Psychodynamic Diagnostic Manual Research Articles

Patient personality and therapist responses in the psychotherapy of adolescents with depressive disorders: toward the Psychodynamic Diagnostic Manual - third edition.

Depressive disorders in adolescence pose unique challenges for assessment and treatment, particularly due to their high comorbidity with various personality disorders. Moreover, young depressed patients may elicit very intense and difficult-to-manage emotional responses in therapists (in this context, countertransference). This study aimed at empirically identifying specific personality disorders (or subtypes) among adolescents with depressive pathology and exploring distinct countertransference patterns emerging in their psychotherapy: 100 adolescents (58 with depressive disorders; 42 with other clinical conditions) were assessed by their respective clinicians (n=100) using the psychodiagnostic chart-adolescent of the Psychodynamic Diagnostic Manual (PDM) - second edition, and the therapist response questionnaire for adolescents. Results showed that depressed adolescent patients exhibited marked traits of four personality subtypes (i.e., depressive, anxious-avoidant, narcissistic, and borderline) characterized by different levels of mental functioning and personality organization. These subtypes were predictably related to specific clinicians' emotional responses, even when controlling for the intensity of depressive symptomatology. Patients with depressive or anxious-avoidant personality subtypes evoked more positive countertransference responses, whereas patients with narcissistic or borderline subtypes elicited strong and hard-to-face emotional responses in therapists. Consistent with the next edition of the PDM, the study emphasizes the importance of comprehensive psychodynamic assessment in the developmental age, which frames depressive disorders in the context of accurate emerging personality and mental functioning profiles. This approach, which also relies heavily on the clinician's subjective experience in therapy, provides crucial information on how to specifically tailor interventions that more effectively meet the needs of adolescents with these heterogeneous and complex clinical conditions.

Common mental disorders in Gestalt therapy treatment: a multiple case study comparing patients with moderate and low integrated personality structures.

Empowerment is central to self-development and growth in Gestalt therapy. The self evolves through interactions with others, forming self- and object-relations, and ego-functions. Underlying structural functions build the ability to regulate, differentiate, and integrate experiences, leading to self-, and emotion-regulation. Our study examined the self-development of seven clients with prevalent mental health issues and structural challenges, all of whom underwent 30 sessions of Gestalt therapy in a real-world individual therapy context. Using a multiple case study approach, we contrasted two client groups: those with moderately integrated and those with low-integrated personality structures, as defined by the operationalised psychodynamic diagnostic manual. Our exploration centered on specific factors of empowerment, therapy processes, and interventions. The study's mixed-method design encompassed quantitative outcome measures (empowerment, wellbeing, psychosocial health, and severity of personality functioning), therapy diaries from both clients and therapists, and semi-structured client interviews about empowering factors in therapy. Both groups showed positive therapy outcomes on wellbeing, psychosocial health, and empowerment. Specific empowerment-related factors included promoting experiences, relationships, and self-efficacy in the low-integrated group. Support of self-regulation was reported to be essential for successful outcomes in the moderately integrated group. While the therapy processes proceeded similarly in both groups, we observed a strong focus on body awareness-oriented interventions and promotion of verbalisation in the low-integrated group and a relationship-oriented emphasis in the moderately integrated group. Emotional experience linked to positive experience was limited in the low-integrated group, suggesting an impairment of emotional processing, including bodily felt feelings. No change was reported in the level of personality functioning after 30 sessions in both groups. These results underscore the need for tailored therapeutic approaches based on the client's level of personality integration. Future research should probe the long-term effects of therapy and delve deeper into shifts in personality functioning, especially concerning emotional and bodily experiences. In practical terms, therapists should prioritize linking bodily sensations with emotions for clients with low-integrated personalities. For those with moderate integration, the emphasis should be on fostering exploration, awareness, and bolstering self-regulation.

