The Four D’S

Students spent a majority of their times at school, they are like second homes. They need to feel safe at schools so they trust and learn. Teachers can maintain the daily schedule after a shooting event occurred but be open to addressing any questions after the event. Teachers can teach and show the students a good way to deal with the stress and concern. They can be truthful about what happened and use the right language to answer the student’s questions. Also, demonstrate a good plan in case it happens at the school. Set up activities that keep their body and mind occupied. It is good to let the student express their feelings about what happened. The teachers need to stay calm and understanding, let them know that you acre about them. The students will need counseling to help them to deal with the trauma, therefore the school needs to have counselors ready for them.

Conflict perspective would be one of the theoretical perspectives to address the question ” why did this happen?” because the students felt weak and someone else took their freedom. The shooter had the control of the environment and the student can not comprehend why the shooting happened.
The student can look at what happened took place because the shooter was not in the right mindset. It was their faults that the shooting happened and they did not do anything wrong. The family of the shooter maybe saw signs that things were not right and they could off get him help.

Brock, S.E., Nickerson, A.B., Reeves, M.A., Jimerson, S.R., Lieberman, R.A., & Feinberg, T.A. (2009). School crisis prevention and intervention. Retrieved from:

McCarthy, C. J., DeLisi, M., Getzfeld, A. R., McCarthy, C. J., Moss-King, D. A., Mossler, R., Privitera, G. J., Spence, C., Walker, J. D., Weinberg, R. S., & Youssef-Morgan, C. M. (2016). Retrieved from:


My Friend

My friend has been married for twenty-something years and he and his wife have a daughter in college and a son in High school. He is freedom Israel and she is a blond mute from different countries. They met at a bar and they liked each other so they dated for about one year than they got married. He is an artist who makes signs for business especially restaurants and bars in NYC. He started his business and built it up, so he makes great money and she works as an accountant in the business. She also does real estate on the side, so one day she asked him for a divorced because they were acting more like friends rather than husband and wife. He was shocked and did not understand what happened, so she moved out and got an apartment in the town near him. He was hurt but he made his best to understand her feelings. So, they lived apart or one year and during that time he brought the house from her and their son and daughter resided at the home, but their son spent the week with mom and the weekends with dad. Their daughter lived on campus and came home during the holidays.
My friend stayed in the home alone during the week and made the best of the situation while they got the divorce. He traveled a lot with his male friends when he has free times in his business. He tried to keep his spirit up, but my friend does not believe in God, how can that be when is a Jew from Israel. Although he lived a wild life when he was younger, he tried drugs and wild crazy sexual encounters.
Somehow, I get attracted to wild and street-smart men. I had a boring childhood because my grandmother was strict and was very religious. I behaved well because I did not want to get discipline in the form of a beaten by her and my uncles. So, my sisters and my brothers and I behaved well to stay out of troubles unlike my cousin Yanithe. I like to spend times with my friend because I feel that he is wise, and he likes to watch the channel from his birth country. His mother and father are still alive, and they live in Israel. When I go to visit him, he teaches me how to play card and other games and he always has foods for us to eat. Anyway, after his divorced, he decided to move to NYC because his son is going to attend college there and he told me that the travel is too much for him. So, he put his house for rent and I suggested to him that maybe it would be better if he sells the house because the rent is very expensive in the area where he lives. He said that he will think about it, the house is very comfortable because he and his ex-wife made all the upgrade and they also have great furniture.
I am comfortable with him for some reasons, my shield is down, and I understand him and what he went through. He did right by his ex-wife compare to my ex-husband. I figured that my ex-husband and I was going to handle the business even though we got divorced. After all the business we started them from scratch, he and I were so proud of what we built and how we helped so many people and we duplicated ourselves.

by Marie Diaz-Cervo


By Carol Abraham

Effective Leaders

There are many leaders who believe they are effective but they actually have the opposite affect – they do not lead but rather they bully.   Effective leaders are individuals with vision that can motivate their team through empowering them rather than intimidation.  They inspire the team to be innovative and find creative solutions to the organization’s problems.  They exhibit clear and consistent communication with their team and resolve disputes before they escalate.  While there are many books on how to be an effective leader it seems as if many miss the mark because they fail to invest the time in their team.  An effective leader focuses on the process to reaching the goal not just the goal itself.


