Journal of Abnormal Psychology 1987, Vol. 96, No. 3,270-272 Copyright 1987 by the American Psychological Association, Inc. 0021-843X/87/$00.75 SHORT REPORTS Cultural Factors Considered in Selected Diagnostic Criteria and Interview Schedules Steven Lopez and Joseph A. Nunez University of Southern California Researchers have argued that diagnostic criteria and interview schedules inadequately reflect cul- tural influences in the definition and expression of psychopathology. In this study 11 widely used diagnostic criteria and interview schedules for schizophrenia, affective disorders, and personality disorders were examined to assess the extent to which they refer to cultural factors. The results indicated that 8 of 11 instruments referred to cultural influences in psychopathology at least once. The consideration of cultural factors, however, was primarily limited to the identification of delu- sions and hallucinations in schizophrenia. Very few cultural references were made in the diagnostic instruments of affective and personality disorders. The clinical implications of these findings are discussed with respect to the evaluation of cultural minority group members residing in the United States. Specific recommendations are offered to increase the attention given to culture in diagnostic instruments and to increase our understanding of how culture influences psychopathology. This study assesses the extent to which frequently used diag- nostic criteria and interview schedules consider cultural factors in the identification of schizophrenic, affective, and personality disorders. Although some authors have discussed how selected diagnostic instruments fail to address cultural influences (Alar- con, 1983; Egeland, Hostetter, & Eshleman, 1983; Klerman, Vaillant, Spitzer, & Michaels, 1984; Swartz, Ben-Arie, & Teg- gin, 1985), none have systematically looked at the extent to which a wide range of diagnostic instruments address the role of culture in psychopathology. Such an examination should re- flect the relative importance given to culture in the classification of mental disorders. Schizophrenic and affective disorders were chosen because much of the cross-cultural psychopathology research concerns these two diagnostic categories (Draguns, 1980, 1984; Klein- man & Good, 1985; Marsella, 1980). Personality disorders were selected because of the recent attention given to their cultural nature (Alarcon, 1983; Klerman et al., 1984). Moreover, sub- jects in current investigations of these disorders are at times drawn from cultural minority groups, including Blacks (Robins et al., 1984), Hispanics (Karno et al., 1987), and the Amish (Egeland et al., 1983). Given the use of these instruments with cultural minority groups as well as with international popula- tions, questions of cross-cultural validity are raised. Method Instruments The diagnostic criteria and structured interview schedules selected for this study were the following: the Diagnostic and Statistical Manual of Mental Disorders (DSM-IH; American Psychiatric Association, 1980), the Feighner Criteria (Feighner et al., 1972), the Flexible WHO (Carpenter, Strauss, & Bartko, 1973), the New Haven Schizophrenic Index (NHSI; Astrachan et al., 1972), the Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robins, 1977), Taylor and Abrams (1975), the Diagnostic Interview Schedule (DIS; Robins, Helzer, Croughan, & Ratcliff, 1981), Present State Examination (PSE; Wing, Cooper, & Sar- torius, 1974), the Schedule for Affective Disorders and Schizophrenia (SADS; Spitzer & Endicott, 1978), the Structured Clinical Interview for RW-///(SCID; Spitzer & Williams, 1984), and the Structured Inter- view for DSM-II1 Personality Disorders (SIDP; Stangl, Pfohl, & Zim- merman, 1983). We chose these instruments because they are among the most frequently used in the study of schizophrenia, major affective disorders, and personality disorders. The International Classification of Diseases: Clinical Modification (U.S. Department of Health and Hu- man Services, 1980) was considered for review, but we decided to ex- clude it because it is based on a classification scheme that offers no spe- cific criteria for mental disorders. Self-report measures were also ex- cluded because of their large number and because they frequently do not have explicit diagnostic criteria. Including such measures would have gone beyond the desired focus of this investigation. This study was completed while Steven Lopez was a recipient of a Ford Foundation postdoctoral fellowship. During this time he was affiliated with the Spanish Speaking Psychosocial Clinic, Neuropsychi- atric Institute, University of California, Los Angeles. Correspondence concerning this article should be addressed to Steven Lopez, Department of Psychology, University of Southern California, Los Angeles, California 90089-1061. Procedure Joseph A. Nunez carefully read the diagnostic criteria and structured interview schedules and identified the instruments' direct references to possible cultural influences in judging the presence of symptomatology regarding schizophrenic, affective, and personality disorders. In addi- tion, introductory comments about the perceived role of culture in psy- chopathology were noted. For the present study, culture generally refers to the distinctive body of customs, beliefs, and institutions characteris- 270