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Contents
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The American Psychiatric Association & Diagnostic Error
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Home
Contents
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 House of Cards: Psychology and Psychotherapy Built on Myth by Robyn M. Dawes
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| They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal by Paula J. Caplan
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| Blaming the Brain: The Truth About Drugs and Mental Health by Elliot Vallenstein
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| Pharmacracy: Medicine and Politics in America Thomas Stephen Szasz
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| Bias in Psychiatric Diagnosis by Paula J. Caplan
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| Destructive Trends in Mental Health by Rogers Wright and Nicolas A. Cummings
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| Creating Mental Illness by Alan V. Horwitz
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| The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder by Alan V. Horwitz
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| Science and Pseudoscience in Clinical Psychology by Scott O. Lilienfeld
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| The reader of this book comes away with a powerful sense of psychiatry as a profession out of control. Cut off from what ought to be its roots in the basic research community, and at the mercy of the strongest political factions of the moment, psychiatry endlessly expands the range of its diagnostic categories until most ordinary people can be fit into at least one DSM category. Thus does psychiatry seem to be in the business, as the authors contend, of making us all crazy.
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| One issue in the diagnostic assessment bias literature is errors in applying the diagnostic criteria (Rabinowitz & Efron, 1997). In one demonstration of this bias, Morey and Ochoa (1989) asked 291 psychiatrists and psychologists to complete a symptom checklist for a client whom they had diagnosed with a personality disorder. When the checklists were later correlated with the DSM criteria, nearly three of four clinicians had made mistakes in applying the diagnostic criteria. Kappa coefficients of agreement between clinicians' checklists and the DSM criteria varied from 0.09 to .59, indicating a poor-to-modest level of agreement (Babbe, 1998). These results demonstrate the pervasiveness of errors in applying diagnostic criteria.
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| Errors in applying the DSM criteria were also reported by Davis, Blashfield, and McElroy (1993). They asked 42 psychologists and 17 psychiatrists to read and diagnose case reports containing different combinations of the DSM-III-R criteria for Narcissistic Personality Disorder (NPD; APA, 1987). They found that 94% of the clinicians made mistakes applying the diagnostic criteria, and nearly one out of four clinicians made a diagnosis of NPD even if fewer than half the DSM criteria were met.
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| Rubinson, Asnis, Harkavy, and Freidman (1988) found clinicians making more mistakes of omission than of commission in applying the DSM criteria. Researchers sent 113 questionnaires to a random sample of clinicians asking them what criteria they used to make a diagnosis of Major Depression. The 54 questionnaires returned indicated that clinicians' most often erred by failing to use all the diagnostic criteria in their diagnostic decision making.
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| Broverman, Broverman, Clarkson, Rosendrantz, and Vogel (1970), in probably the most publicized study of criterion bias, demonstrated how clinicians viewed typical male traits (i. e., independent, forceful, domineering) as more closely associated with a healthy adult than they did typical female traits (i. e., nurturing, deferential, reserved). This study demonstrated diagnostic criterion bias by showing how a prejudice towards typical male traits over female traits can cause misdiagnosis.
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| Fourteen men, who call themselves "The Dirty Dozen," have managed to transform clinical psychology. The reference to dirt in their name underscores their willingness to engage in political activism and "all sorts of 'psychologically unseemly acts'" (Wright, p. 2) to advance the professional and financial interests of practicing clinical psychologists.
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