The concept of self-efficacy by Albert Bandura is a critical one because it shows us how our perceptions shape our response which impacts our life.  Our emotions translate into our behaviors – how we feel about ourselves dictates how we behave.  How we view ourselves impacts every decision we make.   How we view a situation is critical to how we handle it, if we believe we can do it then we will take on challenges head-on.  We will be resilient during hard times because we believe we can shape our lives rather than feeling helpless.  The mind is an amazing thing, if we believe it we will act accordingly – for example, in scientific studies there is something known as the “placebo effect” which basically means sometime people will get better simply because they believe that the treatment is working.  When some individuals are given the placebo pill they report signs of improvement from the fake pill because they believe in the treatment.


Self-determination is about the choices we make based on our beliefs (it is a theory of motivation).  It’s about the action we take based on what we believe; it touches upon self-motivation.  It is of the mindset that we determine our destiny.  We motivate ourselves to reach our goals despite any obstacle or challenges in our environment.  One way we can do this is by developing our emotional intelligence.  Emotional Intelligence is about using techniques to manage your emotions so that you build stronger relationships and make better decisions.  Emotional intelligence is about self-awareness, empathy, impulse control, and keeping an open mind.  Daniel Goleman wrote a book called “Emotional Intelligence: Why it can matter more than IQ”, in his book he explains the importance of cultivating emotional intelligence and how it plays a role in reaching your goals almost as much as intellect.  The reason is that as we interact with our environment we have an instinct to run with our emotions but those that can manage their emotions tend to make proactive choices rather than reactive choices which lead to better results.  When we interact with people rather than make assumptions and let our emotions get the best of us, managing those impulses allow us to not burn bridges or miss out on opportunities for advancement.  In Daniel Goleman’s book he mentions that the most successful leaders are the ones that have emotional intelligence, he explains that there are more programs in schools designed to help children cultivate their emotional intelligence so that they may navigate their environment and make smart choices rather than reactive choices so that they may reach their potential.


Feelings can Lie

God, it feels like the people who are outside of the word of God are the ones who are doing well financially. Some are involved in a same-sex relationship, others have unforgiven personality, some are liars, some are manipulators. some do not believe in the words in the Bible, some have a double mind, some have no empathy for others, not even family members. Some people just care about themselves, their famous word is “do me”. They are unable to have peace in their hearts and love others unconditionally. However, God has a way of protecting His children and show the bad people that He loves his children. He blessed His children right in front of their enemies. as you read Psa 23.


The character behaviors that lead me to believe he had a disorder is the movie IQ the character is Einstein, he was slow in learning how to talk. Also, he had a mild form of echolalia, he repeats phrases to himself two to three times. He was not able to control his temper, his face turns yellow, his nose snow-white and had a temper tantrum. He was great at systemizing and was more impress with it than his ability to emphasize. He did not respect authority.
Einstein did not have respect for authority which is the deviance part of the D’s diagnoses. He had an incident at school which causes him discomfort which leads toward depression and even close to a nervous breakdown. His father business’s suffered a sudden reversal of fortune.

The character had issues with authority and in life, people deal with others at a higher level than them. Some people would be at a level which people delegate to them because he was still young and in school, he had to listen to his teachers and professors.

The character got very depressed after his father lost his wealth which made him had to deal with life in a different manner.
He lost control because of his temper which made him harmful to the people around him. His classmates, his family and anyone that he came in contact with could be in danger if the character lost control of his behavior.

Aggression can be treated with drug or the person can take martial arts, kickboxing to redirect the anger. Therapy session can also help the person to deal with the behavior by utilizing “Humanistic model”. Also, a behavior modification could help to change his behavior, finally the last treatment could be to give the character mild electric shock.

The character Einstein was Jewish and it is normal for his culture to openly display their anger.