Classification, selfhood, and culture in the Diagnostic and Statistical Manual of Mental Disorders and the Psychodynamic Diagnostic Manual

AbstractFor decades, social scientists have critiqued the construction of knowledge in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). However, they have not conducted research with an alternate classification from psychoanalytic and psychodynamic practitioners known as the Psychodynamic Diagnostic Manual (PDM), which is beginning to disseminate globally. This article analyzes cultural assumptions underpinning the classification rationale, concept of the self, and relationship between culture and mental disorders through close readings of DSM‐5‐TR (2022) and PDM‐2 (2017). It shows that DSM‐5‐TR's notion of scientific evidence is informed by an emphasis on biological research in psychiatry, which PDM‐2 views as mostly irrelevant to clinical work. Instead, PDM‐2 claims to speak authoritatively for the inner experiences of patients and clinicians in the therapeutic relationship. Both classifications share a concept of an ideal self that is individualistic, consistent across time, able to narrate rather than just feel emotions, and in control of cognition, emotion, and relationships. Whereas DSM‐5‐TR views the culture concept as a lens to interpret the patient–clinician encounter, PDM‐2 uses the culture concept inconsistently. I situate these findings within extant anthropological research and propose new directions to examine how both classifications are used in local contexts.

Psychoanalytic Explanation of Key Personality Traits of Instagram Micro-celebrities: A Qualitative Study

Background: With the growing use of social networks, a large number of studies have investigated their psychological effects. Previous research has demonstrated that virtual networks, especially Instagram, negatively affect users’ mental health and make them vulnerable to mental disorders. However, the studies have been descriptive and provide descriptive statements; hence, they do not contribute to in-depth understanding of such vulnerability. Accordingly, qualitative studies should be conducted to delve into this phenomenon. Objectives: This article aimed to understand the key personality traits of popular Iranian Instagram users, assuming that the networks make individuals psychoanalytically vulnerable to clinical outcomes. Methods: Regarding the research method, the deductive content analysis was adopted for the data extracted from semi-structured in-depth interviews with users having > 10,000 followers. Psychodynamic diagnostic manual, PDM-2 second edition, and the structured analysis matrix were considered to make sense of the collected data. Results: The results demonstrated that the dominant key personality traits in popular Instagram users were narcissism with three subcategories (namely narcissistic central tension, pathogenic belief about oneself, and pathogenic belief about others) and depression with two subcategories (namely depressive pathogenic belief about oneself and pathogenic belief about others). Conclusions: According to the findings, the structures and categories underpinning our experiences by Instagram are inherently narcissistic. Rather than changing individuals’ dynamics, Instagram promotes this intellectual and communicative style inversely by normalizing it and reinforcing the narcissistic personality disorder established by the family and cultural structure of society.

Introduction to the Special Issue on the Psychodynamic Diagnostic Manual, 2nd Edition (Pdm-2): The Pdm: Yesterday, Today, Tomorrow

In this introductory essay, we review the development of the second edition of the Psychodynamic Diagnostic Manual. We place the first edition in historical context and note the main responses and critiques of professional colleagues to its publication. We then outline the developing process of this second, comprehensively revised edition. Finally, we preview the contributions to this Special Issue. Overall, we emphasize the Psychodynamic Diagnostic Manual’s innovative diagnostic framework, designed to assess the depth as well as the surface of patients’ emotional, cognitive, interpersonal, and social patterns and to foster in the field an integration between nomothetic understanding and the idiographic knowledge useful for case formulation and treatment planning.

A Case for Using the Psychodynamic Diagnostic Manual-2 Instead of the Diagnostic and Statistical Manual of Mental Disorders-5 in University and College Counseling Centers

ABSTRACT Counseling centers are part of a national practice environment that arguably encourages expedience rather than thoroughness in working with psychological difficulties. In this landscape, diagnosis is a process where symptom identification is preferred over a more complex understanding of clients. The predominant diagnostic tool used by mental health professionals is the Diagnostic and Statistical Manual of Mental Disorders (DSM) which has the main purpose of identifying symptom clusters. A less known competitor to the DSM is the Psychodynamic Diagnostic Manual (PDM). Purposefully developed as an alternative to the DSM, the PDM has many unique features and differences that distinguish it from the DSM. Compared to the DSM, the PDM requires a more labor-intensive and thorough assessment process. That process assists clinicians in arriving at a multifaceted diagnosis, including case conceptualization, that provides valuable information on how to approach therapy. In this was the PDM may be more valuable for University and College counselors. This is because the PDM, in addition to identifying symptoms, also provides a wholistic portrait of the person who has them. The usefulness of the holistic view of a person, that the PDM provides, is discussed and illustrated through a case study.

