Let's talk about paranoia and racial disparities in schizophrenia/psychosis.

A thread...

1/10

Black Americans are 2.4x more likely to be diagnosed with schizophrenia than White Americans, and 3-5x more likely to be diagnosed with a psychotic disorder.

Importantly, this is in clinical samples. We don't see this magnitude of disparities in epidemiological samples.

2/10

What is going on here?

First, there may be actually higher rates of psychosis among Black people. This could be due to greater exposure to risk factors for psychosis like poverty, discrimination, chronic stress, exposure to trauma, and lower access to social resources.

3/10

All of these risk factors disproportionately affect Black people because of systemic racism. However, we would expect to see disparities in BOTH clinical and epidemiological samples if this were the case.

4/10

Option 2: There is racial bias in the diagnosis of psychotic disorders.

This is likely due to the misinterpretation of healthy cultural paranoia as pathological paranoia.

Indeed, Arthur Whaley found evidence for a socio-cultural model of misdiagnosis.

5/10

Black Americans are more likely than Whites to show mistrust and suspiciousness, especially when interacting with a White person. These reactions are not pathological, but are rather a healthy reaction to an unjust and racist society.

6/10

However, White clinicians, in particular, may interpret this healthy cultural paranoia as pathological or psychotic paranoia – leading to greater likelihood of diagnosing psychotic disorders among Black people.

7/10

In other words: Black individuals may present with what looks like paranoia whether or not they have an underlying psychotic disorder, and this may influence clinicians to diagnose a psychotic disorder when another disorder may be more appropriate.

8/10

Consequences?
1. Unnecessary anti-psychotic medication (for which there can be debilitating side effects).
2. Lack of appropriate medication.
3. Unnecessary hospitalization, which in and of itself can worsen paranoia and traumatize an individual.
4. Pathologization.

9/10

What can you do?
1. Do your homework. Read Whaley's work and recent work examining racial disparities in schizophrenia and psychosis.
2. Take a moment to understand your own biases and how they may influence diagnosis for each of your patients.
3. Spread the word!

10/10

Oh and by the way, we see similar issues in the UK. I don't know if there has been greater progress there than in the US. UK followers, let me know!