Race bias, social class bias, and gender bias in clinical judgment

Perceived dysfunction of male-typed and female-typed DSM-IV personality disorder criteria

To determine whether female-typed personality disorders are associated with a different pattern of dysfunction than male-typed disorders, lay judges (N = 216) estimated the amount of social impairment, occupational impairment, and personal distress related to symptoms of personality disorders. Results for both the subset of six disorders originally rated by clinician judges in the research of Funtowicz and Widiger (1999) and for a larger set of nine disorders revealed a pattern originally reported by Funtowicz and Widiger where female-typed disorders were associated with relatively higher ratings of personal distress, whereas male-typed disorders were associated with relatively higher ratings of social (and sometimes occupational) impairment. Findings are discussed with respect to the emphasis of different forms of dysfunction for male- and female-typed disorders, lay versus clinician judgments, and directions for future research.

Ethnicity and clinical psychology: a content analysis of the literature

As the demographics of the U.S. population continues to change and become increasingly diverse, clinical psychologists will need to demonstrate their competence in providing culturally appropriate treatments to a wide variety of populations. This article summarizes a comprehensive content analysis of five of the leading scholarly journals in clinical psychology over a 17-year period (1980-1997). Results indicate that only 29.3% of the published articles in the clinical psychology literature included ethnic minority participants. Furthermore, only 5.4% of the articles actually focused specifically on ethnic minority populations. Thus, the clinical psychology literature does not contain adequate coverage of ethnically diverse populations in the U.S., despite their growing numbers. This content analysis provides the field with a baseline for future comparison to determine whether the field in general is responding to the needs of an increasingly diverse society, and to help gauge whether clinical psychologists have the scholarly resources available to assist them with becoming more culturally competent. Implications for the paucity of research and recommendations to ameliorate the problem are discussed.

A comparison of MMPI-2 validity in African American and Caucasian psychiatric inpatients

This study investigated ethnic differences on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in 229 African American and 1,558 Caucasian psychiatric inpatients. Mean differences were found on several MMPI-2 validity and clinical scales. These were generally consistent with differences between the groups, indicated by the available extratest criterion data. To identify potential bias, the authors conducted 65 step-down hierarchical multiple regression analyses, predicting conceptually relevant clinical criteria from either MMPI-2 clinical or content scales for each gender. A number of MMPI-2 scales evidenced bias reflecting minor underprediction of psychopathology in African Americans. It is important to note that, in almost all cases, the magnitude of these differences was small and not clinically significant.

Pathology versus statistical infrequency: potential sources of gender bias in personality disorder criteria

The antisocial, narcissistic, dependent, histrionic, and borderline personality disorders often obtain differential sex prevalence rates. One explanation has been that the diagnostic criteria for these personality disorders have different gender implications for maladaptivity (e.g., perhaps the dependent personality disorder diagnostic criteria are considered by clinicians to be more pathological for women than for men). This hypothesis was explored in two studies that obtained judgments by professional clinicians of the maladaptivity and statistical infrequency of personality disorder diagnostic criteria. Significant differences across gender were obtained for the frequency of diagnostic criteria but not for their maladaptivity. The personality disorder diagnostic criteria appear to be gender neutral with respect to their implications for maladaptivity.

A reporting and response model for culture and child maltreatment

As our society becomes increasingly culturally diverse, there is a growing concern in the mental health field as to whether clinicians are able to accurately distinguish different cultural parenting discipline practices from child maltreatment. Clinicians in various fields continue to differ on what is reportable. Although there is literature describing characteristics of various ethnic minority groups, there are limited data to support why clinicians do what they do and no decision-making model to guide a clinician's reporting behavior when working with clients from different cultures. This article focuses on cultural discipline practices rather than healing practices (e.g., coining) that may be challenging to assess. The authors propose a model to guide clinicians through the decision-making process and discuss interventions and clinical responses that may be most appropriate when presented with different scenarios involving cultural parenting discipline practices and child maltreatment. Finally, limitations of the presented model along with future clinical and research directions are discussed.