LeFrancois, G. (2016). Psychology: The human puzzle (2nd ed.). [Electronic version]. Retrieved from

T Davis. (2009). Conceptualizing Psychiatric Disorders Using “Four D’s” of Diagnoses. The Internet Journal of Psychiatry. Volume 1 Number 1.
Gale. (1994). The Private Lives of Albert Einstein. Retrieved from


Early Intervention

I completed an early intervention course and I received a high grade because I follow the instructions from the professor. The main goal for studying the subject was to get a better knowledge of special needs children and how to guide them to learn lessons and to get rid of some of the behaviors that will hinder their life in general. The people in this field are trying to help others and at the same time earns a better living. They asked questions that will help them to understand what they need to do and they can also solve behaviors and lack of some senses. They gather behaviors data and also an assessment of how much the students know the lessons. The basic idea is to help the students with their behaviors, lack of speech, lack of mobility and so on. I can see how some people do not have sympathy for special need children because they can not see how each student has a special gift and they did not ask to be born that way.

I had to figure out which course did I get the best grade. I had to picture my times in the course and what was the reason that I enrolled in the course. I had to understand the benefits of learning from the experts so I can help my students. We did several exercises so I can truly have a sense of what the students are going through all the times. After the class, I can comprehend and be passionate about the students graduate from the class and move forward to the next class.

My score for the LCI are:
Sequence (30)
Precision (26)
Technical Reasoning (24)
Confluence (25)

Based on my own unique Learning Patterns, I will schedule a time each week to read and reread the assignment. I need to anticipate the point of the reading and what I need to know after I read the article or the assignment. Another way is to look for Que words in the questions. I will read other’s writing to get a better understanding of critical writing skills. I will remember that is ok to write starting from the middle, I do not need to be perfect. To enhance my critical writing skills, I need to take times to plan what I need to do. It is good to break the plan into small tasks, then small steps of what I need to do each day. I need to stay focus and be specific about what is required of me to finish a project. I can implement the SQ3R tips for my sequence learning pattern, “Focus on following the process step by step: Survey, then Question, then Read, Recite, and Review.”
SQ3R for my precision learning pattern, “In the Read stage, focus on reading slowly and carefully to absorb the details. In the Recite and Review stages, make sure you are able to summarize the key points of each section, and if you cannot, be conscientious in going back and rereading.”

Wealth After Divorced

The same way I can now braid my own hair without asking my sisters to braid my hair, the same way I can purchase my own home and get financially independent. They got their master degrees, I can get my degree also and help others to follow their purposes.
I can do it, I believe I can do it. I am smart, I can do it. I am clever, I can do it. I am good enough, I can do it.

4 D’s of Diagnoses

One of the inherent difficulties in diagnosing a mental disorder is determining at whatever level a particular trait or problem becomes a clinical diagnosis. An old joke serves well to illustrate this point. Question: “What is the difference between someone who is crazy and someone who is eccentric?” Answer: “About ten million dollars”. This joke is humorous because it reflects the grey lines that define when symptoms rise to the point of classification as a disorder. As such, it also speaks to the difficulty of mental health diagnosis. An individual with many resources may not experience a similar set of emotions, cognitions or behaviors as a problem since it is likely that the person will be afforded latitude that someone with limited resources will not. Every human being experiences a range of problematic emotions, cognitions, and behaviors across the lifespan. When does a problem become a disorder? To answer the question in part, mental health professionals can utilize the “four Ds”, danger, deviance, dysfunction and distress to conceptualize mental disorders 2.

This article will explore in some detail the four “Ds” and how they contribute to psychiatric disorders. Each “D” will be explored through one of the Axis I disorders of the Diagnostic and Statistical Manual fourth text revised edition [DSM IV-TR] 1.

The first “D” to be discussed is that of deviance. Deviance can primarily understand through formal classification schemes such as those provided in the DSM IV-TR diagnostic criteria. Apart from these, other tests which provide norms for the general population can be helpful to determine a degree of deviation from the norm. Further, clinical interviews can collect information helpful in both these examples. However, many disorders share common patterns of deviance and need to be examined in a differential diagnostic model8.

