The 4D's Flashcards
What are the 4D’s?
Deviance, Dysfunction, Danger and Distress
What is DEVIANCE?
Clinicians look at the extent to which behaviour is ‘rare’ within society. If the behaviour is considered rare enough, or goes against social norms it could suggest a clinical disorder is present.
It’s behaviours, thoughts and emotions that are viewed as extreme, unusual or undesirable which differs from statistical and social norms.
What is the social norms definition of DEVIANCE?
Culture: Different cultures have different social norms. Hearing voices may be normal in a culture that believes in spirits but abnormal in another culture that sees it as a mental disorder.
History: what is abnormal at one time might become normal later. Homosexuallity used to be considered a mental illness and was in the DSM-1 but is now accepted by most people of the western culture.
Situation: behaviours that are normal in one place and context may be abnormal in different situations. e.g nudity is normal in the shower and changing rooms but is not in the supermarket.
Age & Gender: We have different expectations of men and women and old people and young people.
What is DYSFUNCTION?
It is symptoms/behaviours that distract, confuse or interfere with the ability to carry out usual roles and responsibilities or everyday tasks. e.g the behaviour may be interfering with their job or relationships.
What is DISTRESS?
The extent to which symptoms/behaviour causes upset or emotional pain to the individual. e.g experiencing negative feelings like anxiety, isolation, confusion and fear.
The subjective feeling of the patient is important because they may feel a great deal of difficulties in their life but feel no distress. similarly someone else may be very distressed by something that others may view as trivial. making it important that the clinical understands the level of distress a person is feeling before diagnosis.
What is DANGER?
The patient’s behaviour has to be assessed under two key elements: danger to themselves and danger to others. if an individual is putting themselves or other in danger then an intervention may occur.
it is careless, hostile or hazardous behaviour which harms or puts others at risk.
What is the fifth ‘D’?
Some researchers consider the fifth-‘D’ DURATION.
many behaviours may be seen by the above 4D’s in the short term memory but if they persist then this is where
the problem may be seen as a symptom of an illness that requires psychiatric attention.
S/W of deviance
Strength:
It can be used to help decide whether behaviour is abnormal and if further investigation, a diagnosis and treatment are required.
Weakness:
It can lead to the curtailing of people’s human rights as social norms can change with time. E.g, in the past homosexuality was viewed as a mental disorder and now it is not.
Some cultures deem behaviours (e.g. hallucinations) as desirable, rather than deviant and some mental disorders (such as depression) are not actually seen as rare these days.
S/W of dysfunction
Strength:
It can be used by clinicians to help determine when a mental health ‘issue’ could be considered a mental health ‘disorder’.
Weakness:
Lacks objectivity. The problem with the dysfunction dimension is that people can disagree on what is considered dysfunctional behaviour. What a clinician deems as dysfunctional may depend on their own beliefs and bias.
S/W of distress
Strength:
It takes into account how an individual is feeling. It is important that clinicians consider an individual’s subjective experience of distress even if they are functioning normally.
Weakness:
Lacks objectivity. Compares individuals with others, so decisions would be better if made in comparison to a reference group (more objective), not using the clinicians view (more subjective). A clinician needs information not only about the person, but also their community.
S/W of danger
Strength:
The 4 Ds are used by clinicians along with classification manuals (e.g. ICD or DSM) and there are different mixes of Ds in different disorders. For example, danger, dysfunction and deviance from social norms can help define antisocial personality disorder.
Weakness:
It can be difficult to diagnose a person who engages in risky behaviour that does not cause immediate harm. Some risky behaviours can cause personal harm e.g. extreme sports but these do not usually lead to a mental health diagnosis.
Evaluation points
Clinical psych topic 5 Booklet 1 page 5
