Culturally competent case formulation in adolescents: lessons from an adoption disclosure crisis

-Self-injurious behaviour in adolescents frequently indicates deeper emotional and cultural struggles that conventional diagnostic methods may not address. This educational article examines a clinical case of a 13-year-old Malay girl (AI) experiencing Major Depressive Disorder and self-injury following the unexpected revelation of her adoption. The case illustrates why culturally aware, comprehensive case assessment is essential. The article presents the Biopsychosocial (BPS) 4P framework; examining Predisposing, Precipitating, Perpetuating, and Protective elements as an efficient tool for incorporating identity-related trauma, family confidentiality patterns, and community-oriented cultural values into effective clinical planning. This methodology is crucial for suitable evaluation, addressing diagnostic uncertainty, and implementing trauma-sensitive treatments such as Dialectical Behaviour Therapy (DBT) in familyfocused, non-Western environments. The case offers three essential clinical insights for addressing complicated adolescent mental health issues in diverse cultural settings

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