Four D's CODA

- Reliability can be improved by having clinicians communicating during diagnosis to create inter-rater reliability. 

- Use of diagnosis systems means more communication.

- DSM and ICD are always being reviewed and updated, ensuring to make diagnosis more valid based on up-to-date evidence.

-The dsm focuses on the four D's showing each has validity. 

Facitious disorders exist where people fake illness or mental disorders to gain medical attention- idicates deviance from the norm as well as distress felt by the iindividual through the faking illness; here maye be danger, as they harm themselves to back up their claim; dysfunction may incur as ttaking illness involves losing job, withdrawing from social life etc. 

- There are two diagnostic systems with distinct differences in how they classify mental disorders and some disorders are on one but not the other. 

- Diagnosis depends on which system is being used, causes doubt in validity. 

- Only 68% agreement between ICD and DSM. 

- Rosenhan 1973 provides evidence that diagnoses are flawed, as staff were unable to tell mentally disordered patients apart from those who were healthy. 

- No objective measures so therapist has to use their professional judgement. 

- What one views as dysfunctional may not be considered that by a client or by a different therapist.

- Lack of objectivity raises issues about reliability of diagnosis. If the four D's are used by 2 different therapists hey may not reach the same diagnosis.

-Meta analysis of 6 studies

-Found some similarities in how disorders were diagnosed but many differences.

-Reliability is not high for the diagnosis of any mental disorder and that reliability for schizophrenia is just 'fair' no 'good'. 

-This study is from before DSM III (1980) and may be that diagnosis is more valid and reliable today.

-Mitchell Wilson 1993 : DSM III was developed too tackle the unreliability of the previous systems. 

• Timothy Davies proposes that a 5th D should be added - duration.
• Example is grief as a period of grief is normal after the death of a loved one. But if grieving goes on for a long time it is seen as abnormal. 
• Example number two is different types of schizophrenia. 
• Schizophrenia undiffrentiated requires symptoms to have lasted more than a few hours. 
• Schizophrenia disorder is when symptoms have lasted more than a month but no longer than 6 months. 
• one radical new approach is the recovery model.
  • hollistic approach that rejects focusing on symptos and fitting patients into categories. 
  • grew ou of a movement in the 1980's and 90's that rejected institutionalisation and drug therapy and focused on the testimonies of ppeople who beat their illness by changing their lives. 
• jessica arenalla 2015 argues that the recovery model is gaining ground over the medical model because drugs and psychiatrists are expensive bu social workers are much cheaper.
• More extreme advocates of the recovery model reject the idea that their conditions are illnesses at all. 
• their idea is that society should change to accomodate them rather than silencing them. 
• people with menal disorders aren't just broken machines that need fixing. 
• medical diagnosis can become a part of the problem, taking away people's sense of control over themselves as damaged human beings; become dependent on drugs and therapists to make their lie bareable rather than fixing the problem. 

• diagnoses are conducted through clinical interviews. 
• these are semi structured interviews which gather information on clients behavior to make a clinical assessment. 
• this could lead to problems because semi-structured interviews can be unreliable, subjective and biased.
• in the 1960's and 70's the soviet union was condemned for declaring political apponents to be 'mad' and putting them in mental asylums. 
• not clear whether people from poorer backgrounds really do suffer mmore from mental illness or whether there are type 1 erros by doctors who aren't sympathetic.
• labelling soeone as abnormal using the four D's might be used to force people to conform to the societies standards. 
• Timothy davis 2009 argues that diagnosing mental disorders involves deciding when a characteristic is problematic enough to become a clinical diagnosis. the four d's can assist in making a decision by matching behavior and beliefs to the dsm. this helps therapists to know when a condition might need a dsm diagnosis.