Diagnosis of Mental Disorders - The Four D's

Question 1

What are the four Ds referred to as?

Answer 1

Deviance

Distress

Dysfunction

Danger

Question 2

What does deviance refer to?

Answer 2

Refers to behaviour and emotions that aren’t the norm in a society and deviate from cultural or statistical norms

Question 3

What is deviance from cultural norms?

Answer 3

Every culture has certain standards and norms for acceptable behaviour

Concept of abnormality changes over time

Question 4

What is deviance from statistical norms?

Answer 4

Abnormal behaviour statistically infrequent or deviant from the norm

Many characteristics such as height, weight, and intelligence cover a range of values

Question 5

What does distress refer to?

Answer 5

Refers to negative feelings that someone with a disorder experiences

Distress alone not a good indicator of abnormality - may be an obvious cause such as bereavement

Question 6

What does dysfunction refer to?

Answer 6

Refers to a persons behaviour preventing them from carrying out everyday tasks and living their life in general

Include insomnia, being unable to work, relationships being affected, decrease in pleasure

No longer socialising and going out with friends would be considered dysfunctional

Question 7

What does danger refer to?

Answer 7

Refers to danger to others or the individual

Person may seem to be endangering themselves by being least bothered about their diet/health or in extreme cases suicidal thoughts

Question 8

What is the supporting evidence/strengths of the four Ds for diagnosis of mental disorders?

Answer 8

Erroneous diagnosis

Data

Effective

Holistic approach

Question 9

What is the refuting evidence/ weaknesses of the four Ds for diagnosis of mental disorders?

Answer 9

Davis (2009)

No hard and fast rules

Objectivity

Subjectivity

Reliability

Labels

Social control

Question 10

Why is erroneous diagnosis a strength of the four Ds for diagnosis of mental disorders?

Answer 10

Using all four Ds helps avoid erroneous diagnosis

Avoids situations in which eccentric but harmless people are seen as abnormal, and those with common but debilitating symptoms of depression are missed

Important as a valid system should be neither over or under inclusive

Question 11

Why is data a strength of the four Ds for diagnosis of mental disorders?

Answer 11

Use of all four Ds adopts both a qualitative and quantitative approach to defining abnormality therefore proving more objective data from the statistical criteria and more in-depth and individualistic data when considering aspects such as dysfunction and danger

Question 12

Why is effectiveness a strength of the four Ds for diagnosis of mental disorders?

Answer 12

Four Ds are effectively applied to diagnosis of mental disorders

Four Ds are used by clinicians in conjunctions with classified systems (DSM-5 & ICD-10)

Different mixes of Ds in different disorders

e.g. deviance from statistical norms helps define intellectual disability, while deviance from cultural norms dysfunction and danger help define anti-social personality disorder

Shows that each of four Ds is used in diagnosis

Question 13

Why is holistic approach a strength of the four Ds for diagnosis of mental disorders?

Answer 13

Using 4Ds to diagnose abnormality provides a more holistic approach than previous definitions of abnormality

This definition combines a number of previous definitions such as failure to function adequately, social norms and deviation from the statistical norm to provide a more complete definition of abnormality

Question 14

Why is Davis (2009) refuting evidence of the four Ds for diagnosis of mental disorders?

Answer 14

Davis suggested that the use of the 4Ds is insufficient and a further concept must be considered, namely the duration of the symptoms

Question 15

Why is no hard and fast rules a weakness of the four Ds for diagnosis of mental disorders?

Answer 15

No hard and fast rules about how to combine the 4Ds

e.g. someone struggling to cope (signs of distress and dysfunction), but no signs of danger or deviance may not require a diagnosis

Could be the situation causing the problem, so could not be resolved by treatment which is the point of diagnosis

Question 16

Why is objectivity a weakness of the four Ds for diagnosis of mental disorders?

Answer 16

4Ds lack objectivity (reduces validity of diagnosis)

Various methods try to increase objectivity (K10) but this is unlikely as they use self-reported rating of feelings (subjective)

4Ds compare individuals with others, so decisions would be better if made in comparison to a reference group (more objective) rather than a 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 17

Why is subjectivity a weakness of the four Ds for diagnosis of mental disorders?

Answer 17

The use of the 4Ds can be problematic

e.g. what a professional views as dysfunctional may not be considered as dysfunctional by the individual themselves; therefore highlighting issues with subjectivity

This would affect the validity of defining abnormality

Question 18

Why is reliability a weakness of the four Ds for diagnosis of mental disorders?

Answer 18

Two different professionals may not reach the same conclusion regarding the individuals mental disorder

Raises issues surrounding the reliability of defining abnormality

Question 19

Why is labels a weakness of the four Ds for diagnosis of mental disorders?

Answer 19

4Ds create labels

e.g. ‘danger’ as a criterion for mental disorder leads people to equate mental illness with being dangerous

Becomes distorted in the media, but most people with Sz are no more dangerous than those without it

Question 20

Why is social control a weakness of the four Ds for diagnosis of mental disorders?

Answer 20

Potential for social control and the abuse of power

Those who breach social norms or challenge government policies can be quieted by being labelled mentally disturbed

e.g. Russian psychiatrists (Koryagin) described how the KGB pressured psychiatrists in the 1960s to diagnose and impression dissidents