Building Resilience: Tips from a Psychiatrist

Psychiatrist Dr Tay Kai Hong talks about what constitutes a psychiatric / psychological condition and explains his 5Ds framework. How do we differentiate normal stress from a disorder? And when should we seek help for psychological distress?

What constitutes a psychiatric or psychological condition? This may seem a deceptively straightforward question, but there has been much debate over the decades.

Psychological illnesses, or mental illnesses, are unlike physical ones in more than one aspects. In most physical illness or disease, we can expect abnormalities in blood tests and/or radiological scans. The abnormality, whether it’s a cancerous mole, a rash, or a fracture, are readily visible and obvious to the patient and doctor.

Mental illnesses or mental health conditions are quite different. The pathology is not readily visible, and requires careful evaluation of the person’s thoughts, mood, perception and behaviour. The line between normality and abnormality is often grey and amorphous, and somewhat subjective – left to the judgement and interpretation of the physician, patient, family members and society. Indeed, the expert consensus and diagnostic criteria for mental illness (the most established originate from the American Psychiatric Association and World Health Organization) evolves every few years.

A simple framework to intuitively understand what may constitute a mental illness is the 5Ds. Deviation, Duration, Distress, Dysfunction, and Danger.

The first D is Deviation. There are two ways to understand what this means. First, is there a significant Deviation from the person’s baseline (usual) mood, thoughts, behaviours and functioning? Second, is this a Deviation from what is considered “normal” in the person’s cultural, social, educational and spiritual / religious background? Is this considered “normal” in the general population to which the person belongs? A diagnosis is only warranted if there is significant departure from the person’s baseline state, and from what is considered “normal” in the general population.

The second D is Duration. Is this change in mental state persistent and of sufficient and significant Duration? We know that our mood, thoughts and behaviours to fluctuate constantly, moment to moment. This is normal and to be expected. However, if the change in mood and behaviours is sustained, persistent and pervasive (present across all contexts and situations), it is more concerning. The duration cut-off is somewhat arbitrary, is decided by expert consensus backed by scientific research, and varies among different mental illnesses.

The third D is Distress. The symptoms should be distressing, bothersome and cause suffering the person. This is however not always the case. In the manic phase of bipolar disorder, the early stages of eating disorders and addictive disorders, the “symptoms” are not perceived to be distressing and a problem by the sufferer. Instead, the Distress is imposed upon and faced by the family of the sufferer. In these situations, we say that suffer lacks insight into the illness, and often it is the family who want the patient to seek treatment, not the patient himself.

The forth D is Dysfunction. How are the symptoms affecting the person’s ability to perform his duties at school, work and home? We all have different roles in our lives, and each role comes with different responsibilities and duties which we may struggle with at the start, but come to embrace and master as we successfully navigate role transitions in our lives. At home, we may perform the role and duties of a spouse, parent, child or homemaker. At work, we have our professional and social roles. At school, we have roles of a student, a friend, a sportsman or musician. If the person’s ability to function in some of these roles are significantly and adversely impacted by psychological symptoms, a diagnosis may be warranted.

The fifth and final D is Danger. Beyond distress and dysfunction, do the symptoms pose any Danger to the person? Is the Depression so severe that the person is engaging in suicidal behaviors? Or is the person neglecting himself to the extent that he is now malnourished and at-risk of medical complications such as dehydration and fainting spells from low blood sugar? Is the sleeplessness so severe that it has led to road traffic accidents, endangering the lives of the person and other road users? These are safety risks worth considering during a psychological evaluation.

I hope you get a glimpse into how mental illnesses are evaluated and diagnosed. This article is of course not exhaustive. Psychiatrists and Clinical Psychologists go through years of training to become experts in this field. They are trained to elicit symptoms, identify patterns, interpret symptoms in context, read personalities, and pick up nuances in the evaluation process.

If you identify any of the above “D”s in yourself or a loved one, do not hesitate to seek help and reach out to us. At Private Space Medical, we want to serve those in need and aspire to add value to your life. The sooner you seek help, the greater the chances of a full recovery.

Dr. Tay Kai Hong
Psychiatrist, Medical Doctor
Private Space Medical