This “D” can be illustrated using 302.2 Pedophilia, a DSM IV-TR diagnosis in which deviance is the hallmark of the disorder1. Pedophilia is a specific paraphilia, a class of disorders characterized by recurrent intense, sexually arousing fantasies, behaviors or urges. Pedophilia is characterized by recurrent urges, fantasies or behaviors existing over at least 6 months and directed at children 13 years of age or younger. These symptoms must present significant distress or impairment. The individual must be over the age of 16 and 5 years older than the subject of the desire. Seto6 surveyed a number of studies and found that anywhere from three to nine percent of males report some interest in underage children and a number of these studies demonstrated that this interest could be turned into action if the circumstances were right. Thus, those who have the thoughts are either in the minority or in a small minority of males. In addition, he points out that the actual number of males who meet the other criteria of time and intensity is very likely much less than the three to nine percent figure. Given the legal and social attitudes concerning pedophilia, the number of individuals who can be diagnosed with the disorder is difficult to ascertain. The fact that up to nine percent of males may have a sexual interest in children may set an upper limit to the prevalence. This, however, may still be questionable given a potential bias against reporting (e.g., potential respondents would find it taboo to admit to certain tendencies/feelings/thoughts). Females with these propensities are even rarer in the literature as Seto demonstrates. These factors taken together illustrate both the statistical and societal nature of deviance in pedophilia.

A second “D”, dysfunction, is also important to determine the presence of a problem large enough to be considered a diagnosis. Whatever the dysfunction, it must be significant enough to interfere in the individual’s life in some major way. In addition, it is important to look for dysfunction across life domains as they may exist in obvious places as well as less likely places8.

To examine dysfunction, the diagnosis of 296.33 Major Depressive Disorder, Recurrent, without Psychotic Features is chosen1. This disorder is characterized by two or more episodes of a major depressive episode. When the classification of severe is used, it indicates that this episode has elevated to the point where many it markedly interferes with the individual’s occupational or social life. In order to warrant a diagnosis, this interference must be defined by the presence of a minimum number of the symptom classifications outlined in the criteria. These symptoms will evidence themselves through a negative impact (dysfunction) in multiple areas of the individual’s life. For example, the person will experience a depressed mood for most of the day which will interfere with relationships with others, as easily perceived by outside observers. He/she has a great decrease in pleasure in almost all of the activities of life which will likely make the person avoid many of these, resulting in increasing dysfunction. The individual may experience insomnia or hypersomnia to the point of interfering with daily tasks. He/she will experience marked energy loss and may not have the motivation or energy to do common tasks such as personal hygiene or household maintenance. The person may have a diminished ability to concentrate which interferes with the ability to complete tasks at home and work. When a person has been diagnosed with major depression, it is likely that the individual has experienced some dysfunction in almost every area of life and severe dysfunction in many areas. In fact, in an inquiry by Remick4, many areas of dysfunction were identified in the research. He found that depressive disorders and poor work productivity are related as demonstrated by a threefold increase in the number of sick days in the months preceding the illness for workers with depression compared with coworkers who did not show increases in sick days preceding illness that was not depression. There is evidence that children of women with depression have higher rates of dysfunction in school, are less socially competent, and display lower self-esteem than their classmate’s mothers whose mothers who are not depressed. Finally, depression’s ability to cause life dysfunction becomes evident by the fact that the leading cause of disability among people aged 18 to 44 years is depression.

A third “D”, distress, is related to dysfunction in that it becomes an important way to grade perceptual dysfunction in an individual’s life. This relationship is not always linear. A person can experience a great deal of dysfunction and very little distress or vice versa. The essential component of distress is the extent to which the issue distresses the individual, not the objective measure of the severity of the dysfunction8.

