DSM-Based Biases

Research on race-bias and gender-bias has not been done for all mental disorders.

With this in mind, research has elucidated the following biases:

Racial Bias

Racial bias occurs for the diagnosis of:

  • Conduct disorder

  • Antisocial personality disorder

  • Comorbid substance abuse and mood disorders

  • Eating disorders

  • Post-traumatic stress disorder

  • Differential diagnosis of schizophrenia

  • Psychotic affective disorders (Garb, 2021)

Gender Bias

Gender bias occurs for the diagnosis of

  • Autism spectrum disorder

  • Attention deficit hyperactivity disorder

  • Conduct disorder

  • Antisocial and histrionic personality disorders (Garb, 2021)

Learn More

To learn more about the White Supremist applications of the DSM, please read Using a Transdiagnostic Perspective to Disrupt White Supremacist Applications of the DSM.

Note

Biopsychosocial processes that have been shown to influence risk, protective, and maintenance factors for mental illness have emerged from literature in quantitative and molecular genetic studies, structural and functional brain research, socioenvironmental factors including poverty, discrimination, loneliness, early childhood adversity, and childhood trauma and maltreatment, as well as psychological processes (Dalgleish et al., 2020).

There are no biological markers or cognitive processes which have been identified that can be uniquely associated with a specific mental health disorder (Dalgleish et al., 2020). In other words, gender and race are not unique risk factors of a mental health disorder.

Did You Know?

As another example of how the DSM has historically codified discrimination, did you know that homosexuality was formerly a diagnosis in the DSM? It was only removed in 1973 (Drescher, 2015).

Activity

Given DSM-based gender and other biases, spend a few minutes researching DSM-based biases for people who are transgender, gender fluid, or non-binary.

Reflection

What are some ways that I can disrupt white supremacist applications of DSM for diagnosing mental illness?

When more than one diagnosis can explain a person’s symptoms,

  • Choose based on chronicity (episodic non-chronic disorders) e.g. depression carry less stigma then chronic e.g. schizophrenia; and,

  • Consider history and evidence of racial, gender, and other oppressive applications of that diagnosis, e.g. higher likelihood of schizophrenia diagnoses for Black People compared to White People presenting with the same symptoms

When chronic or stigmatized diagnoses best represent a client’s presentation, use provisional diagnosis which enables further evaluation over time to arrive at appropriateness.

References

Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020). Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of consulting and clinical psychology, 88(3), 179–195.

Drescher, J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioural Sciences, 5(4), 565-575.

Garb, H. N. (2021). Race bias and gender bias in the diagnosis of psychological disorders. Clinical Psychology Review, 90

Riquino, M. R., Nguyen, V. L., Reese, S. E., & Molly, J. (2021). Using a transdiagnostic perspective to disrupt white supremacist applications of the DSM. Advances in Social Work, 21(3), 766-778.