defining mhd (4d's)

Question 1

what is diagnosis?

Answer 1

The process of matching a person’s behaviours, thoughts, cognitions, feelings and desires to the signs and symptoms of a recognised mental disorder to provide information about prognosis and treatment.

Question 2

what are the four d’s

Answer 2

• deviance
• dyfunction
• distress
• danger

Question 3

what is deviance?

Answer 3

• Behaviours that are unusual, undesirable or even bizarre
• It is important to understand statistics and social norms to understand how unusual the behaviour is, and the desirability of the behaviour within a particular social/cultural group.
• Failure to conform to social norms may lead to negative attention from others and social exclusions and for this reason, norm-breaking is a useful indicator of psychological abnormality.

Question 4

what is dyfunction?

Answer 4

• The inability to conduct everyday activities.
• This can manifest as trouble getting up in the morning, completing tasks at work or college and problems with participating in routine activities such as socialising, going to the gym and taking time out for hobbies.

Question 5

what is distress?

Answer 5

The subjective experience of feeling upset and/or anxious
* may manifest as physical symptoms e.g. aches and pains, palpitations or tiredness.

• could be considered normal depending on the situation
• A clinician will consider the intensity or duration of the distress as well as functioning to decide on a diagnosis.
• Quantitative data can be collected using scales such as the K10 (Kessler Psychological Distress Scale), a 10-item self-report questionnaire.

Question 6

what is danger?

Answer 6

careless, hostile or hazardous behaviour which jeopardises the safety of the individual and/or others

Question 7

four d’s - validity

Answer 7

The DSM consider the Four D’s alongside the symptoms of a disorder which suggests they are a valid definition which increase the accuracy of diagnosis leading to effective treatment.
Thus plays an important role in achieving accurate diagnoses.

Question 8

four d’s - labelling and medicalising

Answer 8

Used by society to medicalise behaviour which may be unusual, but is not actually harmful. Some behaviours should be accepted rather than controlled and managed through labels and treatments.

Therefore Four D’s may have a negative impact on people’s quality of life.

Question 9

four d’s - application

Answer 9

• Application
• They are a creditworthy starting point to identify if a diagnosis and treatment is needed. Helpful to identify immediate danger and ongoing distress
• Therefore useful to society because it is the first step used by clinicians

Question 10

four d’s - not objective definitions

Answer 10

not objective definitions

Behaviour can be interpreted subjectively based on norms which change over time and across cultures.
- New Zealand, Maori society, hearing voices is respected, but would be a symptom of SZ in western cultures.
- What counts as ‘dangerous’ behaviour depends on individual’s views on danger (eg. bungee jumping)

Therefore not reliable (consistent) across and within cultures

Question 11

four d’s - eval conclusion

Answer 11

Diagnosing MHD is very difficult due to cultural, historical and situational biases. By combining all 4D’s the bias can be overcome to an extent. But diagnosis should still be treated with caution