Introduction to the special issue on the Psychodynamic Diagnostic Manual, 2nd Edition (PDM-2): The PDM: Yesterday, today, tomorrow.

In this introductory essay, we review the development of the second edition of the Psychodynamic Diagnostic Manual. We place the first edition in historical context and note the main responses and critiques of professional colleagues to its publication. We then outline the developing process of this second, comprehensively revised edition. Finally, we preview the contributions to this Special Issue. Overall, we emphasize the Psychodynamic Diagnostic Manual’s innovative diagnostic framework, designed to assess the depth as well as the surface of patients’ emotional, cognitive, interpersonal, and social patterns and to foster in the field an integration between nomothetic understanding and the idiographic knowledge useful for case formulation and treatment planning.

Diagnostic Classification Systems Based on Psychoanalytical Principles.

The diagnostic classification systems in psychiatry practice which are used worldwide extensively, The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD) are far away from the psychoanalytical point of view. It is thought that this gap results in the difficulty to understand psychiatric patients in clinical practice for many years. It has also created an obstacle to scientific researches addressing the validity and reliability of the psychoanalytical principles. On the other hand, psychoanalysis has been much criticised for years due to the lack of empirical foundations. As a result of this paucity, psychiatry is led by the biomedical approach. Without enough grounds in evidence-based medicine, psychoanalytical principles could not become widespread in psychiatric practice. To survive criticism and strengthen its place in contemporary psychiatry, empirical research in psychoanalytical discipline has gained momentum in the last two decades. Development of objective psychodynamic diagnostic tools enabled the design of such studies. The aim of this review is to introduce such diagnostic tools, namely Psychodynamic Diagnostic Manual (PDM) and Operationalized Psychodynamic Diagnosis (OPD), and to discuss the possible contributions they provide for psychoanalytical perspective to take its deserved place in the psychiatry discipline.

The Contribution of Sidney Blatt's Two-Polarities Model to the Psychodynamic Diagnostic Manual.

This article reviews the theoretical and empirical contributions of Blatt’s two-polarities model of personality development and psychopathology to the second edition of the Psychodynamic Diagnostic Manual (PDM-2). First, we briefly provide an overview of the manual’s main features and describe the guiding principles of the revision process. We then discuss in more detail how Blatt’s model, which is focused on the dialectic interaction between anaclitic-introjective and relatedness vs self-definition dimensions in both normal and disrupted personality development, increases the PDM-2’s theoretical and empirical comprehensiveness and clinical utility, especially concerning the classification and assessment of personality and overall mental functioning in adult populations. Finally, we address the implications for the therapeutic process, showing how anaclitic and introjective patients may be differentially responsive to different psychodynamic techniques (e.g., supportive or expressive interventions). Taken together, these considerations demonstrate the importance of a more theory-driven and empirically informed diagnostic system that embraces, in accordance with Sidney Blatt’s empirically supported and psychoanalytically-oriented ideas, the complexities of human experience (both normal and pathological) and captures the subjective and underlying dynamics of psychological symptoms and syndromes.

The psychodynamic diagnostic manual - 2nd edition (PDM-2).

The psychodynamic diagnostic manual - 2nd edition (PDM-2).

The Relationship between Theoretical Orientation and Countertransference Expectations: Implications for Ethical Dilemmas and Risk Management.

Countertransference (CT) awareness is widely considered valuable for differential diagnosis and the proactive management of ethical dilemmas. We predicted that the more practitioners' theoretical orientation (TO) emphasizes insight into the dynamics of subjective mental life, the better they will be at using their CT expectations in differential diagnosis with high-risk patients. To test this hypothesis, we compared psychodynamic therapy (PDT) practitioners who emphasize insight into subjective mental life with practitioners who do not emphasize this epistemology. Results indicated that PDT practitioners expected significantly more CT than practitioners of cognitive-behavioural therapy (CBT) and other practitioners (e.g., family systems, humanistic/existential and eclectic) to patients with borderline personality organization overall. PDT practitioners had significantly more CT expectations to patients with borderline-level pathologies as compared with neurotic-level patients than both CBT and other practitioners. PDT practitioners were significantly more expectant of CT issues than CBT practitioners with respect to the personality disorders most associated with acting out and risk management problems (e.g., paranoid, psychopathic, narcissistic, sadistic, sadomasochistic, masochistic, hypomanic, passive-aggressive, counterdependent and counterphobic). The other practitioners generally had CT expectations between PDT and CBT. These findings suggest that clinical training into CT may be useful in differential diagnoses and in helping to avoid ethical dilemmas regardless of one's theoretical preference. Copyright © 2015 John Wiley & Sons, Ltd. Insight into countertransference can be used to help with differential diagnoses and to help prevent possible management problems with acting out patients. The Psychodynamic Diagnostic Manual is a useful taxonomy in that it includes countertransference as a diagnostic aid.