Distress will be explored using the diagnosis of 300.7 Hypochondriasis1. The features of Hypochondriasis consist of a preoccupation with the fear of having, or the idea that one has a serious disease. This fear is based on the misinterpretation of an individual’s bodily symptoms. Currently, this diagnosis is classified as a somatoform disorder. However, it also features elements of an anxiety disorder. The distress of the preoccupation of the disorder persists in spite of medical evaluations and reassurance. Salkovskis, Warwick, and Deale5 found that these individuals tend to use considerably more medical resources and tend to be rather intractable in terms of their prognoses. Further, although reassurance that is offered may decrease short-term distress, it increases distress in the long run. Therefore, it seems the more medical reassurance that is sought, the more distress increases. This feature makes the problem of distress a fundamental feature of the disorder. In fact, the researchers found that effective treatments all centered on decreasing the amount of distress experienced by the individual with the disorder. This decrease is accomplished through thought restructuring, to refocus the individual’s attention away from somatic symptoms toward distressing thoughts and activities, thus getting the individual to decrease the amount of behavior consumed by the distress. Ultimately, if one can lower the anxiety and distress level, a positive outcome may be more likely.

A fourth “Ds” in danger. To outline this concept more specifically, the danger component consists of two broad themes, danger to self and danger to others. Diagnostically speaking, there is a wide continuum of danger. There is some element of danger in every diagnosis and within each diagnosis, there is a continuum of severity. Once these have been explained in broad strokes one can explore how these are played out in a specific diagnostic picture8.

Danger will be examined using a seemingly benign disorder classified in the DSM IV-TR, 305.10 Nicotine Dependence1. The major features of dangerousness in Nicotine Dependence are the self-inflicted hazards placed on those meeting diagnostic criteria. That being the case, Nicotine Dependence may also be a danger to others through the harmful effects of second-hand smoke. In some substance abuse disorders, danger to self may also be evidenced by vulnerability (a danger that may be inflicted by others), as a result of the usage of the substance. Nicotine Dependence is characterized as a substance abuse disorder and features elements of tolerance and withdrawal. The diagnosis has dangerous physical effects through the health conditions related to it and dangerous mental health effects evidenced by the emotions and behaviors that people exhibit when nicotine is unavailable or when they are trying to quit. Individuals may also avoid activities or situations which negatively impact their lives due to the inability to use the substance. Approximately 80 percent of smokers express the interest in quitting. Thirty-five percent of smokers actually try to quit in any given year, while only five percent are successful. This again illustrates the cognitive dissonance endured by a large number of smokers. With regard to physical dangerousness, an article summarizing a center for disease report, Sibbald7 documented that over eight and a half million Americans are diagnosed with over 12.5 million smoking-related diseases. Moreover, 10 percent of all current and former smokers have a smoking-related chronic disease. These diseases include heart disease, emphysema, stroke, and cancer. Further, 440,000 Americans die prematurely every year due to a smoking-related illness. Clearly, nicotine dependence is a diagnosis wrought with danger.

Though the danger of Nicotine Dependence may obvious given the statistics, it is also clear that other mental illnesses carry substantial elements of danger. This is true even for those diagnosed not involving dependence on chemical substances that negatively impact one’s health. Hiroeh, Mortensen, and Dunn3 followed over 257,000 individuals in the Danish psychiatric register and documented their causes of death. They found that individuals with mental illnesses had a 25 percent higher chance of dying from any unnatural cause, including homicide, suicide, and accidents. Further, they found that almost all psychiatric diagnoses show elevated mortality as compared to the general population. Of all types of unnatural deaths, suicide was the most prevalent. This evidence clearly shows the necessity of assessing danger when conceptualizing a mental diagnosis.

As the “four D’s” have been developed in the literature, some have suggested including a fifth “D”, that of Duration2. Duration becomes important since it can illuminate whether an emotion, cognition or behavior is a fleeting symptom without consequence or is persistent enough for classification. Further, this “D” can sometimes help the clinician differentiate between Axis I disorders. To illustrate this, one can examine the diagnoses of 298.8 Brief Psychotic Disorder, 295.40 Schizophreniform Disorder, and 295.90 Schizophrenia, Undifferentiated Type1. If an individual presents to the clinician with the necessary symptoms to meet the criteria for 295.90 Schizophrenia, Undifferentiated Type, without evidence of duration, it will be difficult to accurately diagnose the individual. For instance, if the individual has these symptoms but the symptoms have only lasted one hour, that individual cannot be diagnosed with any of the above disorders. To meet the criteria for Brief Psychotic Disorder, the symptoms must be present for at least one day but not longer than one month. Schizophreniform Disorder becomes a possibility after one month and until six months have passed. After six months of time with this individual exhibiting the necessary symptoms, Schizophrenia, Undifferentiated Type becomes the only diagnosis available (of the aforementioned) with which the individual can be accurately classified.

