The Psychodynamic Diagnostic Manual – 2 (PDM-2)

The PDM uses a multidimensional approach to describe the intricacies of each patient’s functioning and ways of engaging in the therapeutic process. In this way, it attempts to provide a comprehensive profile of an individual’s mental life.

The first edition covered adults, children and adolescents, and infants, emphasizing individual variations as well as commonalities. It included four major sections: Classification of Adult Mental Disorders, Classification of Child and Adolescent Mental Health Syndromes, Classification of Infant and Early Childhood Disorders, and Conceptual and Empirical Foundations for a Psychodynamically Based Classification System for Mental Health Disorders.  

There are two key purposes for the next edition. First, we need to enhance dialogue between PDM diagnosis and other diagnostic systems, in particular the DSM and the ICD. Furthermore, PDM-2 will involve more systematic and empirical research than the first edition included, especially as such research informs more operationalized descriptions of the different disorders.

The second edition will maintain the basic multiaxial structure (Axis P, Axis M, Axis S), but will be characterized by several important changes. Seven specific Task Forces have been considered:

1 – Adults,
2 – Adolescents,
3 – Children,
4 – Infancy and Early Childhood,
5 – Elderly,
6 – PDM-2 Tools,
7 – Clinical Illustrations.

In order to connect PDM-2 more closely with empirical research, the section on “Level of Personality Organization” will be integrated and reformulated according to the empirical results from measures such as the Inventory of Personality Organization (IPO), the Structured Interview of Personality Organization (STIPO), and the Karolinska Psychodynamic Profile (KAPP). The section on “Types of Personality Disorders” will be revised and integrated according to theoretical, clinical and empirical indications from the clinical literature and according to clinically and empirically sound measures such as the Shedler-Westen Assessment Procedure-200 (SWAP-200) and its new versions and applications (SWAP-II), SWAP-200-Adolescents and the Psychodynamic Diagnostic Prototypes.

With respect to the M and MCA Axis of the Adult section, a better coordination is needed among the PDM labels of the nine mental capacities and other descriptions of the elements of mental functioning. We will revise and reformulate the “Illustrative descriptions of the range and adequacy of functioning” in a way that is more clinician-friendly, empirically grounded, and assessment-relevant, by introducing an assessment procedure with a Likert-style scale.

Regarding the S Axis of the Adult section, we will enhance its integration with the more symptom-syndrome oriented diagnostic manuals such as the DSM and the ICD. Finally, we will give a more exhaustive explanation of the rationale for the description of “affective states,” “cognitive patterns,” “somatic states,” and “relationship patterns” and give some references of related clinical and empirical studies.

The section dedicated to the Classification of Child and Adolescent Mental Health Disorders will also be subject to some changes. First, we intend to separate the Adolescent section (age 11-18) from the Child section (4-10).

Regarding the Special Section on Infancy and Early Childhood (IEC) Mental Health Disorders, we are considering the possibility of adding a specific section on developmental lines and homotypic/heterotypic continuities of early infancy, childhood, adolescent and adult psychopathology, which are objects of investigation in the clinical and empirical literature. We will give better definitions of the quality of primary relationships (between the child and his or her caregivers), emphasizing more strongly the evaluation of family systems and their characteristic relational patterns, including a paragraph about attachment patterns and their possible relationship to psychopathology and normative development.

An important change in the incoming new version will be the inclusion of a section on Mental Health Disorders of the Elderly, absent in the first edition.

Finally, PDM-2 will contain two special sections dedicated to Clinician-friendly Tools and to Clinical Exemplifications, with the aim of helping practitioners to have a better and deeper understanding of the manual’s contents.