New frontiers and applications of attachment theory.

New frontiers and applications of attachment theory.

The Psychodynamic Diagnostic Manual (PDM) and the PDM-2: Opportunities to Significantly Affect the Profession

In this article, we discuss the development of the Psychodynamic Diagnostic Manual (PDM) and its upcoming revision, the PDM-2. We describe the processes by which the PDM-2 is being developed and highlight important differences across both editions. At the same time, we emphasize the value of assessing internalized experience and how that can be of use toward the diagnostic assessment process.

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

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,

Reply to a commentary on “The Psychodynamic Diagnostic Manual Version 2 (PDM-2): Assessing patients for improved clinical practice and research”.

We appreciate John Clarkin’s (2014) thoughtful, friendly commentary on the original Psychodynamic Diagnostic Manual (PDM) project and on our hopes and intentions for the second edition of the PDM. As there is very little in his essay with which we disagree, we expand on some of his points. First, his emphasis on the process rather than the product of the PDM fits with our sense of our overall aim; namely, to initiate an open conversation in the psychodynamically oriented community—and beyond that, to the practitioner community in general— about how best to represent individual psychology and psychopathology in the more dimensional, inferential, and contextual ways that the psychoanalytic tradition has valued and found clinically useful over many decades of psychotherapeutic efforts. Stanley Greenspan was explicit in defining the PDM as a work in progress and certainly not as the last word in nosology. When we published the first edition of the PDM, we were hoping for ongoing critical feedback from clinicians and researchers, and despite Greenspan’s untimely death and the consequent loss of his role in mediating all such communications, the contributors to PDM-1 have received many useful critiques from our colleagues that we hope will improve PDM-2. Second, Clarkin’s sense that the project was perhaps too ambitious feels right to us. And yet we have persisted in that ambitious attitude: We could not resist attempting to address a very wide range of diagnostic issues in PDM-2. Such a goal involves continuing communication among numerous experts who often disagree, or who at least come at the work from substantially different angles of vision, and who bring widely varying experiences in theory, research, and practice to the common task. Trying to turn this chorus of discordant voices into something like a choir has been daunting to say the least. And yet,

"A child's nightmare. Mum comes and comforts her child." Attachment evaluation as a guide in the assessment and treatment in a clinical case study.

There is a gap between proposed theoretical attachment theory frameworks, measures of attachment in the assessment phase and their relationship with changes in outcome after a psychodynamic oriented psychotherapy. Based on a clinical case study of a young woman with Panic Attack Disorder, this paper examined psychotherapy outcome findings comparing initial and post-treatment assessments, according to the mental functioning in S and M-axis of the psychodynamic diagnostic manual. Treatment planning and post-treatment changes were described with the main aim to illustrate from a clinical point of view why a psycho-dynamic approach, with specific attention to an “attachment theory stance,” was considered the treatment of choice for this patient. The Symptom Check List 90 Revised (SCL-90-R) and the Shedler–Westen Assessment Procedure (SWAP–200) were administered to detect patient’s symptomatic perception and clinician’s diagnostic points of view, respectively; the Adult Attachment Interview and the Adult Attachment Projective Picture System (AAP) were also administered as to pay attention to patient’s unconscious internal organization and changes in defense processes. A qualitative description of how the treatment unfolded was included. Findings highlight the important contribution of attachment theory in a 22-month psychodynamic psychotherapy framework, promoting resolution of patient’s symptoms and adjustment.

