4 Ds Flashcards
What are the 4 Ds?
Deviation
Dysfunction
Distress
Danger
What are the 4 Ds used for?
They’re used by clinicians to assess whether an individual requires further clinical diagnosis
Describe Deviation
Rare, unique, different or extreme behaviour
Deviation from statistical norm or social norm
Describe deviation from the statistical norm
Can see statistical deviation through standardised tests that provide quantitative data
When plotted, results form a ‘curve of normal distribution’
Both ends of the curve are abnormal (top and bottom 2.2%)
Behaviour outside of 2 standard deviations is abnormal
eg: schizophrenia is abnormal as it has a prevalence of 1-2%
Describe deviation from the social norm
Behaviour that doesn’t conform to social norms is abnormal
We tend to notice and be wary of people that go against social norms
It has to be clear to everyone what social norms are, so abnormality is seen by everyone in the society
This varies between cultures and over time.
Socially normal behaviour is often contextual and role-specific
Describe Dysfunction
If behaviour significantly interferes with a person’s ability to carry out everyday tasks and live their life, it may indicate mental illness
Symptoms can distract, confuse or interfere
Different objective functions can be used to measure functioning, such as the GAF scale or WHODAS 2
The day-to-day impact may not be obvious
eg: severe unipolar depression may cause someone to be unable to work
Describe Distress
The extent to which the behaviour is causing upset or anxiety to the individual
Can manifest physically (fatigue or heart palpitations)
Scales can be used to assess, such as the Kessler psychological distress scale (K10)
Should be treated in isolation from the other Ds because people may be facing a lot of difficulties but not distress, and vice versa
Eg: hypochondria (fear that they have a serious disease). It’s based-on misunderstanding bodily symptoms and leads to distress
Describe Danger
Careless, hostile or hazardous behaviour that jeopardises the safety of the individual and/or others may be ground for diagnosis
Can be a danger to themselves (self-harm, suicide etc.) or to others
Rated on a scale of severity
If the behaviour is extremely risky, getting worse/more frequent and/or is not being addressed, then a diagnosis may be required
eg: bipolar often leads to extreme risk-taking behaviour
Strengths of Deviation
Statistical deviation - Quantitative measures so more objective and reliable
Weaknesses of Deviation
Statistical Deviation - No scope for clinicians judgement on how well someone’s coping and cut off points are arbitrary
Some disorders are not statistically rare but are still abnormal eg depression
Social Deviation - social control aspect to label those who are abnormal
Difficult to measure objectively
Strengths of Dysfunction
Standardised tests such as GAF and WHODAS2 give quantitative objective measures
Weaknesses of Dysfunction
Subjectivity when deciding what is dysfunctional, reducing reliability
Doesn’t take into account the reasons for dysfunction, such as people may not want to see friends because of personality differences not because of mental illness
Strengths of Distress
Standardised tests eg K10 give quantitative objective data, increasing reliability
Weaknesses of Distress
People may be unwilling to discuss distress, so they go undiagnosed
There are different ways of showing distress, some may not get help as they’re perceived as not in distress as they internalise it
Strengths of Danger
Danger is often criteria for sectioning, so people can get the help they need even if they may not have sought it out
