Biases in Diagnosing Child Abuse and Neglect

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According to a clinician's personal bias, there may be instances of projection and counter-transference. This is especially critical if the clinician was a victim of abuse and the client is the perpetrator of abuse and the gender of the client is that of the same gender of the person that committed the abuse against the clinician. Now, diagnostic bias is defined by Sinecore-Guinn (1995) as an "error in judgment that counselors make when they collect and interpret information" (p. 18), and by Widiger and Spitzer (1991) as "a differential prevalence of either false-positive diagnoses ... and/or false-negative diagnoses" (p. 3). Greater skills with the DSM requires that counsellors learn ways of overcoming diagnostic bias.

Psychologist Franz Epting suggests that we can overcome our tendency to get sucked into the diagnosis bias through what's called "personal construct theory". One of the main principles of this theory is that we make diagnostic errors when we narrow down our marker of possibilities and zero in on a single interpretation of a situation. All of us have certain schemas or constructs, that we use to sift through the endless flow of information we encounter. Is it a matter of faulty thinking? But we talk a lot less about why we make these mistakes and how to avoid making them in the first place. Physicians often point to the influence of cognitive errors in diagnosis and strategies to minimize those errors.

First, let's define the term bias as it relates to clinical practice for abuse or any potential treatment outcome. Bias is defined statistically as measurement error (Mertens, 1998). Widiger and Sptizer (1991) used a statistical definition of diagnostic bias in suggesting it is "deviation from an expected value" (p. 3). For instance, in 100 coin tosses, bias is expected if the number of heads or tails greatly exceeds a 50-50 ratio, the expected value. Widiger and Spitzer identified sampling, assessment, and criterion bias as risks to accurate diagnosis. The purpose of this article is to define, demonstrate, and discuss ways of reducing sampling, assessment, and criterion bias. First, definitions are presented of each form of diagnostic bias. Second, empirical demonstrations are provided of each form of diagnostic bias. A final section lists ways of reducing each of these forms of diagnostic bias, and implications for counselor training, research, and practice.

Wilke (1994) also demonstrated diagnostic sampling bias in research with women and alcohol abuse. She observed that, because the most research on alcohol abuse and treatment has focused on men, conclusions about treatment are inappropriate when applied to women. Because women with alcohol problems are less likely than men to drink in public, drink with others, become violent or aggressive, or to come into contact with the law, many of their alcohol problems go undiagnosed and untreated. This research demonstrates how over-generalizing from one group to another can lead to misdiagnosis.

There is also the self-confirmatory bias. This error refers to categorizing something by focusing only on confirmatory information (Stromer, Boas, & Abadie, 1996). This error is demonstrated by counseling and counseling psychology students who first saw a video of an initial counseling session and then were asked to provide a list of questions they wanted to ask the client and explanations for their questions. The questions were then coded as to whether they sought confirmatory, disconfirmatory, or neutral client information.

Really, there may be a myriad of serious implications for clinicians in professional and direct clinical practice. First, training in key social-science or theoretical concepts should precede DSM training in program curriculum because understanding key theoretical concepts promotes critical inquiry (Arnoult & Anderson, 1988; Dawes, 2001; Lehman, Lempert, & Nisbett, 1988). Counseling students should understand at minimum the concepts of representative sampling, reliability and validity, correlation, and the logic of theories that can be applied and tested before taking coursework in the DSM.

Moreover, therapists must have in-depth critical information about the current scientific information of the DSM (Nathan & Langenbucher, 1999). This information is imperative for clinicians to make informed clinical ...