Issues in Diagnosis

Psychology: AQA A Level, topic 12.1.2

Issues in Diagnosis – Comorbidity and Symptom Overlap

Diagnosing schizophrenia is challenging due to overlapping conditions and social biases that affect accuracy across groups.

The issues in diagnosis of schizophrenia include:
- Co-morbidity.
- Symptom overlap.
- Gender bias.
- Cultural bias.

Comorbidity is the extent to which two or more conditions occur together, calling into question the validity of diagnosis.
Buckley et al. (2009) found that around half of all patients diagnosed with schizophrenia also had a diagnosis of depression. This factor called into question the ability to tell the difference between the two conditions and diagnose accurately.
It could be that very severe depression can present as schizophrenia because it looks a lot like it.

Symptom overlap refers to the extent to which the symptoms of one disorder are also present in a different disorder.
For example, schizophrenia and bipolar disorder both include symptoms such as delusions and avolition (lack of motivation to do tasks with an end goal).

Symptom overlap also calls into question the ability to accurately diagnose specific conditions.
Under ICD, a patient might be diagnosed with schizophrenia; while under DSM, they might be classified with bipolar disorder.
This might even mean that the two are actually the same disorder.

Gender bias is defined as an inclination towards, or prejudice against a particular gender.

According to Longenecker et al., (2010), schizophrenia diagnosis might suffer from gender bias because of the disproportionate number of men diagnosed with disorder in comparison to women.

While it could be that more men are diagnosed because they are more genetically vulnerable, it could also be because women are able to function better with the disorder than men.
According to Cotton et al. (2009), female patients appear to be more able to continue in work and have good family relationships. This better interpersonal functioning might lead to practitioners under-diagnosing schizophrenia in women.

Cultural bias refers to the process of judging someone against your own cultural norms.

Cultural bias might account for higher numbers of African American and others of Afro-Caribbean descent being diagnosed with schizophrenia compared to in Africa and the West Indies, where rates are not particularly high.

Some African cultures have different attitudes to some positive symptoms, such as hearing voices, which can be more acceptable because of their beliefs about communicating with ancestors.
This would mean that some symptoms seen as acceptable in some cultures would be seen as atypical in others.

Escobar (2012) has suggested that, because the psychiatric profession is dominated by white people, psychiatrists might be over-interpreting symptoms and distrusting the honesty of black people during diagnosis.

Approximately how many of the patients diagnosed with schizophrenia in Buckley et al. (2009) study also had a diagnosis of depression?
Who studied patients diagnosed with schizophrenia who also had a diagnosis of depression?
Why might schizophrenia diagnosis suffer from gender bias, according to Longenecker et al. (2010)?
Which study suggested that psychiatrists might be over-interpreting symptoms and distrusting the honesty of black people during diagnosis of schizophrenia?