Biases in diagnosis

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Introduction

The Diagnostic Statistical Manual (V) and the International Classification of Disorders (10) were created by American psychiatrists - typically white, middle-class males. The DSM contains symptoms and classifications of mental disorders. 

Issues with the DSM v

The DSM was written by middle-class white males - 

  • it is ethnocentric and androcentric

It was written in American English

  • language barrier for those who wish to read/interpret it 

There are issues with subjectivity as they can be interpreted differently by different experimentors.

Rosenhan's study suggested psychiatrists often undergo a strong type 2 error.

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Overdiagnosis

In its first edition, the DSM had 106 disorders in it. By the fifth edition, there were 300+ disorders. 

One source of bias is a psychiatrist's need to describe any out-of-place behaviour as a mental disorder. The American Psychiatrist Association feel the need to classify any behaviour of this nature as a disorder. 

Examples include 

  • Temper tantrums- disruptive mood deregulation disorder. 
  • Elderly forgetfulness - Mild Neurocognitive Disorder
  • Normal grief - Major depressive disorder.

Development of the DC: (0-3 R)

The Disorder Classification of Mental Health and Disruptive Disorders in Infancy and Early Childhood Years provides clinical diagnosis on behaviours of children from the ages of 0-3 years old and classifies temper tantrums as a mental disorder. 

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Cultural Bias

The DSM was created by American psychiatrists therefore means non-Western individuals may be deemed psychotic or with a mental disorder whilst being unable to claim otherwise due to the societal norms they are used to in their own society. 

  • Turkey - placing hands in pockets is considered rude.
  • Thailand - can't show soles of the feet in religious halls.

Nazroo - African Caribbeans are more 3-5 times more likely than UK residents to be diagnosed with schizophrenia. 

Blake - African Caribbeans are more likely to be diagnosed during case studies when their race is mentioned.

Higher genetic risk - actually proved wrong when you look at statistics from Jamaica. 

Social deprivation - Bhurga et al - African Caribbeans are more likely to live alone, be welfare dependent and have less social contact which could instead explain why they are more likely to be diagnosed with schizophrenia and it may not actually be a case of cultural bias at all. 

APA - created working groups in order to help understand the inequality of gender and ethnic diagnosis in exams. 

Cultural formulation - Susto is a type of disorder in Central and South America/Mexico where the soul becomes frightened and leaves behind the ill body. Psychiatrists are taught to understand these types of illness. 

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Gender bias

Males - more likely to develop alcoholism and antisocial personality disorder. 

Females - more likely to develop depression and eating disorders.

Ford and Widiger - clinicians were given case studies of people with anti-social personality disorder (moodiness and brooding) and others had histronic personality disorder (strong emotions and hysteria) - diagnosed 40% of males correctly and diagnosed 80% of females correctly. 

Broverman - agreed with Ford and Widiger and believed clinicians were more likely to stereotype as soon as they knew the gender of the person they were dealing with. 

Why might females genuinely be more likely to be depressed?

  • Post-natal depression
  • Contraceptive pill
  • Domestic violence
  • Heavy burden of dual burden/triple shift. 
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Class bias

Lower class citizens were more likely to be diagnosed with mental health disorders except for eatinf disorders which are typically diagnosed to those who are middle class.

DeWitte- those who are clinicians are less likely to make encouraging disorders to those who are lower class than they would if they were middle class. 

Bruce - lower class citizens are 80 times more likely to be diagnosed with schizophrenia and twice as likely to be diagnosed with depression and alcoholism. 

Social causation hypothesis - 

Those living below the breadline will suffer from psychological harm as a result of their status and will not be able to afford private health care in order to combat the issue. 

Social drift hypothesis - 

Someone may lose their job and therefore lose their income and move down the social spectrum and therefore their mental stability will be a consequence of their social status as opposed to a cause. 

Turner and Wagonfeld theorised it is very difficult to tell the difference.

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