The authors examined the schizophrenia diagnosis in 292 psychiatric inpatients in a largely African American community. Clinicians completed a free-response questionnaire that described their diagnostic decisions. Psychotic symptoms such as hallucinations, which were attributed to African American and non-African American patients at different rates, did not necessarily correspond to differences in diagnostic rates. Rather, symptoms not differentially attributed between groups often corresponded with higher rates of schizophrenia for African American patients. Attributions of negative symptoms showed the largest differences between African American and non-African American patients in rates of schizophrenia diagnosis; thought disorder equalized rates of the diagnosis between the 2 groups of patients. Logistic regression analyses suggested that different aggregate decision models were applied to patients of differing race.