The 4Ds of diagnosis

Question 1

The 4 Ds

Answer 1

Deviance
Dysfunction
Distress
Danger

Question 2

Deviance

Answer 2

(deviant behaviours are unusual, undesirable and even bizarre)
- statistical norms, these are used to measure the unusualness of any behaviour.
-social norms, desirability of the behaviour depends on the historical context, the age and/or gender of the individual.

-failure to conform to statistical and/or social norms may lead too negative attention from others and social exclusion (so norm-breaking is a useful indicator of psychological abnormality).

Question 3

Dysfunction

Answer 3

(symptoms that distract, confuse or interfere with ability to carry out roles and responsibilities)
Psychologists use a variety of objective measurements to asses everyday functioning.
-e.g the WHODAS II questionnaire assessing a persons understanding on what is going on around them, communication and deterioration on self care etc.
-Dysfunction can also include trouble getting up in the morning, failure to complete tasks at work or college and problems participating in routine activities (e.g socialising).

Question 4

Distress

Answer 4

(when symptoms cause emotional pain or anxiety)
- sometimes psychological distress shows as negative symptoms (e.g aches and pains, palpitations and feeling tired all the time), so these are important for diagnosis.
-Distress could be seen as normal depending on the situation (e.g it would be normal in relation to a job loss or bereavement)
-A clinician considers the intensity and duration of the distress, as well as the persons level of functioning when making a diagnosis.

Question 5

Danger

Answer 5

(careless, hostile or hazardous behaviour jeopardises safety of there person and/or others).
Predicating violent behaviour is difficult but a history of aggression makes another incident more likely.
-in the UK, a person may be detained under the Mental Health Act (‘sectioned’) if three professionals agree they are a danger to themselves or others.
-The person can be taken (without consent) to hospital treatment.

Question 6

Strengths (what does it help to avoid?)

Answer 6

-using all 4 helps avoid erroneous diagnosis
-for example, more factors than just deviance from statistical or social norms are considered when making a diagnosis.
-This avoids situations in which eccentric but harmless people are seen as abnormal, and those with common but debilitating symptoms of depression are missed.
-The importance of this is that a valid system should be neither over- nor under- inclusive like using the 4Ds.

Question 7

counter argument

Answer 7

However
there are no hard and fast rules about how to combine the Ds
e.g someone struggling to cope (signs of distress and dysfunction), but with no signs of danger or deviance, may not require a diagnosis.
It could be the situation causing the problem (so could not be resolved by treatment, which is there purpose of a diagnosis).

Question 8

Weaknesses (what does it lack?)

Answer 8

-The 4Ds lack objectivity
-various methods try to increase objectivity, but this is unlikely (for example because ratings are being made of feelings).
-4DS compare the individual with others, so decisions would be better if made in comparison to a reference group (more objective), not using the clinicians view (more subjective).
-This shows that if the 4Ds are to be applied meaningfully, a clinician needs information not only about the person, but also their community.

Question 9

another weakness (what does it create?)

Answer 9

-the 4Ds create labels
-For example, ‘danger’ as a criterion for mental disorder leads people to equate mental illness with being dangerous.
-This becomes distorted in the media, but most people with schizophrenia are no more dangerous than people without it (Fazel et al. 2009).
-This matters because such attitudes may become ‘self-fulfilling prophecies’ - stereotypes lead people to act ads predicted by7 the stereotype.

Question 10

Application (how are the 4Ds effectively used and applied, what does this show?)

Answer 10

• 4Ds are effectively applied to to diagnosis of mental disorders
  -They are used by clinicians in conjunction with classification manuals (e.g DSM-5 and ICD-10). There are different mixes of Ds in different disorders.
  -For example, deviance from statistical norms helps define intellectual disability, while deviance from social norms, dysfunction and danger help define anti-social personality disorder.
  -This shows that each of the 4Ds is used in diagnosis.