diagnosis: 4 Ds

Question 1

what are the 4 d’s? when are they used?

Answer 1

• deviance
• dysfunction
• distress
• danger
• they are used when defining abnormality

Question 2

what is meant by deviance?

Answer 2

• behaviour and emotions that are not the norm in society
• they must be seen as unacceptable by society
• deviance can be difficult to use in diagnosis because different mental disorders can show similar deviance.
• however, some diagnoses are clearly illustrated by deviance, such as paedophilia

Question 3

what is meant by dysfunction?

Answer 3

• a person’s behaviour not being successful in relation to carrying out everyday tasks and living their life in general
• can be deliberate
• can be difficult to use in diagnosis, as many life events and issues can be dysfunctional
• dysfunction must occur in more than one part of person’s life for diagnosis to be given

Question 4

what is meant by distress?

Answer 4

• when someone with a disorder experiences negative feelings
• thought that abnormality in a mental health sense is accompanied by feelings of distress
• can be hard to measure as person may be unable to function but does not experience feelings of distress, while someone else can feel a great deal of distress and yet still be able to function

Question 5

what is meant by danger?

Answer 5

• danger to others or the individual
• violent behaviour directed towards others signals danger, while behaviour that is a danger to the individual themselves would include suicidal thoughts
• Davis 2009 cites figures that individuals suffering from a mental illness have 25% higher chance of dying from unnatural causes

Question 6

who discussed a fifth ‘D’? and what is it?

Answer 6

• Davis 2009
• duration

Question 7

what is meant by duration?

Answer 7

• length of time individual has had the symptoms
• important to consider the duration a patient has had symptoms, when diagnosing mental illness
• e.g. different types of schizophrenia may be diagnosed depending on how long patient has experienced symptoms

Question 8

strengths of the 4Ds and diagnosing abnormalities

Answer 8

• Davis 2009 has shown how the 4 Ds can be used with DSM-IV-TR, and adds fifth - duration. four Ds have practical application as they are useful for professional when considering when patient’s symptoms or issues become a clinical diagnosis
• four Ds support the validity of the DSM as a diagnostic classification system in that various diagnoses are shown to focus on specific Ds showing each has value
• four Ds are used by mental health clinicians in conjunction with classification manuals such as DSM, showing it has strong application. different disorders tend to have different applications of Ds and therefore shows how each of the four Ds is used in diagnosis

Question 9

weaknesses of the 4Ds and diagnosis abnormalities

Answer 9

• likely to be subjectivity in the application of the four Ds - what a professional views as dysfunctional, such as not going to work, for example, might not be considered dysfunction by the individual themselves. it might be dysfunctional more for society, for example
• questions about a lack of generalisability of the four Ds raises issues about their reliability. if the four Ds are used by two different professionals they may not reach the same conclusion about mental disorder
• could be claimed that, as Davis 2009 suggested a fifth D, the four Ds are sufficient in themselves as a tool, which is a criticism
• we end up with labels for people with mental health issues. using ‘danger’ for example, as a criterion for mental health disorder leads people to equate mental illness with diagnosis. this can become distorted in the media for example and this could therefore lead to attitudes becoming ’self-fulfilling prophecies