Evaluate the use of the 4Ds in the diagnosis of mental disorders (8)

Question 1

AO1

Answer 1

One of the biggest issues for clinical psychologists is the point at which a behaviour that is displayed by an individual becomes so ‘abnormal’ that is requires clinical diagnosis and possibly treatment. One method used by clinicians is to refer to the 4D’s. Deviance is where clinicians look at the extent to which the behaviour is ‘rare’ and so not the ‘norm’ in society. If considered rare enough, unacceptable and ‘deviant’ from the norm, a clinical disorder may be present. Dysfunction considers if the behaviour is significantly interning with the person’s life and if it is, a mental illness may be present. Distress considers that extent to which the behaviour is causing upset and negative feelings for the individual and Danger assess the patients behaviour on a scale of severity under two elements: danger to themselves eg if they are suicidal, and danger to others. If either pf these s present it mat indicate intervention is needed.

Question 2

Validity Strength

Answer 2

The 4D’s are standardised tests used to assess symptoms of many disorders and these should be used where possible rather than making a personal judgement about the patients’ symptoms. Davis suggests that this supports the validity of the DSM. For example, when assessing dysfunction, psychologists use a variety of objective measures to assess everyday functioning, such as a questionnaire looking at factors such as a person’s understanding of what is going on around them, communication and self-care. Therefore, the use of the 4D’s may avoid errors in diagnosis and have a practical application as they are useful for professionals when considering when a patient’s symptoms or issues become a clinical diagnosis.

Question 3

Updated D’s

Answer 3

Equally, the D’s have been updated over time. For example, Davis showed how the 4D’s can be used with DSM IV, and added a 5th, Duration, which is the length of time a symptom has lasted. Therefore, this further strengthens the use of the 4Ds when used alongside classification systems as a tool enabling clinicians to reach valid diagnoses.

Question 4

However Danger

Answer 4

However, using danger as a criterion for a mental disorder leads people to equate mental illness with being dangerous in society where as most are not. For example, Fazel et al suggests that most people with SZ are not actually more dangerous than people without this diagnosis. Therefore, the use of this term may lead to ‘self-fulfilling’ stereotypes and stigma for many disorders.

Question 5

Lack of objectivity

Answer 5

Another issue is that the 4D’s can be applied and combined in different ways by different clinicians and there is also a lack of objective judgment. The 4D’s involve making comparisons between the individual and others in society, such as through norm or expectations, and so a clinician requires detailed information, not only of the person but also of their community. Equally, there is potential for subjectivity in the interpretations of the individual patient’s experience and the clinician must take into account how the person is coping with the behaviour being discussed because, for example, what is considered to be dysfunctional by one person will be seen differently by another. Therefore, although use of the 4Ds has led to improvements in diagnosis, the extent to which this is achieved is still limited by patient and clinician factors.

Question 6

Reliability issues

Answer 6

There are also issues of reliability as the decision of whether the behaviour requires further diagnosis relies on what is discussed between the patient and clinician. To be reliable the clinician should ensure they explore all 4D’s with every patient to ensure everyone is measured in a standardised way. Equally, an issue with the concept of deviance is that some problematic behaviours are not actually rare. For example, depression occurs in 20% of the population. Therefore, depression would technically not be considered requiring a diagnosis on the use f deviance alone, however, using a social norms definition and the other D’s, most in society would consider depression an abnormality, as recognised by its inclusion in classification systems such as the DSM.