Diagnosis of mental disorders is very important, as practitioners need to ensure that there is certainly a mental disorder present. Diagnosis of mental disorders is much more complex than that of physical disorders which a blood tests or scan can normally pick up. The 4Ds can help determine if an individual may be suffering from a mental health issue, however, it cannot determine which issue or even for certainty if it is indeed a mental health issue.
Deviance is classified as any behaviour that is unusual, strange and/or undesirable. It is important that practitioners understand the statistical norms for what is considered ‘unusual’ as often such can be subjective to the individual. Additionally, age, culture and social group may also play a part in in an individual’s behaviour, what may be not usually be accepted in society may be accepted in their social group. Hence it is important that the practitioner remains objective at all times.
Dysfunction is defined as symptoms that distract, confuse, and interfere with a persons ability to carry out daily tasks. Dysfunction may interfere with an individuals work, school and even hobbies. Usually, people who are affected by dysfunction start having problems socialising and communicating, self-care may go down and may have difficulty leaving the house.
If a symptom causes emotional pain such as anxiety or even physical such as palpitations, then this can be classified as distress. However, sometimes distress can be considered normal, for example if you have recently lost your job. Hence, clinicians will need to consider the severity of the distress as well as its duration when assessing it. Quantitative data can also be collected such as through the K10 questionnaire.
If an individual displays behaviour that is deemed as careless, and hostile that may put their or other peoples life in danger then this may be considered grounds for diagnosis. In the UK if someone is deemed a danger to themselves and other, they can be detained under the Mental Health Act if three professionals agree that help is needed.
The 4Ds have been applied to classifications manuals such as the DSM-5 and ICD-10. The manuals explain how different disorders may display a different combination of the Ds and their severity. Hence the 4Ds have a constant use in diagnosis.
Using all of the 4Ds combined, may help reduce/avoid erroneous diagnosis. For example, if clinicians were only looking for those with abnormal behaviour they may miss those with normal behaviour that show other signs of the 4Ds.
Lack of objectivity is a key issue with using the 4Ds of diagnosis. Whilst many protocols and methods used aim to maximise objectivity it is still down to what the individual clinician thinks hence making it subjective. Hence, lack of objectivity causes lack of reliability.
Another weakness links with labelling, the use of the 4Ds of diagnosis may lead to labelling by the wider society. Such can be seen when using ‘danger’, this may lead to other labelling individuals as dangerous which may lead to an element of ‘self-fulfilling’ prophecy.
Additionally, there may be issues of social control and potential abuse of power involved with using the 4Ds as well. Koryagin (1981) described how the KGB forced psychologist to make a diagnosis on opposing political members.
References/ Further Reading:
Psychopathology– Wikipedia - https://en.wikipedia.org/wiki/Psychopathology#The_four_Ds