Diagnosis and Classification of Schizophrenia

Discuss reliability and/or validity in relation to the diagnosis and classification of

schizophrenia (16 marks):

Reliability refers to the consistency of a measuring instrument, such as the ICD or DSM, to assess
something. In terms of schizophrenia (scz), this could refer to how consistent the ICD or DSM is in
assessing the severity of their symptoms for example. Inter-rater reliability is the extent to which 2
or more psychiatrists come at the same diagnosis for the same patient – there needs to be 80%
agreement for it to be reliable. Test-retest occurs when a clinician makes the same diagnosis for scz
on separate occasions from the same information.

Validity in terms of scz refers to the extent that a classification system such as the ICD or DSM
measures what thy claim to measure i.e. the symptoms of schizophrenia. One type of validity is
criterion-validity. This is whether different assessment systems arrive at the same diagnosis of the
same patient. As Cheniaux et al highlighted, schizophrenia is over-diagnosed using the ICD and, is
under-diagnosed when using the DSM.

One limitation is culture bias in diagnosis. Javier Escobar found that physicians (overwhelmingly who
are white) tend to over-interpret symptoms and distrust the honesty of black people, especially
since African Americans are several times more likely to be diagnosed. This could be due to the fact
that a Western psychiatrist would not understand that their positive symptom of auditory
hallucinations, for example, may be a norm in some African cultures, and this may then be viewed as
bizarre. This shows how cultural bias can lead to over-diagnosis if psychiatrists aren’t sensitive about
the individual’s culture, especially when using the DSM which is based on American culture. This
therefore decreases its validity.

Another limitation is gender bias in diagnosis. Longenecker concluded that men since the 1980s are
more likely to be diagnosed than women. This could be due them being more genetically vulnerable
to scz, but may be gender bias, as women’s better interpersonal functioning may bias practitioners
to under-diagnose scz in women, and over-diagnose it in men. This again decreases the validity as it
means that many women are left undiagnosed, which could be harmful.

Finally, co-morbidity can also make us question the validity of the classification and diagnosis of
schizophrenia. Peter Buckley et al concluded that around half of patients who have been diagnosed
with schizophrenia, have also been diagnosed with depression (50%) or OCD (23%). This poses a
challenge for both classification and diagnosis of schizophrenia. In terms of diagnosis, if half the
schizophrenic patients are also diagnosed with depression, maybe it’s because psychiatrists can tell
the difference between the two conditions. In terms of classification, it may be that, if very severe
depression looks a lot like schizophrenia and vice versa, then they might be better seen as a single
condition. This therefore is a weakness as it questions the validity of the classification systems such
as ICD or the DSM which are used to diagnose schizophrenic patients.
Diagnosis and Classification of Schizophrenia