What are Clinical Biases? (DP IB Psychology)

Clinical Bias in Diagnosis

• Bias is present when an attitude/viewpoint/opinion is directed towards what should be a universally agreed or accepted way of dealing with a subject or with a person or group of people

• Bias prevents impartiality, neutrality and objectivity being applied e.g. to the depiction of social or cultural groups in the media; to the perception of some social or cultural groups in terms of their intelligence, ability or skills; to the diagnosing of some social or cultural groups depending on whom is responsible for the diagnosis

• Clinical bias in diagnosis occurs when the diagnosing clinician allows their own prejudice, discrimination or political views to influence the diagnostic procedure

• Clinical bias may occur at both the conscious and the unconscious level i.e. the clinician may be fully aware of their bias or  they may be oblivious to it

• One negative consequence of clinical bias in mental health diagnosis is that a patient may not be heard properly, their symptoms may be dismissed or ignored which in turn may lead them to think that they are ‘making a fuss’ or that their symptoms are nothing to be concerned about

• Another negative consequence of clinical bias in diagnosis is that the wrong treatment or no treatment at all may be diagnosed which could have devastating consequences for the patient

• The medical model (as adhered to by many clinicians in Westernised, individualistic cultures) may be implicated in perpetuating clinical biases, particularly gender bias and culture bias

Clinical diagnosis should not be at the mercy of any sort of bias.

What is Gender Bias in Diagnosis?

• Gender bias is the tendency to either over-estimate (alpha bias) or under-estimate (beta bias) differences between males and females, usually resulting in one of the genders being viewed as inferior/abnormal and/or being treated negatively or unfairly

• One general example of gender bias can be seen in the gender pay gap (women are paid less than men for performing the same task)

• Gender bias in diagnosis may result in one gender being given preferential treatment in diagnosis while the other gender is treated according to the clinician’s assumptions or prejudices (which are often the result of stereotyping)

• Women are more likely than men to be diagnosed with depression and physicians perceive divorced, separated or widowed women presenting with health issues as more likely to be depressed than men presenting with the same issues (Bertakis et al., 2001)

• Gender may be used to guide and inform mental illness diagnosis - often incorrectly - which can obscure the symptoms and lead to  disparity in diagnosis (this links to the issue of reliability of diagnosis which is covered on a separate RN)

• Gender bias is more likely to affect females than males as medicine has traditionally been a field in which men have predominated and much of the medical ‘norms’ for ideal mental (and physical) health have been based on male models (Vlassoff, 2007)

What is Culture Bias in Diagnosis?

• Culture bias is the tendency to assume that one culture provides a template for ‘normality’ so that other cultures are viewed as inferior/abnormal and the members of those cultures may be treated negatively or unfairly

• Culture bias can be seen in research studies which take an ethnocentric approach, assuming that behaviour is universal, ignoring cultural relativism

• Culture bias in diagnosis may result in one culture being given preferential treatment in diagnosis while the other culture is treated according to the clinician’s assumptions or prejudices (which are often the result of stereotyping)

• More people from African-Caribbean backgrounds are diagnosed with schizophrenia in the UK and USA than are Caucasian people (McLeod, 2018)  

• People from Puerto Rico have a tendency to respond to stress with severe physiological responses such as fainting fits and heart palpitations but these symptoms have frequently been misdiagnosed as psychotic episodes by clinicians from the USA (Guaraccia et al.,1990)

• Culture may be ignored and symptoms misunderstood if culture-bound syndromes are not considered as part of the diagnostic process (this links to the issue of validity of diagnosis which is covered on a separate RN)

• Culture bias is more likely to affect people from collectivist cultures as these cultures are more likely to be guided by culture-bound concepts of mental health and to use traditional forms of treatment rather than adhering to the medical model

Which studies investigate clinical biases in diagnosis?

• Longnecker et al. (2010) - gender bias in the diagnosis of schizophrenia

• Jenkins-Hall & Sacco (1991) - culture bias in the diagnosis of depression

Both Longnecker et al. (2010) and Jenkins-Hall & Sacco (1991) are available as Two Key Studies of Classification Systems – just navigate the Factors Influencing Diagnosis section of this topic to find them.