Ethnicity/race, paranoia, and psychiatric diagnoses: Clinician bias versus sociocultural differences

Abstract

Two contradictory assumptions underlie research on race differences in psychiatric diagnoses: (1) the “clinician bias” (CB) hypothesis, which assumes that Blacks and Whites exhibit symptomatology similarly, but diagnosticians mistakenly judge them differently; and (2) the “cultural relativity” (CR) hypothesis, which assumes that Blacks and Whites have different modes of expressing psychopathology but diagnosticians are unaware of or insensitive to such cultural differences. The purpose of the present study is to conduct a comparative test of the CB and CR hypotheses focusing on paranoid symptoms. The study examines race differences on the scales of Distrust (DST), Perceived Hostility of Others (PHO), and False Beliefs and Perceptions (FBP) from the Psychiatric Epidemiology Research Interview (PERI), which measure different types of symptoms ranging from relatively ordinary suspiciousness (i.e., mild paranoia) to the severe kind of paranoia often observed in schizophrenia, in relation to rigorous research diagnoses of depression and schizophrenia-like disorders. In effect, the CB and CR hypotheses become the null and alternative hypotheses, respectively, under conditions where the diagnoses are made according to research criteria. The present findings support the CR hypothesis over the CB hypothesis. The implications of these results for the psychiatric misdiagnosis of Black individuals are discussed.