VALIDITY IN THE DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA

~GENDER BIAS~

• Longennecker et al (2010) reported that, since the 1980’s, schizophrenia has been more commonly diagnosed in males than females

• Cotton et al (2009) found that female patients with schizophrenia function at a higher level than male patients (often able to work and maintain good family relationships)

• This masking of symptoms may make cases seem too mild to warrant a diagnosis, leading to an underdiagnosis in females

• Males tend to display more negative symptoms (e.g. social withdrawal & lack of emotion) which align more closely with traditional diagnostic criteria

• Women are more likely to display affective symptoms (e.g. depression, anxiety, mood swings) which may lead clinicians to diagnose mood disorders (such as depression or bipolar disorder) instead of schizophrenia

• Under-diagnosis in women means they may not receive adequate treatment and support

• Over-diagnosis in men may lead to unnecessary medication and increased stigma

• Loring & Powell (1988) conducted a study in which they randomly selected 290 male and female psychiatrists to read two case studies describing patient’s behaviour. They were then asked to make a diagnosis using standard diagnostic criteria. When the patients were described as male, 56% of psychiatrists diagnosed schizophrenia. However, when the patients were described as female, only 20% were given a schizophrenia diagnosis

• This gender bias did not appear to be evident amongst the female psychiatrists, suggesting that the diagnosis is influenced not only by the gender of the patient, but also the gender of the clinician

~CULTURE BIAS~

• Some symptoms of SZ such as hearing voices have different meanings in different cultures. For example, in some Afro-Caribbean societies, voices may be attributed to communication from ancestors

• Afro-Caribbeans in the UK are up to 10x more likely to receive a SZ diagnosis compared to white individual

• This means that Afro-Caribbean people may be discriminated against by a culturally-biased diagnostic system

~SYMPTOM OVERLAP~

• There is considerable overlap between the symptoms of SZ and the symptoms of other conditions

• For example, both SZ and bipolar disorder involve positive symptoms (such as delusions) and negative symptoms (such as avolition)

• In terms of classification, this suggests that SZ and bipolar disorder may not be two separate conditions, but instead variations of a single condition

• In terms of diagnosis, it means that SZ is hard to distinguish from bipolar disorder