diagnosing mental health disorders - the four ‘Ds’ of diagnosis

Question 1

deviance

Answer 1

• refers to the behaviour and emotions that are not the norm in a society
• not only do the behaviours and emotions have to deviate from social and cultural norms, they must
  also be seen as unacceptable by the society
• eg it may not be the norm in a society to be exceptionally clever, but it is accepted by
  society and is seen as a positive, so it not classed as deviance
• can be difficult to use in diagnosis because different mental disorders can show similar
  deviance
• however, some diagnoses are clearly illustrated by deviance, such as paedophilia

Question 2

dysfunction

Answer 2

• refers to a person’s behaviour not being successful in relation to carrying out everyday tasks and
  living their life in general
• however dysfunctional behaviour can be deliberate, and does not on its own signal a disorder.
• dysfunction can be difficult to use in diagnosis, because many life events and issues can be
  dysfunctional. the dysfunction must occur in more than one part of the person’s life for the
  diagnosis to be given
• examples of lack of functioning include insomnia, being unable to work, relationships being affected and a decrease in pleasure in many areas of the person’s life

Question 3

distress

Answer 3

• refers to when someone with a disorder experiences negative feelings
• thought that abnormality in a mental health sense is accompanied by feelings of distress
• distress can be 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

Question 4

danger

Answer 4

• refers to danger to others or the individual
• violent behaviour directed towards others signals danger, while behaviour that is a danger to the
  individual themselves would include suicidal thoughts
• Davis (2009) cites figures that individuals suffering from a mental illness have a 25% higher chance
  of dying from unnatural causes

Question 5

what fifth D did Davis introduce?

Answer 5

duration

Question 6

duration

Answer 6

• refers to the length of time the individual has had the symptoms
• it is important to consider the duration a patient has had the symptom, when diagnosing a mental
  illness.
• eg, different types of schizophrenia may be diagnosed depending on how long the patient
  has experienced the symptoms

Question 7

strength: DSM-IV-TR

Answer 7

• Davis (2009)
• shown how the four Ds can be used with the DSM-IV-TR, and adds the fifth – duration
• the four Ds have a practical application because they are useful for professional when considering when a patient’s symptoms or issues become a clinical diagnosis

Question 8

strength: validity

Answer 8

• four Ds 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

Question 9

strength: application

Answer 9

• 4 Ds are used by mental health clinicians in conjunction with classification manuals such as the DSM, showing it has strong application
• different disorders tend to have different combinations of Ds and therefore shows how each of the 4Ds is used in diagnosis

Question 10

weakness: subjectivity

Answer 10

• there is likely to be subjectivity in the application of the four Ds
• what a professional views as dysfunctional, such as not going to work, for example, might not be considered dysfunctional by the individual themselves
• it might be dysfunctional more for society, for example

Question 11

weakness: reliability

Answer 11

• questions about a lack of generalisability of the four Ds raises issues about their reliability
• if the four Ds are used by two different professionals, they may not reach the same conclusion about mental disorder

Question 12

weakness: fifth D

Answer 12

• could be claimed that, as Davis (2009) suggested a fifth D, the four Ds are insufficient in themselves as a tool, which is a criticism

Question 13

weakness: labels

Answer 13

• weakness with diagnosis is that we end up with labels for people with mental health issues
• using ‘danger’ for example, as a criterion for mental disorder leads people to equate mental illness with
  being dangerous
• this can become distorted in the media for example and this could therefore lead to attitudes becoming ‘self-fulfilling prophecies’