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Cognitive Biases, Misdiagnosis, and Overdiagnosis
Primer
Cognitive Bias, Misdiagnosis, Diagnostic Overshadowing, Iatrogenic Diagnosis, and Overdiagnosis are important clinical issues to be aware about.
“I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”
[1]
– Abraham Maslow
“Clinical experience. Making the same mistakes with increasing confidence.”
“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
Cognitive Biases
Types of Cognitives Biases
Dunning-Kruger Effect
Confirmation Bias
Gender Bias in the Diagnosis of Borderline Personality Disorder
Robust research studies suggest that prevalence of borderline personality disorder may actually 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]Attrition Bias
Misdiagnosis
Premature Closure
Diagnostic Overshadowing
Martha Mitchell Effect
Overdiagnosis
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.
Resources
For Providers
Articles
References
2)
Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., ... & Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry, 69(4), 533.