Editorial: The Cultural Formulation

The Outline for Cultural Formulation, developed for DSM-IV by the Group on Culture and Diagnosis of the National Institute of Mental Health (Mezzich, 1995; Lewis-Fernandez, 1996), represents the most substantive cultural contribution to the DSM series. It provides instructions for conducting a cultural formulation, a systematic assessment of the patient’s cultural identity, illness representations, perceived causation, treatment expectations, cultural context of stressors and supports, and other relevant cultural factors that can be carried out with a patient from any cultural background during a mental health evaluation. The information obtained on these aspects of the patients’ socio-cultural context is intended to improve diagnostic validity as well as to help align clinicians’ recommendations with the patient’s and family’s illness understandings and help-seeking expectations in order to enhance treatment satisfaction, adherence, and response (Lewis-Fernandez & Diaz, 2002). Since the publication of DSM-IV in 1994, the Cultural Formulation has become a primary component of cultural mental health training in psychiatric and family medicine residency programs and graduate schools both in the US and abroad. However, it remains underutilized in actual clinical practice, likely due to limited dissemination efforts towards practicing clinicians and because of the time required for its implementation. In addition, the last 15 years have revealed areas of the Cultural Formulation in need of improvement, such as its conceptualization of illness models,