To assess the reproducibility of psychiatric diagnoses made in
immigration proceedings, the authors examined cases of 109 Cuban refugees
who had appealed psychiatric diagnoses that precluded their admission to
the United States according to the Immigration and Nationality Act. Medical
review boards upheld only 23 (42%) of 55 initial diagnoses of antisocial
personality disorder but affirmed exclusionary certifications in 39 (72%)
of the 54 other cases. Failure to sustain a high proportion of diagnoses of
antisocial personality disorder may reflect interviewer biases,
cross-cultural inappropriateness of diagnostic criteria, or other
deficiencies in the current system of psychiatric evaluation of potential
refugees.
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