Gender and ethnic bias in the diagnosis of antisocial and borderline personality disorders

Miriam Elizabeth Delphin, Purdue University

Abstract

Research investigating gender bias in Axis II diagnoses has generated a considerable degree of controversy in the literature. Few studies have assessed the role of client ethnicity upon the diagnostic accuracy of personality disorders, despite research demonstrating ethnic bias Axis I disorders. The current study, expanded upon Houghtaling's (1993) investigation in its assessment of gender and ethnic bias in the diagnosis of antisocial and borderline personality disorders. Using an analogue research design, 135 members from the Society of Personality Assessment were given either two African American or European American male or female case histories meeting full clinical DSM-IV diagnostic criteria for either antisocial or borderline personality disorder. Additionally, the subclinical presence of each disorder was manipulated allowing an assessment of over- and underdiagnostic errors. Logistic regression analyses and follow-up descriptive statistics showed that European American case vignettes were diagnosed with antisocial personality disorder more accurately and to a greater degree than African American case vignettes. Predictions that African American females would receive a borderline personality disorder more than other groups, and that African American case vignettes would be rated as more impaired were not supported. Other findings included: male clinicians being significantly less accurate than female clinicians in the BPD case condition and generating significantly more subclinical diagnoses than female clinicians; low occurrence of overdiagnostic errors; and participants believing themselves to have greater diagnostic accuracy than they actually obtained. Post hoc analyses revealed significantly more clinicians given the African American rather than the European American case history condition, correctly guessed the purpose of the study. It was speculated that clinicians who knew the purpose of the study were trying to be both unbiased and accurate in their clinical-decision making, suggesting that practitioners may underdiagnose African Americans when consciously trying to be culturally sensitive. Results suggest that practitioners may benefit from cultural awareness training with a focus on the differential diagnosis of pathology and cultural phenomena.

Degree

Ph.D.

Advisors

Merritt, Purdue University.

Subject Area

Minority & ethnic groups|Sociology|African Americans|Psychotherapy

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