Operationalizing the Psychodynamic Diagnostic Manual: A preliminary study of the Psychodiagnostic Chart

The Psychodiagnostic Chart (PDC) operationalizes the Psychodynamic Diagnostic Manual (PDM) Adult section. The authors collected 104 PDC cases from 15 psychologists who are experts with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). They found very good construct validity when the PDC was compared to MMPI-2, the Karolinska Psychodynamic Profile (KAPP), and the Operationalized Psychodynamic Diagnosis (OPD) Psychic Structure/Mental Functioning Scales. They found very good reliability for the 73 cases with a 2-week test-retest of the PDC. Additionally, 61 psychologists were recruited from listservs and asked to use the PDC on a recent client; 84% rated Level of Personality Organization as "helpful-very helpful" in understanding their patients. There was also similar support for the Personality Patterns or Disorders and Mental Functioning dimensions. In comparison, only 31% rated the ICD or DSM symptoms as "helpful-very helpful" in understanding their patients. The PDC may be used for diagnoses, treatment formulations, progress reports, and outcome assessment, as well as for empirical research on the PDM.

The Psychodynamic Diagnostic Manual M Axis: Toward an articulation of what it can assess.

The Psychodynamic Diagnostic Manual M Axis: Toward an articulation of what it can assess.

Encountering Object Relational Gestalt Therapy as presented by Gilles Delisle

"Abstract: In the context of Gestalt psychotherapy being situated within an evolving psycho- logical therapies profession, I present a discussion, along the lines of an appreciative enquiry, around some of the key concepts and illuminating features of Delisle’s ORGT model, based on Delisle’s delivery of his approach over a two-day workshop I attended in March 2011. Starting from the foundations of Gestalt psychotherapy to current influences, I make reference to some of the strengths and limitations of Gestalt theory and practice highlighted by Delisle, and reflect on the enduring elements of Fritz Perls’ legacy. I consider the principal discussion points in relation to working with clients with borderline personality disorder and underscore two features of Delisle’s model: the use of hermeneutics, which includes an element of interpretation; and working with past experience, as one of the parts of the four-dimensional field presented by Delisle. I include reference to the underpinning developmental theory within Mentalisation Based Therapy (MBT) and neurobiological explanations within neuroscience on some of the neural functioning patterns of borderline personality disorder, drawing links to concepts of Delisle’s model. The impetus for writing this article was primarily a profound experience I had during an exercise at Delisle’s workshop, and my enjoyment of the conceptual nourishment that the theoretical material offered, as well as my appreciation of Delisle’s efforts to include a developmental theory of health and pathology into Gestalt theory and practice. Overall, my reflections are a deliberation of Gestalt theory and practice at the juncture of now. Key words: Object Relational Gestalt Therapy (ORGT), development, contact, field, attach- ment, mentalisation, capabilities, neuroscience, Psychodynamic Diagnostic Manual (PDM), borderline personality disorder."

P02-431 - Psychodynamic diagnostic manual in clinical practice-case report

Psychodynamic diagnostic manual was created by collaborative work of organisatios in the field of mental health and an authorial group with the aim of supplementing currently valid diagnostic systems ICD-10 and DSM-IV-TR. PDM is based on traditional psychoanalytical and psychodynamic concepts of genesis of mental disorders, currently valid diagnostic systems, new insights in the area of neurosciences, as well as on the evaluation of outcomes of different therapeutic approaches. The concept of mental disorders understanding adopted by PDM is bio-psycho-social and it follows a primary course of topical trends dictated by World Psychiatric Association towards personality orientated psychiatry. The purpose of this paper is the usage presentation of the useful guide in clinical practice with the aim of diagnosing mental disorder in the case of the described patient of a type of psychoanalytical approach applied in her treatment. The multi-axis diagnostic system of PDM has been used in the methodology of this paper. Based on this research we conclude that the described patient suffers from somatisation personality disorder, she also possesses the level of mental functioning with the moderate to higher degree of limitation, and symptomatically demonstrates somatiform disorder from the class of gastrointestinal system dysfunction and anxious disorder from a class of phobia.The mind-set of patient, and the limited level of her mental functions which suggests the inclination to a borderline level of type of personality organisations indicate plausible grounds for using supportive expressive psychoanalytical psychoterapeutic approach.