Abnormal Psychology

76 CHAPTER 3

Other researchers have examined how best to treat people with both substance

abuse and depression, compared to those with only substance abuse (Dodge,

Sindelar, & Sinha, 2005; Torrens et al., 2005). Such comparisons are possible

only because the diagnoses are part of a classifi cation system.

• A diagnosis can indicate that an individual is in need of attention (including
  treatment), support, or benefi ts. For example, children diagnosed with a learn-
  ing disorder may receive special accommodations or services at school. For some
  adults, a diagnosis may allow them to have special accommodations at home or
  work or to receive certain services paid for by their health insurance plan or by
  government programs. For some people involved in criminal justice proceed-
  ings, a diagnosis of a psychological disorder, such as schizophrenia, may make
  the difference between being sent to a mental health facility and going to prison
  or jail.


• Some people fi nd great relief in learning that they are not alone in having par-
  ticular problems (see Case 3.1). People may derive a measure of comfort from
  merely being given a label for their problems—knowing not only that there is a
  term for their disturbing thoughts, feelings, and behaviors, but also that they are
  not the only one with the specifi c diffi culties. Moreover, once they have a name
  for the symptoms they are experiencing, they can learn more about the disorder
  and treatments for it.

CASE 3.1 • FROM THE OUTSIDE: On Being Diagnosed with a Disorder

Sally, an articulate and dynamic 46-year-old woman, came to share her experiences with our

psychiatry class. For much of her adult life, she had suffered from insomnia, panic attacks,

and intense fear. Then, six years ago, a nightmare triggered memories of childhood sexual

abuse and she was fi nally diagnosed with posttraumatic stress disorder.

Being diagnosed, she told us, was an intense relief.

“All those years, I thought I was just crazy,” she said. “My whole family used to call me the

crazy one. Once, my brother called my mom and asked, ‘So, how’s my crazy sister?’ But all of a

sudden I wasn’t crazy any more. It had a name. It had a real reason. I could fi nally understand

why I felt the way I did,’ she said.”

(Rothman, 1995)

A Cautionary Note About Diagnosis

Having a classifi cation system for mental illness has many advantages, but assign-

ing the appropriate diagnosis can be a challenge. For example, clinicians may be

biased to make—or not make—particular diagnoses for certain groups of people.

Patients, once diagnosed with a disorder, may be stigmatized because of it. Relatives

and friends, as well as patients, often struggle to answer this question: Does having

a psychological disorder exempt patients from being responsible for their behavior?

Let’s examine the possibilities of bias and stigma in more detail.

Diagnostic Bias

Adiagnostic bias is a systematic error in diagnosis (Meehl, 1960). Such a bias can

cause groups of people to receive a particular diagnosis disproportionately, on the

basis of an unrelated factor such as sex, race, or age (Kunen et al., 2005). Studies

of diagnostic bias show, for example, that in the United States, black patients are

more likely than white patients to be diagnosed with schizophrenia instead of a

mood disorder (Abreu, 1999; Garb, 1997; Neighbors et al., 2003; Trierweiler et al.,

2005). Black patients are also prescribed higher doses of medication than are white

patients (Strakowski, Shelton, & Kolbrener, 1993).

When the mental health clinician is not familiar with the social norms of the

patient’s cultural background, the clinician may misinterpret certain behaviors as

Diagnostic bias
A systematic error in diagnosis.