Proposer: Lingiardi Vittorio (1)
(1) Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
Discussant: Zennaro Alessandro (2), Caviglia Giorgio (3) (2) Department of Psychology, University of Turin, Italy (3) Università degli Studi della Campania “Luigi Vanvitelli”
The second edition of the Psychodynamic Diagnostic Manual (PDM-2; Lingiardi, McWilliams, 2017) has been developed during a critical era of change in mental nosology, in which many clinicians still consider the “diagnosis” as a dirty word (McWilliams, 2011) that “desiccate” human experience (Hoffman, 2009). The PDM-2 reflects an effort to articulate a psychodynamically oriented diagnosis that bridges the gap between clinical complexity and empirical validity, promoting an integration between nomothetic understanding and the idiographic knowledge that is useful for individual case formulation and treatment planning. Among its several innovations, the PDM-2 pays specific attention to the various age groups with dedicated sections, emphasizing continuity and internal coherence from infancy and early childhood to adulthood and later life. In the present panel, these issues are addressed from different age-related points of view:
1) In the first contribution, Lingiardi, Muzi and Piacentini offers an outline of the PDM-2’s structure and its main innovations compared to the previous
edition, focusing on how the new Manual enhances clinical utility of the diagnostic process;
2) The second presentation by Speranza and Banella describes the PDM-2 assessment process in infancy and early childhood through the presentation of a relevant case study;
3) The third contribution by Mundo aims to highlight the differences between the PDM-2’s and DSM-5’s classifications of psychiatric disorders in adult populations, enriching the discussion with clinical case vignettes; 4) The final contribution by Del Corno illustrates by clinical exemplifications how the PDM-2 conceptualize the process of personality evaluation in elderly patients, an age-period neglected by other diagnostic classifications.
THE PSYCHODYNAMIC DIAGNOSTIC MANUAL-2 (PDM-2): PROMISES AND HOPES
Lingiardi Vittorio (1), Muzi Laura (1), Piacentini Eleonora (1)
(1) Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
The publication of first edition of the Psychodynamic Diagnostic Manual (PDM Task Force, 2006) met with considerable international appreciation and have enhanced the debate about the usefulness of diagnostic systems in the psychodynamic community. After eleven years, the PDM-2 (Lingiardi, McWilliams, 2017), sponsored by 10 organizations, has just been published in the USA and it will be published in Italy in 2018. It offers a diagnostic framework that characterizes an individual’s full range of functioning - the depth as well as the surface of emotional, cognitive, interpersonal, and social patterns. The aim of this contribution is to describe the PDM-2’s structure and its main innovations. In particular, the most important changes are: a) significant revisions to all chapters, reflecting a decade of clinical
and empirical advances; b) an enhanced developmental perspective that considers the specific tasks of different phases (from infancy and early childhood to adulthood); c) a separate section on Later Life, not included in other widely used diagnostic systems; d) a detailed descriptions of recommended assessment instruments, plus reproducible diagnostic tools; e) the inclusion of case illustrations and PDM-2 profiles; f) a description of the therapeutic implications for psychotic level of personality organization; g) greater attention to cultural issues, and to both the clinicians’ and patients’ subjectivity; h) in-depth comparisons to DSM-5 and ICD-10. Too often clinicians feel compelled to “choose” between oversimplified diagnostic labels and idiosyncratic or unreliable diagnostic procedures, missing the dynamic and relational aspects of the diagnostic process. In this way, diagnosing stops making sense. Thus, the PDM-2 represents an essential counterweight to the symptom focused emphasis of DSM-5 and ICD-10, providing a more nuanced, clinically relevant and patient-centered framework for conceptualizing normal and pathological functioning.
