Ford and Widiger (1989) – Biases in Diagnosis

Ford, Maureen R., and Thomas A. Widiger. “Sex bias in the diagnosis of histrionic and antisocial personality disorders.” Journal of Consulting and Clinical Psychology 57.2 (1989): 301.



This is the second study we will be looking at from the ‘Diagnosis of Dysfunctional Behaviour’ section of ‘Dysfunctional Behaviour’, as part of your OCR A2 Health and Clinical Psychology course. It is further categorised into ‘Biases in Diagnosis.’


According to The Mental Health Act Commission’s ‘Count Me In Census’ (2005) the admission rates for people from the black and White/Black Mixed groups had rates of up to  three or more times higher than average. It is important to consider the extraneous variables that might affect this; socioeconomic status might be one.


Ford and Widiger (1989) – studied the stereotyping diagnoses based upon the individual’s gender.


To find out if clinicians were stereotyping genders when diagnosing disorders.

Method and Design


Health practitioners were given scenarios and asked to make diagnoses based on the information.

The independent variable was the gender of the patient in the case study and the dependent variable the diagnosis made by the clinician.

An independent design as each participant was given either a male, female or sex-unspecified case study.


A final sample of 354 clinical psychologists from 1127 randomly selected from the National Register in 1983, with a mean 15.6 years clinical experience. 266 psychologists responded to the case histories.


Participants were randomly provided with one of nine case histories. Case studies of patients with anti-social personality disorder (ASPD) or histrionic personality disorder (HPD) or an equal balance of symptoms from both disorders were given to each therapist

Each case study was either male, female or sex-unspecified.

Therapists were asked to diagnose the illness in each case study by rating on a 7-point scale the extent to which the patient appeared to have each of nine disorders:

  1. Dysthymic (low-grade depression)
  2. Adjustment  Disorder (classification of mental disorder that is a psychological response from an identifiable stressor or group of stressors that causes significant emotional or behavioural symptoms that does not meet criteria for more specific disorders)
  3. Cycothymic Personality Disorder ; (mild hypomanic and depressive episodes. It is defined in the bipolar spectrum.)

  4. Narcissistic Personality Disorder (pervasive pattern of grandiosity, need for admiration, and a lack of empathy)

  5. Alcohol abuse
  6. Histrionic Personality Disorder (excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood)

  7. Passive- Aggressive Personality Disorder ( passive, sometimes obstructionist resistance to following through with expectations in interpersonal or occupational situations.)

  8.  Antisocial personality disorder: a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood – Psycho/Sociopaths

  9. Borderline personality disorder: prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterised by depth and variability of moods.


Sex-unspecified case histories were diagnosed most often with borderline personality disorder.

Anti-Social Personality Disorder was correctly diagnosed 42% of the time in males and 15% of the time in females. Females with Anti-Social Personality Disorder were misdiagnosed with HPD 46% of the time, whereas males were only misdiagnosed with Histrionic Personality Disorder 15% of the time.

Histrionic Personality Disorder was correctly diagnosed in 76% of females and 44% of males.


Practitioners are biased by stereotypical views of genders as there was a clear tendency to diagnose females with histrionic personality disorder even when their case histories were of antisocial personality disorder.

There was also a tendency not to diagnose males with histrionic personality disorder, although this was not as great as the misdiagnosis of women.

Ford and Widiger (1989) Evaluation

+ Validity – the independent variable was clearly manipulated.

+ Quantitative data was collected which means that the data is easy to compare and draw causation from the results.

– Quantitative data – the use of quantitative data without qualitative data means that the conclusions have to been inferred by the researchers.


Ford, Maureen R., and Thomas A. Widiger. “Sex bias in the diagnosis of histrionic and antisocial personality disorders.” Journal of Consulting and Clinical Psychology 57.2 (1989): 301.

Further Reading

OCR A2 Psychology Student Unit Guide New Edition: Unit G543 Health and Clinical Psychology (Student Unit Guides)

Psych Yogi’s Top Ten Psychology Revision Tips for the A* Student

Article Name
Ford and Widiger (1989) - Biases in Diagnosis
'Diagnosis of Dysfunctional Behaviour' 'Dysfunctional Behaviour', as part of your OCR A2 Health & Clinical Psychology G543 exam. revise 'Biases in Diagnosis.'