Editorial : Clinical implementation of the DSM-5 cultural formulation interview

There is an increasing need for mental health care to adapt assessment and treatment to cultural and social variety of populations. If cultural factors are not properly assessed, patients may receive an incorrect diagnosis, or the severity of their condition may be misjudged (1). Further, a lack of clinicians’ cultural sensitivity can create communication barriers leading to a patient’s breakdown of trust in the therapeutic process and a hesitancy to communicate important information (2). The introduction of the Cultural Formulation Interview (CFI) in DSM-5 in 2013 (3) involved a breakthrough for improving cultural sensitivity in mental health care with a clinical model and method to enhance cultural awareness in psychiatric assessment based on a person-centered, non-stereotyping approach. Nussbaum (4) defined the CFI as the most person- centered portion of DSM5 and pointed to the necessity to understand the patient as a person before defining a mental disorder. Already in DSM-IV the core elements of the CFI were introduced as an Outline for Cultural Formulation Interview (OCF), however without instructions on clinical application (5). Aggarwal et al. point at the fact that the CFI emerged from a confluence of approaches from social medicine and interpretive anthropology. To this can be added that the CFI has also roots in the psychodynamic idiographic formulation of exploring different layers of interaction between patient and cultural environment (6). The OCF has been described as a guide for a “mini-ethnographic” narrative assessment (7). Ethnography emphasizes the importance of trying to understand the other’s point of view (8) with the term “thick description” (8) emphasizing the way that ethnography can provide rich and detailed accounts of the social world under study.