Diagnosis of a mental disorder

Question 1

When a diagnosis is helpful

Answer 1

-Diagnosing a mental disorder is harder than diagnosing a physical illness, but the four Ds can help determine whether a mental health ‘issue’ could be considered a mental health ‘disorder’

-This is a crucial decision with implications for treatment and the potential for being stigmatised as ‘mentally ill’

Question 2

Deviance

Answer 2

-Deviant behaviours are unusual , undesirable and even bizarre

-Statistical norms- these are used to measure the unusualness of ay behaviour

-Social norms- Desirability of the behaviour depends on historical context, age , culture , gender

-Failure to conform to statistical and or social norms may lead to negative attention from others and social exclusion

Question 3

Dysfunction

Answer 3

-Symptoms that distract, confuse or interfere with ability to carry out roles and responsibilities

-The WHODAS II - is a questionnaire assessing a persons understanding of what is going on around them, communication & deterioration in self care.

Question 4

Distress

Answer 4

-When symptoms cause anxiety - could be normal depending on the situation so important for clinician to consider the intensity or duration of the distress, as well as persons level of functioning when making a diagnosis.

-Kessler psychological distress scale (K10), a 10 item self report scale focusing on experiences in last month.

Question 5

Danger

Answer 5

-Careless, hostile behaviour jeopardises safety of themselves and others.

-Predicting violent behaviour is difficult but a history os 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 for treatment

Question 6

Strength

Answer 6

-Strength of using the 4Ds is that using all four helps to avoid wrong 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 whose 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 this one)

Question 7

Weakness

Answer 7

The 4 Ds creates labels, for example ‘danger’ as a criteria for mental disorder leads people to equate mental illness with being dangerous

-This becomes distorted in the media, but most people with SZ are no more dangerous than people without it

-This matters because such attitudes may become ‘Self-fulfilling prophecies’ - stereotypes lead people to act as predicted by the stereotype

Question 8

Application

Answer 8

4Ds are effectively applied to diagnosis of mental disorders

-The 4Ds are used by clinicians in classification manuals (DSM-5 and ICD-10). There are different mixes of Ds in different disorders

-For example, deviance from statistics norms helps define intellectual disability, while deviance from social norms, dysfunction and danger help define anti-social personality disorder

-This shows that the each of the 4Ds is used in diagnosis