The 4Ds

The main method of assessment used by clinical psychologists is to consider the 4 Ds

Deviance

This is where behaviours and emotions that are rare are deemed unacceptable. It can be calculated statistically because if a behaviour is more than 2 standard deviations from the mean of the public it is seen as abnormal. Another way to assess deviance is to see whether the behaviour breaks social norms.

E.g. wearing a cat costume to work breaks the social norm of wearing a uniform

Dysfunction

This is when abnormal behaviour significantly interferes with someone’s ability to carry out their usual roles and responsibilities. A person is considered abnormal if they cannot cope with the demands of every day life.

E.g. someone with depression may not shower for weeks due to their mental disorder

Distress

The view that abnormality involves being upset including feelings of anxiety, confusion and fear. These negative feelings occur inappropriately or persist longer than usual.

E.g. someone with OCD will was their hands 50 times a day as they are fearful of contracting a disease

Danger

Careless, hostile or hazardous behaviour which may affect the safety of the individual or others. Predicting violent behaviour is difficult but a history of aggression makes an incident more likely.

E.g. Someone hearing voices telling them to harm themselves physically is dangerous

Strength of using the 4Ds

I: The 4Ds are useful in the sense that they avoid erroneous diagnosis

J: If only one component of the 4Ds was used e.g. deviance many eccentric/rare behaviours although harmless may be falsely diagnosed and contrarily the symptoms of depression may be missed as the affect a large minority of the population.

E: Therefore using the 4Ds in combination is useful as it allows clinicians to determine is a patients behaviour requires further investigation from a classification system e.g. the DSM.

Weakness of the 4Ds

I: However, using the 4Ds as a method of diagnosis can lead to the stigmatisation of people with mental health issues

J: E.g. using danger as a criteria leads to the perception of people with metal health disorders as hazardous. This is supported by Fazel 2009 who found that people with schizophrenia are not more dangerous than those without it.

E: This can lead to people not wanting to seek treatment for the fear of being unfairly labelled, or even self-fulfilling prophecies.

Weakness of using the 4Ds (2)

I: Another problem using the 4Ds is that there may be subjectivity in utilising this method of diagnosis

J: Definitions of behaviour are not a standardised way of measuring health. What is considered dysfunctional or dangerous may differ for each clinician. Some people may think taking a day off work is dysfunctional but another sees it as acceptable behaviour

E: This lack of objective measurement could lead to different professionals making different diagnoses for the same patient potentially leading to incorrect diagnoses and treatments

Strength of using the 4Ds (2)

I: However, a fifth dimension could be added to make the 4Ds a more useful method of diagnosis

J: David (2009) suggests that it is also important to consider the duration of symptoms when making a diagnosis as different psychotic disorders are characterised by the different duration of symptoms. therefore not considering the duration of symptoms could lead to the wrong disorder being diagnosed and incorrect treatment being given.