Psychodynamic Diagnostic Manual
By Alliance of Psychoanalytic Organizations
— Reviewed by Paul L. Fazekas
Undoubtedly, I am dating myself by informing you that I still have in my possession a personal copy of the DSM II, published in 1968. It is a whopping total of 133 pgs, of which only 56 are devoted to the manual itself; the rest deals with the ICD-8 (yes 8, not 9). Therefore, like many of you, I was rather pleased when the 800 pg. gorilla DSM III first made its appearance in 1980. We now had a much more descriptive and behavioral system for the diagnoses of mental disorders, as well as significant input from psychology and social work in its development. Unfortunately, the DSM approach is based on symptoms and surface phenomena, and, for this writer anyway, just a skeleton of the possibilities that can be utilized for the diagnosis of human mental disorders. Enter the Psychodynamic Diagnostic Manual (PDM) in 2006, which promises to complement, not replace, the DSM IV-R, and flesh out the richness in the diagnostic categories found in clinical settings. A true collaborative undertaking, the PDM was the work of an interdisciplinary task force representing psychodynamically oriented clinicians from the fields of psychiatry, psychology and social work.
“Although the PDM is unabashedly psychodynamic, it’s insights can be appreciated by all practitioners.”
Like the DSM-IV-R, the PDM is also a sizeable manual numbering over 800 pgs. It is divided into three major sections. Part I deals with Adult Mental Health Disorders and classifies individuals on three different dimensions. The first, Personality Patterns and Disorders (P Axis), is based on individual functioning on a continuum of healthy to disordered functioning and manner in which he/she organizes and engages the world. The second, Mental Functioning (M Axis) provides a more “microscopic” view of the individual’s inner resources, e.g., information processing, self-regulation, capacity for relationships, defense mechanisms and coping strategies. The third diagnostic dimension, Manifest Symptoms and Concerns (S Axis) reviews the specific behavioral descriptors of the DSM-IV-TR categories and presents them from the personal experience of the patient’s current struggle. I especially appreciated the inclusion of three comprehensive case histories integrating the PDM approach to diagnosis.
Part II addresses Child and Adolescent mental health disorders along similar three axis diagnostic categories. For clinicians like myself, who are also engaged in a pediatric practice, this is a most welcomed addition. There’s even a separate area dedicated to infancy and early childhood, an age group sorely underrepresented in the DSM-IV-R, and is presented within the context of a strong neurodevelopment framework. This section also has includes some illuminating case illustrations for the reader.
Finally Part III, is entitled Conceptual and Research Foundations for a Psychodynamically Based Classification System for Mental Health Disorders. These remaining 400 pgs provide an excellent overview of the history, relevance, and research of different aspects of psychodynamic psychology.
Although the PDM is unabashedly psychodynamic, its richness of clinical insights can be appreciated by practitioners representing a variety of theoretical orientations, as it remains faithful to the biopsychsocial approach to understanding human mental functioning. It will prove invaluable not only to clinicians, but also to those involved in the teaching of our craft. My highest recommendation that you obtain this book for your personal library.
Paul L. Fazekas, Ph.D., N.P., is a clinical psychologist and psychiatric nurse practitioner in private practice with offices in Niagara Falls, Hamburg, and Orchard Park, N.Y. He may be contacted at PFazekasPHDNP@adelphia.net
