A commentary on “The Psychodynamic Diagnostic Manual Version 2 (PDM-2): Assessing patents for improved clinical practice and research."

Abstract

Every individual with psychological difficulties, whether suffering from a major symptom disorder such as depression or experiencing serious difficulties with self and relationship functioning, has a unique personality organization. The nature of the personality organization is most likely to influence all forms of therapeutic intervention, whether it is through medication compliance or other aspects (i.e., therapeutic alliance) of a psychotherapeutic process. This clinical reality ensures that the Psychodynamic Diagnostic Manual (PDM) is a conceptually important and clinically useful addition to the Diagnostic and Statistical Manual of Mental Disorders (DSM), as it provides the clinician with the structure and tools to assess personality and personality functioning to a greater depth than the DSM. DSM–III (American Psychiatric Association, 1980) made it clear that it was a diagnostic manual and that it was not intended to be sufficient for case formulation and treatment planning, and the DSM successors have done no better. As Robert Michels (1984, p. xiii) stated some time ago, “The easiest way to practice psychiatry is to view all patients and problems as basically the same, and to apply one standard therapy or mix of therapies for their treatment.” Michels goes on to say that this is a flawed approach, as we “have progressed to the point where we can recognize and describe differences among patients, their disorders, and the problems they bring us” (p. xiii), and we have an array of treatments to utilize. The PDM potentially sits at the cross roads of matching each unique individual with treatments tailored to that individual. It is difficult to see how psychodynamic treatments can move forward without this approach. The first edition of the PDM has a track record, and the committee is now preparing a revision based on prior experiences with the first edition and advances in the field. Lingiardi and McWilliams (2014) and their colleagues detail the positive public response to the PDM and describe impressive initial empirical efforts at issues of reliability and validity. I am a friendly reviewer and commentator, as I have contributed to the empirical assessment of personality pathology (Clarkin, Caligor, Stern, & Kernberg, 2004; Lenzenweger, McClough,