The 4 Ds (with Evaluation) Flashcards
What are the 4 Ds and what are they used for?
-the 4 Ds of diagnoses are used as an assessment tool to decide whether behaviour is abnormal (may require investigation and diagnosis) and should now be considered a mental disorder. This is a crucial decision given the implications for treatment and also the potential for being stigmatised for being mentally ill
Describe the first of the four Ds ‘deviance’
-when behaviours and emotions that deviate from social or cultural norms, and are seen as unacceptable by society
-they are behaviours that are unusual and undesirable
-by understanding statistical norms we can determine HOW unusual the behaviour is, and secondly the desirability of the behaviour within a particular social group
-failure to conform to social norms may lead to negative attention from others and social exclusion, therefore norm-breaking is seen as a useful indicator of psychological abnormality
-e.g Paedophilia
Describe the second of the four Ds ‘distress’
-when symptoms of a disorder cause emotional pain or anxiety this is a sign that a diagnosis may be beneficial to the person
-sometimes psychological distress can be manifested as physical symptoms e.g aches and pains, palpitations, or feeling tired all the time.
-sometimes distress can be considered normal depending on the situation e.g just lost your job
-a clinician will consider the intensity or duration of the distress as well as functioning order to make a decision about diagnosis
-e.g hypochondriasis
Describe the third of the four Ds ‘dysfunction’
-symptoms which detract, confuse or interfere with a persons ability to carry out their unusual roles and responsibilities may be seen as dysfunctional
-psychologists use a variety of objective measures to assess everyday functioning such as the WHODAS II which is a questionnaire looking at factors such as a persons understanding of what is going on around them, communication and deterioration in self care
-dysfunction can also manifest as trouble getting up in the morning, completing tasks at work or College and problems participating in routine activities such as socialising, going to the gym, or taking time out for hobbies
-e.g OCD
Describe the final one the four Ds ‘danger’
-careless, hostile and hazardous behaviour which jeopardises the safety of the individual and/or others may be considered grounds for diagnosis
-predicting violent behaviour is difficult but a history of aggression makes another incident more likely
-in the UK if a person is perceived to be a danger to themselves or others, either in their own home or in a public space, they may be detained under the Mental Health Act. This requires the agreement of three professionals. The client can be taken, without their consent to a mental hospital where treatment can be provided.
-e.g nicotine dependence
Explain what the ‘fifth’ D is which is duration
-Timothy Davis (2009) notes that clinicians need to consider how long a person has been experiencing symptoms before taking the next step and making a diagnosis. If unusual symptoms have only been experienced very briefly, making a diagnosis may not be appropriate and a longer period of observation is necessary.
Give a strength for the use of the 4 Ds in diagnosis
P: using all 4 may help to avoid errors in diagnosis
E: for example, if deviance from statistical or social norms were the only consideration when making a diagnosis, then those who are ethnocentric yet harmless may be considered mentally ill whilst those with common but debilitating symptoms of depression may be missed
E: this is important because a valid system should be neither over or under inclusive
Give a weakness for the use of the 4 Ds in diagnosis
P: there is no hard and fast rules about how the Ds should be combined
E: for example if a person is struggling to cope and showing signs of distress and dysfunction but there are no signs of danger or deviance, the person may not require a diagnosis. It is possibly the situation which is causing the problem and not a problem that could be resolved by treatment which is the purpose of a diagnosis
Give another strength to using the 4 Ds in diagnosis
P: they have good practical application to society
E: the 4 Ds are used by mental health clinicians in conjugation with classification systems such as the DSM-5 and the ICD-10 to help decide whether making a diagnosis is appropriate, and if so which one. Different disorders tend to display different combinations of Ds. E.g deviance from statistical norms is used to determine intellectual disability while deviance from social norms, dysfunction and danger all feature in the diagnostic criteria for anti social personality disorder
E: this shows how each of the 4 Ds is valued and used in diagnosis
Give another weakness to the use of the 4ds in diagnoses
P: they do not lend themselves to objective measures
E: there are various methods used that aim to be objective but this is unlikely because ratings care being made of feelings. Lack of objectivity in turn affects reliability. Since the 4 Ds involve making comparisons between the individual and others in society, decisions would be better if they were made in comparison to a reference group, I.e objectively rather than on the basis of the subjective view of the clinician
E: this shows that if the 4 Ds are to be applied meaningfully, a clinician requires detailed information of not only the person, but their community
