Bias in diagnosis

To be recognised as mentally ill - must display 5 symptoms of disorder for 2 weeks

Diagnoses made using classification system that lists all possible symptoms - helps eliminaye bias by having setcriteria

However, systems such as DSM IV mran certain people/groups more likely to be classed as having particular disorder

2 main types of bias - cultural and gender

Based on cultural assumptions about what counts as normal/abnormal behaviour 

West - abnormal to hear voices leading to diagnosis however desirable in religious groups 

Look at social norms to define mental illness - classification system based only on norms of Western culture - members of other cultures diagnosed as ill when exhibt behaviours normal within their own culture 

Use personality test as part of diagnostic process 

Devised by Western psychologists on own ideas about personality and standardised on western populations 

 Non-western assessed less accurately on tests 

Major bias in regards to people from African descent - especially disorders like schizophrenia

Cochrane and Sashidharan (1995) - black Afro-carribean immigrants in UK 7 times more likely to be diagnosed with schizphrenia than white people - however doesn't tell us whether there is cultural divide in diagnosis or whether there is a genuine difference in rates of schizophrenia

Blake (1973) - more likely to diagnose Afro-American as schizophrenic

Possible diagnosis of disorder in certain subgroups is due to genetic difference rather than bias 

Might be that black Afro-carribeans have greater genetic vulnerability to schizophrenia

. However, rates of diagnosis in Afro-carribeans isn't as high elsewhere in world as it is in UK

Alternative explanation for high rates in UK - members of minority ethnic groups in Britain have more stressful life leading them to disorder - difference due to social/environmental diagnosis

Type 1/2 errors-

Malgady (1996) considered consequences of over/under diagnosis in terms of type1/2 errors

Argued if clinician believe there is no cultural bias and this is a mistaken belief they are doing a disservice to their minority clients by failing to recognise and treat their problem - mistakently accepting null hypothesis

Result in misdirection of healthy individuals to mental health servicdesystem

Malgady believes type 2 error is more serious and so it is desirable to accept that there is a cultural bias

Treated differently according to geder - one gender inferior and more likely to develop disorder

Practice of psychiatry was male dominated until recently - male behaviours are set as the standard by which all behaviour is measured against 

Results in "normal" female behaviours being seen as abnormal and a sign of illness

Clinical characteristics of illnesses such as anorexia include things which are normal in women due to their menstrual cycle - would then assume all sufferers of anorexia are female which we know not to be true

Significant differents in rates of diagnosis between men and women

UK - women more likely to be admitted to hospital for depression

Walker (1994) - women with depression out number men between two and six times - however, no differences with disorders such as schizophrenia and bipolar - leads to question why differences exist with some disorders and not others

Possibility the bias is based on stereotypes - Ford & Widiger (1989) gave psychologists written case studies - Histrionic personality disorder was correctly diagnosed 80% of time when patient said to be female, and just 30% of time when said to be male 

Worrell and Remer (1992) - identified possible reasons why there may be gender bias leading to over diagnosis - possible reaosns included holding stereotypes such as interpreting women's behaviour as hysterical or submissive than males, or disregarding environmental context and focuses on diagnosis of the symptoms rather than individual circumstance

Leo and Cartagena (1999) look into research participation as a possible explanation for gender bias - studies of mental disorders typically rely on male samples as female behaviour thought to fluctuate with hormone cycle

Leads to studies influencing classification system despite being inapproprately applied to women

Psychiatric textbooks under-represent women and may lead to clinicians being less able to deal with female patients

Wissman et al (1997) - some evidence for hormone contribution but can't completely account for such large differences between men and women

Possible at least some cases of differential diagnosis due to real difference

Gender differences in social roles and life experience (pregnancy) could explain why women are more likely to suffer depression

Nolen-Hoesksema (1987) - men and women respond differently to depression - women focus on negative emotions and seek professional help while men use distractions such as alcohol to cope with mood

Legitimate difference supported by fact that rates of bipolar are similar in men and women whereas if there was a systematic gender bias in diagnosis it would be reflected in both bipolar and depression - relies on same symptoms 

Fact diagnosis can be unreliable/inaccurate suggests shouldn't be used however same is partly true of medial diagnosis generally, yet we wouldn't suggest abandoning practice

Classification systems regularly updated so reliability and validity in diagnosis are improving

Major issue with giving psychiatric diagnosis is that they result in labelling - person becomes "schizophrenic" rather than person suggering with schizophrenia - label tends to stick even when disorder has gone

An invalid diagnosis would lead to label being given falsley, resulting in life long implications 

Due to this, critics prefer to avoid these types of labels and instead use a more idiographic approach that doesn't require classification but emphasises analysing each person individually