Mental health misdiagnosis twice more likely for socially disadvantaged groups

The shooting of an unarmed teenager in Ferguson, MO, has ignited a global discussion about implicit racial bias. One group of people you might think would be immune from this hidden bias is clinical therapists, people trained to understand the human mind. But a new field study finds that the social identities of patients and their therapists affect the accuracy of the diagnosis: Therapists were twice as likely to misdiagnose mental illness when their patients were members of a disadvantaged, compared to an advantaged, group.

In her own practice, Ora Nakash, a clinical psychologist at the Interdisciplinary Center in Herzliya, Israel, began wondering how the social identities of her clients were affecting her decision-making process. "For example, a White therapist can interpret affect disregulation symptoms of a client who is also White as rooted in financial pressures and diagnose him/her as having transient adjustment disorder," she explains. "Conversely, if the client is African American, the same symptoms might be seen as proof of the client's persistent borderline personality disorder."

In a previous study, Nakash found that even with similar information collected during the mental health intake, clinicians weighed the information differently to assign a diagnosis depending on patients' ethnicity or race. "Here, we wanted to check if the therapist's social identity might impact the diagnostic decision-making process as well," she says.

So Nakash and colleague Tamar Saguy took to the field, investigating regular practice in community mental health clinics in three large cities in Israel that serve mostly low- to middle-class populations. The study focused on differences between encounters involving Mizrahi (Jews of Asian/African descent) and Ashkenazi (Jews of European/American descent) patients.

"These ethnic groups are interesting both in the context of the Israeli society, as they make up the majority of the Jewish population in Israel, but also in the broader context of mental health disparities," Nakash explains. "We know that minority groups, including migrants and ethnic minorities in many Western societies, tend to receive lower quality mental health care and may suffer from greater risks for mental illness." Both the Mizrahi and Ashkenazi migrated early in the history of Israel, making it easier for the researchers to investigate the effects of belonging to a disadvantaged ethnic group while controlling for the effects of migration.

Why are Mental Health Issues Routinely Misdiagnosed? It’s hardly a secret that in the mental health field, everyone gets their take; There is no definitive medical test for any mental illness, and most mental health professionals don’t have the time or resources to dig as deep as one hopes.

Do Mental Health Professionals Favor Certain Diagnoses?

In the 1970-80s eating disorders were en vogue, diagnosed at never before seen rates (partly due to increased awareness amongst medical professionals). The past decade has seen a dramatic rise in the diagnosis of Borderline Personality Disorder (and/or self-injury, which isn’t actually a diagnosis but let’s not be picky, shall we?).