SZ otherwise known as first rank symptoms
acknowledging such symptoms are open to interpretation leading to cultural issues
so it states to not focus on these in diagnosis
Culture in DSM and ICD
Weaknesses 1/2
Ignore warning of First rank SZ symptoms By DSM V
A clinician may not follow the warning against bizarre first rank symptoms of schizophrenia
and therefore leaving room for subjectivity in the diagnosis of schizophrenia cross-culturally leading to it this diagnosis being invalid
Culture in DSM and ICD
Weaknesses 2/2
Using cultural symptoms in Diff cultures or universaly
There are cultural differences in some SZ Symptoms
so these should be considered separately for those exact cultures
as if included SZ cultural symptoms in diagnosis (in a diff culture or universaly)
it may lead to false or misdiagnosis of the wrong mental health disorder or a misdiagnosis of a healthy person
decreasing the validity of this diagnosis
