Four D's CODA
- Created by: Lshaw19
- Created on: 11-09-17 16:53
Credibility of four D's
- 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.
Objections of four D's
- 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.
Spitzer and Fleiss 1974
-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.
Differences of four D's
- 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.
Application.
- 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.
Related discussions on The Student Room
- Is mental health nursing a good path/career for one who is interested in psychology? »
- I can't drop out!! Failing Psychology masters but i want a phd for ego reasons »
- KCL Forensic Mental Health MSc - Firmed Offer Thread »
- Swansea University enquiry »
- About a course advise »
- Postgraduate Msc for clinical psychology »
- Mental health urgent course »
- University of Manchester or University of Bristol for Psychology? »
- psychology from level 3 health and social care »
- Could I, as a clinical psychologist, step into the role of a mental health nurse? »
Comments
No comments have yet been made