Bias in diagnosis


Introduction and culture bias

  • DSM and ICD developed in western countries and been developed over time but has culture bias. This was demonstrated when DSM was changed in 1980s to remove homosexuality as a mental disorder - this was due to cultrue change and social pressure from gay rights.
  • One of the most investigated cultrue biases is between white westerns and non-western or native whites - due to socail norms not medical problems. Supporting evidence from the UK shows that carribean immigrants are 7 times more likely to be diagnosed with scizophrenia when white natives. And in the USA doctors are more likely to offer schizophrenia as a diagnosis if they know that patient if Afro-American.
  • Psychological testong is biased as most are rooted in the western culture and are normalised on white samples.
  • May not necessarily be racist, May be real genetic differences - however unlikely as the same pattern of over-diagnosis isnt reflected elsewhere in the world. 
  • Secondly, it may reflect that western society is divided by social class as much as ethnicity. Afro-carribeans are often in a lower socail class so may suffer multiple discriminations causing huge amounts of stress, amking them mroe vulnerbale to disorders.
  • Johnstone (1989) found that lower social class people spent longer in hospital, were more likely to be given physical treatments and had poorer outcomes than missle-class patients.
  • Karasz (2005) found that Asian immigrats in NY saw depressive symptoms as a social problem but Euopean immigrants saw it as a biological and medical problem.
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Gender bias

  • Stereotypes form the basis of diagnosis and psychiatry has mainly been male dominated. Some conditions seem set up to be 'female' such as anorexia, where a lack of menstral periods is a symptom of the disorder.
  • Ford (1989) showed that hysterical personality disorders are more likely to be corrected in diagnosis when the symptoms are said to be a female in a case study rather than a male. Women are more likely to be diagnosed as having depression and men as having anti-social conduct.
  • However, women may react differently to depression and look for profesisonal help, while men become alcoholics. 
  • No gender differences in dignosis of bipolar or schizophrenia - suggests alleged gender bias may be partly based on reality and not entirely a bias.
  • Research often uses male subjects. Leo and Cartagena (1999) agrue that women are thought to have less stable behaviour die to hormal changes so are used less in research. Results are male biased and doctors are less trained to deal with women.
  • Conclusion - biases in diagnosis and these reflect class-dominated societies. However, it is important to realise there are real differences.
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