DIAGNOSIS IN INFANCY AND EARLY CHILDHOOD: CLINICAL CASE ASSESSMENT FROM A PSYCHODYNAMIC PERSPECTIVE Speranza Anna Maria (1), Banella Fabia Eleonora (1)
(1) Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Italy
The special section dedicated to mental health disorders in infancy and early childhood (IEC 0-3) in PDM-2 provides significant advantages to the assessment and diagnosis from a psychodynamic perspective considering relational and developmental features, specificity of symptomatology, child and family functioning among others. The aim of this paper is to present the assessment process in infancy and early childhood conducted on the basis of the classification of mental health and developmental disorders of the PDM-
2 through the presentation of the case of Anne, a little girl observed in Kris’s longitudinal project. Data were gathered in interviews with the mother and in several observations of home life and of the child in a variety of settings, allowing the description of the main features of the decline and the recovery of Anne’s development. From this case it will be possible to describe the biopsychosocial model and the IEC multi-axial approach to infancy and early childhood. Moreover, since there are longitudinal data describing the child's developmental problems, two different periods of Anne’s development will be presented through the use of the Psychodynamic Chart (PDC-IEC) to show how PDM-2 can be used to assess the developmental and clinical process.
SUBJECTIVITY AND PSYCHIATRIC SYMPTOMS IN ADULTS: CLINICAL ISSUES ON THE PDM-2 S AXIS
Mundo Emanuela (1), Zingaretti Pietro (2)
(1) Institute for Research on Applied Psychoanalysis, Milan, Italy (2) Department of Psychology, Sapienza University of Rome, Italy
Although the categorical and descriptive approach of the DSM have been traditionally considered as a permanent fixture in the world of mental health, several clinicians and clinical researchers have highlighted its limited clinical and therapeutic utility. The second edition of Psychodynamic Diagnostic Manual (PDM-2; Lingiardi, McWilliams, 2017) adds a needed perspective to the DSM-5 and other mainly categorical diagnostic systems: in addition to considering symptom patterns described in existing taxonomies, the S Axis includes descriptions of “affective states”, “cognitive patterns”, “somatic states”, and “relationship patterns” associated with each clinical disorder in adults’ populations. The aim of this contribution is to further explore the role of patients’ and therapists’ subjective experience and the related clinical issues that have been
considered in the development of the PDM-2’s S Axis. The following topics will be addressed: a) differences between PDM-2 and DSM-5 classification of psychiatric disorders; b) the addition of suicidality as a trans-diagnostic dimension with its specific features; c) the inclusion of transference and countertransference as critical clinical issues in defining the subjective experience of certain clinical conditions; d) the addition, within the S Axis, of non pathological conditions that may require clinical attention (e.g., linguistic or ethnic minorities). The discussion of clinical vignettes will underscore the significant innovation that PDM-2’s structure and classifications of psychiatric disorders in the S Axis of Adult section has brought with respect to other diagnostic manuals for mental illness and mental health.
PERSONALITY DISORDERS IN LATER LIFE: THE DIAGNOSTIC APPROACH OF THE PSYCHODYNAMIC DIAGNOSTIC MANUAL-2 (PDM-2)
Del Corno Franco (1)
(1) Associazione per la Ricerca in Psicologia clinica (ARP), Milano
With the aging of modern societies and further advances in health care delivery, the need for a reflection on the characteristics of psychopathology in older adults is increasingly evident. An important innovation in the second edition of the Psychodynamic Diagnostic Manual (PDM-2; Lingiardi, McWilliams, 2017) is the inclusion of a separate section on Later Life, in which a specific and systematic description of individual profiles of mental functioning, healthy and disordered personality functioning, and symptom patterns of elderly individuals has been included for the first time in a major diagnostic manual, along with the indication of specific diagnostic tools and psychosocial interventions. The aim of this contribution is to illustrate the PDM-2’s assessment of personality functioning in later
life, one of the most challenging topic in this clinical and research field. In particular, the PDM-2 presents a new and specific diagnostic model for: a) the core features of the process of aging, in the presence of some personality styles or disorders; b) the particular expressions of a personality style or disorder which are the results of the process of aging; and c) the possible age-related personality features that may confound the diagnosis of a personality disorder. Some clinical exemplifications will enrich the description of this diagnostic approach. These considerations suggest that aging process may increase the severity of certain symptoms and behaviors typical of the various pathological personalities, or, in certain cases, can reduce the extent and the amount of pain subjectively felt or objectively observed.