Diagnosis

What are the 4 Ds of diagnosis?

• Deviance

• Dysfunction

• Distress

• Danger

What are the pros of a method like the 4 Ds existing?

• good for professional use as a classification system

• practical application for use alongside the DSM

Deviance

• Statistical deviance is where behaviour is judged as abnormal based on how rare or statistically infrequent it is. The assumption is that any human characteristic is spread in a normal way across the general population, forming a graphical curve of normal distribution where the majority of people fall at the centre of the graph.

• If someone’s behaviour falls into the bottom or top 2.5% (more than 2 S.D. away from the mean) then their behaviour is considered abnormal 

• Social norms deviance is where abnormality is judged on cultural expectations and what society views as desirable behaviour. Anyone who deviates from such behaviour is classified as abnormal.  

+/- for Deviance

• (+) Statistical deviance can provide objective, numerical data therefore reducing risk of subjective diagnoses. Makes research more comparable 

• (-) Different cultures have different standards and norms for acceptable behaviours, so therefore social deviance differs in different places 

• (-) The concept of abnormality changes over time, even within the same society, as social norms can change and update 

• (-) Many other factors can influence whether a behaviour is deviant and abnormal, including age/gender of the person or context, subjectivity

Dysfunction

• Abnormal behaviour that tends to interfere with daily functioning, upsetting, distracting or confusing the individual until they cannot care for themselves properly 

Rosenhan and Seligman’s (1989) Criteria for Dysfunction 

• Unpredictability/loss of control  

• Irrationality  

• Causes observer discomfort  

• Suffering or distress 

• Maladaptiveness  

• Unconventionality  

• Violates moral standards

+/- Dysfunction

(+) 

• Diagnoses focus on a more individual level at the impacts upon the individual’s life, rather than society’s view of them  

(-) 

• Dangers of misdiagnosing different lifestyle choices, can stigmatise cultural differences and promote discrimination 

• Definition of dysfunction is subjective 

Distress

• An individuals’ emotional suffering and subjective feelings of pain, anxiety, depression, agitation etc. This is typically intense and prolonged 

+/- Distress

(+) 

• Deals with quality of life and personal emotions rather than soley outsider-observed behaviours 

(-) 

• Must be used alongside other Ds for diagnosis 

• Subjective and unable to be measured or proven 

Danger

• When psychologically dysfunctioning behaviour becomes dangerous to oneself or others. A pattern of functioning that is marked by carelessness, poor judgement, hostility or misinterpretations can jeopardise one’s own wellbeing and that of many other people as well 

+/- Danger

(+) 

• Focus on protecting the individual and others, ability to reduce harm 

(-) 

• Needs to utilise the other Ds to help distinguish the motives behind living ‘dangerously’ - whether this is harmful or purely for fun. For example, some risky sports may lead to personal harm, but not a diagnosis of a mental disorder