Behaviors that deviate from the norm, normally measured through formal classification schemes (ex. DSM-V). It is important to note that many disorders share similar deviances.

Deviance

The dysfunction criteria of a disorder examine whether the behavior is interfering with one's ability to fulfill their social responsibilities and impede their social functions. Various life domains should be compared

Dysfunction

Distress in the four D's looks at people's perceptions of the dysfunction in an individual’s life, whether or not the person feels particularly distressed by it. However, dysfunction and distress may not always go hand in hand together.

Distress

Danger is typically characterized by two themes, whether the behavior may be dangerous to the person themself (danger to self) or to the people around them (danger to others)

Danger

The "Four D's," which are known as deviance, dysfunction, distress, and danger, can be valuable for practitioners when assessing reported traits, symptoms, or conditions in order to illuminate the point of which these factors might represent a DSM IV-TR disorder 

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Commonly used tools for diagnosing mental disorders 

Assessment/Diagnosis 

Davis, T. O. (2010). Conceptualizing Psychiatric Disorders Using “Four D’s” of Diagnoses. The Internet Journal of Psychiatry, 1(1). https://doi.org/10.5580/7e6 

Conceptualizing Psychiatric Disorders Using “Four D’s” of Diagnoses

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

The Four D's

1. Cohen-Mansfield Agitation Inventory
2. Behaviour Problem Checklist
3. Revised Memory and Behaviour Problems Checklist
4. Behavioural Competence Inventory
5. NeuroPsychiatric Inventory 
6. Instrutmental  Activities of Daily Living Scale
7. Bayer Activities of Daily Living Scale
8. Functional Independence Measure

Types of Assessments

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the standard language by which clinicians, researchers, and public health officials in the United States communicate about mental disorders.

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