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Journal of Personality Disorders, 10(3), 260-270. 1996
1996 The Guilford Press
PERSONALITY DISORDERS AND CULTURE IN
DSM-IV: A CRITIQUE
Renato D. Alarcon, MD, MPH
A brief history is presented of the suggestions on personality
disorders (PDs) made by the NIMH-sponsored Culture and Di agnosis Group to APA's DSM-IV Task Force. A quantitative
analysis of the level of acceptance of such suggestions in the fi nal version of DSM-IV shows that, overall, only 27.5% of them
were included. This figure Increases to 51% for texts specifi cally related to 10 PD types. Paranoid and schizoid PD texts in cluded most of the Group's recommendations whereas those for narcissistic, histrionic, and avoidant were almost totally ig
nored. Conceptually, very important notions such as a cultural dimension, self-image, acculturation, contextualization, exclu
sionary criteria, and differential diagnosis were omitted. The
uneven presence of culture in the PDs section of DSM-rV calls for renewed efforts to increase research, clinical observations, and theoretical discussions in order to make the cultural per
spective more visible and relevant in the national mental health debate.
Although there seems to be agreement about the powerful impact of culture in the development of normal personality, authors are less inclined to concur on the most appropriate ways to measure such impact (Kirmayer,
1989; Leighton, 1981; Millon, 1983) The debates are even more contentious when considering culture vis-a-vis the psychopathology of personality.
Issues such as child-rearing practices or styles, early intrafamily interac tions, transmission of values, religious practices, and even the historical evolvement of communities have been studied as sources of both stability
and developmental disruptions (Al-Issa, 1982). The situation is com
pounded by the fact that personality disorders (PDs) have the lowest
reliability among all clinical diagnostic conditions in psychiatry, and by the
conflicting typological and dimensional views on the study of personality
and its disorders (Cloninger, 1987; Dana, 1984; Frances, 1980).
Developmentalists have appropriately documented the reinforcing char acter of cultural factors In the establishment of an individual's personality.
Renato D. Alarcon. MD. MPH. is Professor and Vice Chairman, Department of Psychiatry
and Behavioral Sciences, Emory University School of Medicine, and Chief. Psychiatry Service,
Atlanta VA Medical Center.
Address correspondence to the author at VA Medical Center, 1 670 Clairmont Road, Decatur, GA 30033.
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