Bias in Diagnosis


Mark Scheme


·         Types of diagnostic system (ICD, DSM, CCMD)

·         Ideals of diagnostic tools (validity, reliability)

·         Known cultural and gender differences


·         Questions of validity and reliability in diagnostic systems

·         Psychiatry as a source of bias (medicalisation of misery)

·         Gender, culture, ethnicity as factors in bias 

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Types of Diagnosis Tool

·         Diagnostic and Statistical Manual of mental disorders

·         International classification system

·         Constantly revised and updated

·         Chinese Classification of Mental Disorders

·         Should be reliable and valid but we will never achieve this

·         Revision should help

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Cultural Bias

·         Classification systems based on cultural assumptions of normality

·         Can’t use the same diagnostic tools due to imposed etic

·         Personality tests are inaccurate cross culturally

·         Cochrane (1995) black immigrants in the UK are more likely to be diagnosed with depression

·         Johnstone (1989) working class patients are given longer hospitalisation periods and are treated physically rather than psychologically

·         Over diagnosis may be due to genetic vulnerability rather than a bias

·         Social factors may have an influence – ie. Stress of immigration

·         Safer to make type 1 errors (class sane people as ill)

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Gender Bias

·         Standardised towards males, some symptoms only displayed by one gender e.g. periods stopping in women with anaeroxia

·         Robins et al (1984) showed women are more likely to be diagnosed with depression and phobias due to gender stereotypes

·         No difference in diagnosis rates from some disorders

·         Ford and Wildiger (1989) found histrionic personality disorder was diagnosed more accurately in women

·         Women aren’t used in many studies due to hormonal imbalances

·         Females are underrepresented in diagnostic handguides

·         May be due to real gender differences e.g. pregnancy

·         Each gender handles mental illness differently, depression in women manifests as negative emotions, men often use distractions such as alcohol

·         If it was a bias it should exist in EVERY medical condition, it doesn’t  

·         DCM and ICD are unreliable and invalid but still useful

·         Need a more idiographic approach 

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