Without the clarifying aids of danger, deviance, dysfunction, distress, and duration, separating everyday problems from those that elevate to levels of disorders would be difficult. The four “D’s” are a valuable construct for the clinician to identify the points on a continuum at which human cognition, emotion and behavior change from normal into abnormal and thus can be classified as a psychiatric disorder. They provide assistance to increase diagnostic accuracy and reliability by imparting another framework with which to think about the individual’s experience. The clinician can then use this framework to guide the process of devising an individualized care plan to decrease deviance, dysfunction, distress, danger, and duration of the presenting problems. The four “D’s” cannot provide nor should it be offered as an alternative to the more traditional DSM IV-TR multi-axial diagnostic structure. It can, however, provide a complementing construct to aid the clinician to holistically assess human emotions, cognitions, and behaviors that may constitute mental disorders.

1. Diagnostic and statistical manual of mental disorders. 4th text revision ed. Washington D.C.: American Psychiatric Association; 2000
2. Comer, RJ. Abnormal Psychology. New York, NY: Worth Publishing; 2010.
3. Hiroeh U, Mortensen P, Dunn G. Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. The Lancet. 2001; 358(9299): 2110-2112.
4. Remick R. Diagnosis and management of depression in primary care: a clinical update and review. Journal of the Canadian Medical Association. 2002; 167(11): 1253-1260.
5. Salkovskis P, Warwick H, Deale A. Cognitive-behavioral treatment for severe and persistent health anxiety hypochondriasis. Brief Treatment and Crisis Intervention 2003; 3(3): 353-368.
6. Seto M. Pedophilia and sexual offenses against children. Annual Review of Sex Research 2004; 15, 321-361.
7. Sibbald B. Smoking’s morbidity toll estimated in the US. Journal of the Canadian Medical Association 2003; 169(10): 1067.
8. Wilmhurst L. Essentials of Child Psychopathology. Hoboken: NJ: John Wiley & Sons; 2005.
Author Information
Timothy O. Davis, Ph.D., LSCSW
Social Work Practicum Director, Fort Hays State University Hays, Kansas U.S.A.
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Money Magnet

  1. You are a money magnet.
  2. Money flows freely to me.
  3. I release all resistance to attracting money. I am worthy of a positive cashflow.
  4. There is always more than enough money in my life.
  5. I naturally attract good fortune.
  6. I am financially free.
  7. My income exceeds my expenses.
  8. I deserve to be paid for my skills, time and knowledge.
  9. I have a positive relationship to money and know how to spend it wisely.
  10. My income increases constantly.
  11. I am wealthy in more ways than one.
  12. My job/business allows me to live the life I desire.
  13. I am connected to the universal supply of money.
  14. I am grateful for the abundance that I have and the abundance on its way.
  15. Every dollar I spend and donate comes back to me multiplied.
  16. I can look at my finances without fear.
  17. I choose to live a rich and full life.
  18. I give myself permission to prosper and grow.
  19. I am worthy of all the richness I desire.
  20. I have the power to create the success and build the wealth I desire.

    By Theresa Avila

Another of my dreams

I was at a mansion on top of a hill with a gate entrance, and that is the only way to the home also someone has to drop an anchor to let you in. There were celebrities all over the place and one of them I went with and had a relationship with. After I got up and took a long stair up without looking back. I went to check the different room, and one had two men about to have intercourse, and I asked the one that is my friend “do you know if that man you ‘ r with if he is safe?” he answered I don’t know. After a few minutes, they couldn’t t get it on, and the strange man came out of the room, and I started talking to him. He said that he wants to have fun that is all, and I ordered him to leave the party. He didn’t want to go so I escorted him to the exit and made sure he left. The party was wild with so many people; it looks like a Jean family party. I also saw three women that were trying to get me to go to the spa area, and they said that they had a bath waiting for me, but I told them I can’t now. I also saw in one room a young lady singing.