Cognitive Biases, Misdiagnosis, Iatrogenesis, and Overdiagnosis

Cognitive Bias, Misdiagnosis, Diagnostic Overshadowing, Iatrogenic Diagnosis, and Overdiagnosis are important clinical issues to be aware about in medicine. This is especially important in psychiatry, since there are few objective clinical tests for most disorders, and relies on the subjectivity of both patient report and interpretation of these symptoms by clinicians.

“I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”

– Abraham Maslow[1]
“We offer what we have, not what we should.”

– Anonymous
“Clinical experience. Making the same mistakes with increasing confidence.”

– A Skeptic's Medical Dictionary
“The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts.”

– Bertrand Russell

Gender Bias in the Diagnosis of Borderline Personality Disorder

Robust research studies suggest that prevalence of borderline personality disorder may actually be equal between males and females, yet in clinical settings and according to the DSM, females are diagnosed with a ratio of 3:1 compared to men.[2] Clinician bias in diagnosis and sampling bias are both thought to be causes for this difference. For example, men may possibly be diagnosed with antisocial personality disorder over borderline personality disorder because of co-occuring substance use.[3]

Overdiagnosis is not unique to psychiatry among medical specialties, but it is much more susceptible due to the lack of measurable biomarkers and reliance on diagnostic checklists like the DSM.