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Chapter: Essentials of Psychiatry: Cultural Aspects of Psychiatric Disorders

Adjustment and Personality Disorders - Cultural Aspects of Psychiatric Disorders

The effect of culture on the adjustment disorders is pervasive.

Adjustment Disorders

 

The effect of culture on the adjustment disorders is pervasive. Cul-turally based interpretations are essential to the appraisal of the repertoire of behavioral and emotional responses that pattern both normal and disordered reactions to stress (Jenkins and Kinzie, 1997). Whereas some experiences are uniformly stressful (e.g., natural disaster), others may make sense only within particular cultural contexts (e.g., facing deadlines, witchcraft accusations) (Fábrega and Mezzich, 1987). In addition, the judgment of what constitutes a maladaptive response to a stressor must be made in relation to what exceeds cultural norms (Kleinman, 1988). Diag-nosis of an adjustment disorder may be a particular problem among refugee populations. These groups have undergone distressing ex-periences, but their intensively challenged coping styles may be unknown to caregivers in the host country (Beiser, 1996).

 

Personality Disorders

 

The current configuration of the personality disorders has re-ceived substantial cross-cultural challenge. Even the basic con-cept of personality as a set of individual internal traits is con-sidered inseparable from the Western cultural assumptions on individuality by many authors (Lewis-Fernández and Kleinman, 1993). Difficulties in the reliable assessment of these disorders within the Western cultures may be due to the degree to which these conditions are determined by social and contextual factors. These factors include adaptational strategies toward adverse com-munal environments (including the relative value of aggression or avoidance), family-based customs and traditions, occupational and educational options and cultural methods of child-rearing (Alarcón and Foulks, 1997). It is striking, for example, that the antisocial personality disorder is nearly absent among the Hut-terites, an ethnoreligious enclave living for more than a century in the USA and Canada (Favazza, 1985). Intracultural diversity may be more important in this respect than cross-cultural differ-ence. For example, in his studies of affective and personality dis-turbances among the Inuit and the Yoruba, Leighton (1981) was unable to disentangle cultural influences from “the much more powerful effects’’ of gender, age and class.

 

Epidemiological assessment of DSM-III antisocial perso-nality disorder has been performed as part of the Epidemiological Catchment Area study using a clearly operationalized survey instrument, the Diagnostic Interview Schedule (Robins et al., 1984). This yielded similar prevalence rates in the USA and Puerto Rico (Canino et al., 1987). However, low reliability rates for the diagnosis of personality disorders across standardized instruments raise serious doubts about the validity of this aspect of the Epidemiological Catchment Area study data (Perry, 1992). One World Health Organization study was able to identify cases of most of the International Classifi cation of Diseases personality disorders in 15 urban clinic samples in Africa, Asia, North America and Europe (Paris, 1991), but the cross-cultural validity of the definitions of these categories had been criticized earlier by Shepherd and Sartorius (1974)

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