Lesson Two – Evaluation of the Four Ds of diagnosis Clinical Psychology Lesson Two – Evaluation of the Four Ds of diagnosis

Application

Dimension Definition Key words Example 1. Deviance 2. Dysfunction 3. Distress 4. Danger Duration Behaviour which is ‘rare’ within society. If the behaviour is considered deviant from the norm then it could suggest a clinical disorder is present If the behaviour is significantly interfering with the person’s life a disorder may be present. All aspects of a patient’s life is discussed to assess the problematic behaviour When the behaviour is causing upset to the individual. This involves negative feelings. If the person is putting their own life or other’s people’s lives at risk. Refers to danger to themselves or others. Length of time the symptoms have been present

Should Martin (the patient) be referred for clinical diagnosis? Deviance? Dysfunction? Martin is a 21 year-old business major at a large university. Over the past few months his family and friends have noticed increasingly bizarre behaviours. On many occasions they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his cell phone, claiming that if he does it will activate a deadly chip that was implanted in his brain by evil aliens. He has accused his family on several occasions of conspiring with the aliens to have him killed so they can remove his brain and put it inside one of their own. Martin frequently breaks down in tears when he confronts his family of conspiring with the aliens to have him killed. He doesn’t understand why they want to hurt him. He has stopped attended classes altogether. He is now so far behind in his coursework that he will fail if something doesn’t change very soon. Danger Distress Duration?

Are there any limitations to this process? Group Two Group one You are reading about Martin’s case and you decide to argue the previous decision. Are there any limitations to this process? Can you refer to reliability and validity? Issues/Debates? You are the clinician that referred Martin to have a clinical diagnosis. Explain why you did this. What are the strengths of the 4 ds of diagnosis process? Subjectivity – interpretation Differen social norms in different countries – cultue of patient needs to be taken into account Seen differently by different people reliability Measured in a standardised way? Deviation – based on standard measure Standardised tests available and used – not use personal judgements

Davis (2009) Limitations Deviance Danger Dysfunction Distress Duration

Reliability and validity when it comes to diagnosis Is the diagnosis reliable? Reliability of diagnosis: Will different diagnosticians using the same classification system arrive at the same diagnosis? What should happen if three different practitioners interview the client and they all use the 4 ds? Is the diagnosis valid? Validity of diagnosis: Does the person diagnosed have real symptoms with a real underlying cause? (the illness is not socially constructed, the person is not faking) Diagnoses may be consistent but what if they are wrong? What if the conclusions are wrong?

Objectivity vs Subjectivity Evaluative Points Culture Objectivity vs Subjectivity Reliability Validity Socially sensitive – labelling good to label or not? Development over time – addition to ds Application Put a ‘+’ or ‘-’ and explain why. N/A if not applicable

Discuss the difficulties of using the 4ds to define abnormality (8 marks) How do we answer this? Structure?