'Pathological Bias' Being Considered for DSM-V: Some Fear That Inclusion May Provide an Excuse for People Charged with Engaging in Racist Behavior

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SAN DIEGO -- Racism, a concept absent from DSM-IV, is under consideration for inclusion in DSM-V under the rubric "pathological bias," Dr. Carl C. Bell said at the annual meeting of the National Medical Association.

In addition to racism, pathological bias might include sexism and heterosexism, and might be included in DSM-V as either a symptom or a full-blown disorder.

The decision on whether to include pathological bias in DSM-V, and, if so, in what form, is certain to be controversial.

"Some folk are very concerned about having this conversation about racism being a mental illness as medicalizing a social problem, and there's some truth to that," said Dr. Bell of the department of psychiatry and public health at the University of Illinois at Chicago.

"But at the same time there are those cases of people with paranoia or schizophrenia or mania who are engaged in racist behavior but if their [illness] is adequately treated, that racist behavior goes away."

Dr. Bell guessed that 95%-98% of racist behavior is socially, culturally, or politically determined, but that "a sliver" of racist behavior may be based on psychopathology, which argues for its inclusion in DSM-V, due out in 2012.

At present, the state of research is inadequate to suggest one course or another, and the first step will be to look at pathological bias scientifically, and to determine whether it is a valid construct that can be measured reliably, said Dr. Bell, also president and chief executive officer of the Community Mental Health Council, Chicago.

Several committees are helping to define the research agenda and are spearheading the discussion.

These include committees of the American Psychiatric Association; the department of psychiatry at Massachusetts General Hospital, Boston; and the Social Sciences Research Council, an independent, nonprofit organization based in New York.

The research, which is likely to include neuroimaging, may help determine whether pathological bias should be considered as a symptom of certain disorders (such as paranoid personality disorder or bipolar disorder), or as a disorder in its own right.

Edward Dunbar, Ed.D., of the University of California, Los Angeles, has written a rough draft of what the DSM-V criteria for pathological bias might look like if it does come to be considered a full-blown disorder. (See sidebar.)

Dr. Bell said that he sees an analogy between violence and pathological bias. Some diagnoses in the DSM-IV list violence as an associated feature, and some have violence as a central feature of the disorder.

Likewise, pathological bias may sometimes be a feature of some disorders and in other patients may be their central psychopathology.

The issue of how to classify such a disorder must also be resolved. Dr. Bell has published articles arguing that pathological bias may be a manifestation of narcissistic personality disorder.

Others have argued that pathological bias might be seen as a relational problem.

"You could have a situation in which two people, as a result of their values and their belief systems, have interpersonal friction, but in fact they have no real psychopathology," Dr. …