5.1.1 the four Ds Flashcards Preview

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what are the 4Ds

the four dimensions of diagnosis, used to define abnormality. this is the initial diagnostic process and not to be mixed up with ICD/ DSM

when using the 4DS a persons context and situation must be taken into account and are useful in summarising how mental health professionals might define abnormality


what is deviance

these are behaviours and emotions that are viewed as unacceptable.

refers to behaviour and emotions that are not the norm in society. have to deviate from social and cultural norms


what is dysfunction

refers to a persons behaviour not being successful in relation bro carrying out everyday tasks. but dysfunction behaviour can be deliberate and does not in its own signal a disorder

this is when the abnormal behaviour is significantly interfering with everyday tasks and living your life. a person is considered abnormal if they are unable to cope with the demands of everyday life eg holding down a job


what is distress

this is the simple view that abnormality involves being unhappy : experiencing negative feelings like anxiety, isolation, confusion and fear for a long time. but a problem with this is that judging distress is quite subjective


what is danger

this is when the behaviour harms , or puts at risk the individual or others around them

including suicidal thoughts


what is the 5th D (put forward by Davis 2009)


it refers to the length of time the individual has had the symptoms. E.G different types of SZ may be diagnosed depending on how long the patient has experienced symptoms.

the duration of symptoms is important in diagnosing mental disorders.


in terms of deviance, what did davis 2009 suggest

he said different mental disorders can show similar deviance

this is a problem as some diagnosis are clearly illustrated by deviance eg paedophillia where the symptoms shown in the dsm indicate deviance eg withdrawal


in terms of dysfunction, what did davis 2009 suggest

many life events and issues can be dysfunctional. the importance of dysfunction in diagnosis is seen in the disorder depression

he points out that to receive this diagnosis, the episodes of depression must affect normal everyday functioning (work/social life) eg insomnia


in terms of distress, what did davis 2009 suggest

quite hard to measure as a 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.

hypochondriasis is a fear of having a serious disease. main feature is distress. treatment is based on distress : by getting the person to focus on their bodily symptoms and decrease the time they focus on their distress


in terms of danger, what did davis 2009 suggest

davis 2009, look at nicotine dependence -> danger to the person from smoke . - related illness and danger to others from second hand smoke.

mental illness has danger.

davis 2006 uses figures that individual suffering from mental illness have a 25% higher chance of dying from unnatural causes


evaluate 4Ds : strengths

davis 2009 has shown how the 4Ds can be used with the DSM, and that they have a practical application because they are useful for professionals when considering when a patient’s symptoms or issues become a clinical diagnosis

the 4Ds 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. Davis 2009 offers evidence for this claim

using all 4 may avoid errors in diagnosis

there are standard tests to use, so clinicians do not have to reply on person judgement

each are used in diagnosis - different disorders have different combinations of the 4Ds


Evaluate 4Ds: weaknesses

subjectivity in the application of the 4Ds, and may not be considered such by the patient

questions about a lack of objectivity of the 4Ds raises issues about their reliability. if the 4Ds are used by 2 different professionals, they may not reach the same conclusion about mental disorders

it could be claimed that as davis 2009 suggested adding a 5th D, therefore the 4Ds on their own are not sufficient in themselves as a tool

4Ds may not always point to a problem that requires treatment; a situation may need to change rather than treating the person

4Ds lack objectivity as rely on feelings - this impacts reliability. subjectivity in the interpretation of the patient’s experience is a serious weakness ; what is seen as dysfunctional by one person is not the same as to another

another issue of reliability is to ensure standard measures eg of deviance

a result is that we give labels which add to stereotypes and can foster negative views eg sz and danger