Effects of sex and sex roles on the perceived maladaptiveness of DSM-IV personality disorder symptoms

This study investigated the influence of sex on the perceived maladaptiveness of DSM-IV personality disorder criteria based on previous findings that inconsistency of symptoms with sex roles affects the perception of personality disorder symptoms. The effects of rater characteristics (i.e., sex, sex role) were also examined. A total of 161 undergraduates (65 men, 96 women) rated the diagnostic criteria according to how maladaptive they were for males (male condition), females (female condition), or without regard to sex (neutral condition that served as a baseline) using a 7-point scale. Participants' sex role was determined using the Bem Sex Role (1981a) Inventory. Dependent and depressive personality disorder criteria (trend for borderline) were rated more maladaptive for females than males, whereas obsessive-compulsive personality disorder criteria were rated more maladaptive for males than females. Participant sex and sex role had little or no significant effects on the ratings. Results are compared with those of previous research. Methodological issues and implications for the diagnosis of personality disorders are discussed.

Patterns and correlates of agreement between parent, teacher, and male adolescent ratings of externalizing and internalizing problems

The authors examined how well 394 triads of male youths, caregivers, and teachers agreed about youth problems reported on the Achenbach checklists. Dyadic agreement was measured through difference scores (subtracting the raw score of youth self-report from the caregiver's or teacher's score for shared items), q correlations between pairs of raters across items, and D2 (generalized distance between item profiles) for both externalizing and internalizing items. Teachers reported fewer internalizing and externalizing problems than did caregivers or youths. Teacher-youth disagreement was higher for African American than European American males about externalizing criteria. Caregiver depression and stress (but not paternal antisocial behavior or maternal substance abuse) correlated with higher disagreement with other informants about all criteria. These factors appear to increase disagreement about the level of problems but not about specific symptom patterns.

Toward DSM-V and the classification of psychopathology

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) developed by the American Psychiatric Association (1994) is a compelling effort at a best approximation to date of a scientifically based nomenclature, but even its authors have acknowledged that its diagnoses and criterion sets are highly debatable. Well-meaning clinicians, theorists, and researchers could find some basis for fault in virtually every sentence, due in part to the absence of adequate research to guide its construction. Some points of disagreement, however, are more fundamental than others. The authors discuss issues that cut across individual diagnostic categories and that should receive particular attention in DSM-V: (a) the process by which the diagnostic manual is developed, (b) the differentiation from normal psychological functioning, (c) the differentiation among diagnostic categories, (d) cross-sectional vs. longitudinal diagnoses, and (e) the role of laboratory instruments.

Computers will become increasingly important for psychological assessment: not that there's anything wrong with that!

Though one can expect that computer programs will become increasingly important for psychological assessment, current automated assessment programs and statistical-prediction rules are of limited value. Validity has not been clearly established for many automated assessment programs. Statistical-prediction rules are of limited value because they have typically been based on limited information that has not been demonstrated to be optimal and they have almost never been shown to be powerful. Recommendations are made for building and evaluating new computer programs. Finally, comments are made about the ethics of using computers to make judgments.

Psychopathology: description and classification

DSM-IV's strong empirical base has yielded an instrument with good to excellent reliability and improved validity. Diagnostic reliability depends on both the clarity and validity of diagnostic criteria and the changeability of disorders over time: The reliability of schizophrenic spectrum disorders, personality disorders, and some childhood and adolescent disorders remains problematic. Findings on diagnostic validity appear paradoxical: Attempts to validate schizophrenic spectrum disorders with neurobiological and genetic-familial validators have been only modestly successful, whereas the tripartite personality trait model has differentiated a range of depressive and anxiety disorders. Research on comorbidity has identified several highly comorbid disorders (substance-related disorders, personality disorders, depression, and anxiety) as well as some adverse consequences of comorbidity. The advantages of dimensional approaches to diagnosis have largely been demonstrated conceptually; ultimate conclusions about the strengths and weaknesses of dimensional and syndromal methods await substantial additional empirical research.