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The proposed changes within the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 ) attempt to address some of the previous concerns regarding the lack of a contextual assessment process regarding the role of culture within the lives of clients (Alarcón et al., 2009 ; Flaskerud, 2012 ; New York State Psychiatric Institute, Center of Excellence for Cultural Competence, 2012 ). The DSM is used across the world for diagnostic purposes. Hence, the Cultural Psychiatry Committee of the American Psychiatric Association (APA) recommends that users of the DSM develop a clinical expertise in the area of cultural assessment of all clients because of increasing cultural and ethnic diversity across the world (Alarcón et al., 2009 ). Experts in the areas of culture, cultural competence, and diversity recommend that every client's cultural perspectives be examined regarding his or her level of mental health, wellness, and/or illness (Campinha-Bacote, 2007 ; Flaskerud, 2012 ; Warren, 2012a ). Additional cultural areas for assessment consideration include clients' social and political context (Flaskerud, 2012 ; Warren, in press-a, b ). Past editions of the DSM have not adequately addressed any of these areas of consideration (Alarcón et al., 2009 ; Driscoll, 2012 ; Flaskerud, 2012 ). The purposes of this article are to discuss (a) how culture was assessed in the DSM , fourth edition, text revision (DSM-IV-TR ); (b) what new assessment cultural factors are proposed for inclusion in the DSM-5 ; and (c) the implications for psychiatric-mental health (PMH) nursing education, practice, and research based on the inclusion of the proposed cultural assessment changes.
Background
The DSM-IV-TR (APA, 2000 ) attempted to address the issue of culture and associated misdiagnosis of clients through the addition of the Appendix I that focused on cultural formulation and culture-bound syndromes. This appendix, Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes, defined cultural formulation according to "cultural identity, explanations of the individual's illness, factors related to psychosocial environment and levels of functioning, element of the relationship between the person and the clinician, and assessment for diagnosis and care" (APA, 2000 , pp. 897--898). Additional information on culture was included within specific disorders sections. The Glossary of Culture-Bound Syndromes...