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Psychodynamic Diagnostic Manual (PDM)

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Gordon, R.M. (2010). The Psychodynamic Diagnostic Manual (PDM). In I. Weiner and E. Craighead,
(Eds.) Corsini’s Encyclopedia of Psychology (4th ed., volume 3, pp.1312-1315), Hoboken, NJ:
John Wiley and Sons.

The Psychodynamic Diagnostic Manual (PDM)

Robert M. Gordon, Ph.D., ABPP in Clinical Psychology and in Psychoanalysis in Psychology

WHY A NEW DIAGNOSTIC MANUAL?

The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is the first
psychological diagnostic classification system that considers the whole person in various
stages of development. A task force of five major psychoanalytic organizations and
leading researchers, under the guidance of Stanley I. Greenspan, Nancy McWilliams, and
Robert Wallerstein came together to develop the PDM. The resulting nosology goes from
the deep structural foundation of personality to the surface symptoms that include the
integration of behavioral, emotional, cognitive, and social functioning.

The PDM improves on the existing diagnostic systems by considering the full range of
mental functioning. In addition to culling years of psychoanalytic studies of etiology and
pathogenesis, the PDM relies on research in neuroscience, treatment outcome, infant and
child development, and personality assessment.

The PDM does not look at symptom patterns described in isolation, as do the
International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual
of the American Psychiatric Association (DSM). Research on brain development and the
maturation of mental processes suggests that patterns of behavioral, emotional, cognitive,
and social functioning involve many areas working together rather than in isolation.
Although it is based on psychodynamic theory and supporting research, the PDM is not
doctrinaire in its presentation. It may be used in conjunction with the ICD or DSM. The
PDM Task Force made an effort to use language that is accessible to all the schools of
psychology. It was developed to be particularly useful in case formulation that could
improve the effectiveness of any psychological intervention.

The PDM has received very favorable reviews from mostly the psychoanalytic
community (Clemens, 2007; Ekstrom, 2007; Migone, 2006; and Silvio, 2007). However,
even non-psychodynamic psychologists that were introduced to the PDM as part of
MMPI-2 and ethics/risk management workshops had a positive reaction to the new
diagnostic system. Ninety percent of 192 psychologists surveyed (65 Psychodynamic, 76
CBT and 51 Family Systems, Humanistic/Existential, Eclectic with no primary
preference) rated the PDM as favorable to very favorable (Gordon, 2008).

CLASSIFICATION OF ADULT MENTAL HEALTH DISORDERS

Personality Patterns and Disorders- P Axis
The PDM covers the full range of human development: adults, adolescents, children, and
infants. The adult diagnostic section begins with personality. The P axis- Personality
Patterns and Disorders has been placed first in the PDM system because of the
accumulating research findings that symptoms cannot be understood or well treated in the
absence of an understanding of the deeper personality traits of the adult who has the
symptoms.
The P axis takes into account two areas. We are first asked to consider the person's level
of personality organization or severity of personality disorder. This continuum goes from
a mainly healthy personality (absence of a personality disorder), to a mainly neurotic-
level personality disorder, and at the most severe end- a mainly borderline-level
personality disorder. “Borderline” is used by the PDM as a level of severity and not as a
specific personality disorder as in the DSM.

The levels of personality organization (healthy, neurotic or borderline) are determined by

assessing one’s capacities. These capacities are: identity maturation, ability for stable
satisfying relationships, affect tolerance and regulation, moral reasoning, reality testing
and the ability to respond to and recover from stress.

After determining the over-all level of personality organization, we consider the P axis
personality patterns (which may be adaptive and cause minimum if any impairment) or
the more pervasive personality disorders (which repeatedly cause pain to ourselves or to
others). The personality patterns or disorders are: schizoid; paranoid; psychopathic
(antisocial), subtypes- passive/parasitic and aggressive; narcissistic, subtypes-
arrogant/entitled and depressed/depleted; sadistic and intermediate manifestation-
sadomasochistic; masochistic (self-defeating), subtypes- moral masochistic and relational
masochistic; depressive, subtypes- introjective and anaclitic, converse manifestation-
hypomanic; somatizing; dependent, passive-aggressive versions of dependent, converse
manifestation- counterdependent; phobic (avoidant), converse manifestation-
counterphobic; anxious; obsessive-compulsive, subtypes- obsessive and compulsive;
hysterical (histrionic), subtypes- inhibited and demonstrative or flamboyant; dissociative;
and mixed/other.
Then the PDM P axis considers each personality disorder in terms of temperamental,
thematic, affective, cognitive, and defense patterns. The psychopathic (antisocial)
personality for example has aggressiveness and a high threshold for emotional
stimulation as part of the temperamental or contributing constitutional-maturational
factors. The main thematic or central tension/preoccupation is manipulating/being
manipulated. The central affects are rage and envy. Characteristic pathogenic belief about
the self is, “I can make anything happen.” Characteristic pathogenic belief about others
is, “Everyone is selfish, manipulative and dishonest.” Central ways of defending is
reaching for omnipotent control over others.
The PDM does not consider disorders as artificially isolated and distinct. For example,
depression can be a mood disorder on the symptom axis, and also a personality disorder
on the P axis with different traits. The PDM classifies a depressive personality disorder
with the subtypes of introjective (self critical), anaclitic (high reactivity to loss and
rejection) and the converse manifestation: hypomanic personality disorder (high energy,
counter-depressive, fear of closeness). The PDM also makes treatment suggestions when
there is sufficient data. The introjective type tends to respond better to interpretations and
insight, while the anaclitic type tends to respond better to the actual therapeutic
relationship. The hypomanic type often flees from commitment and therefore does not
stay long enough in treatment. The PDM suggests emphasizing that the commitment to
the treatment is important to improvement. People with hypomanic personality disorders
are most likely to be at the borderline level favoring defenses such as idealization of self
and the devaluation others, as compared to those with depressive personalities who favor
defensives such as devaluation of self and the idealization of others.

Profile of Mental Functioning- M Axis

The second PDM dimension, the M axis- Mental Functioning is a detailed look at the
capacities that contribute to an individual's personality and overall level of psychological
health or disturbance. These are: the capacity for regulation, attention, and learning; the
capacity for relationships (including depth, range, and consistency); the quality of
internal experience (level of confidence and self-regard); the capacity for affective
experience, expression, and communication; the level of defensive patterns; the capacity
to form internal representations; the capacity for differentiation and integration; the self-
observing capacities (psychological-mindedness); and the capacity for internal standards
and ideals, that is a sense of morality.

Symptom Patterns: The Subjective Experience- S Axis

Lastly, the PDM considers the S axis- Manifest Symptoms and Concerns. These are the
DSM-IV-TR symptom patterns, but with an emphasis on the patient’s subjective
experience of the symptoms. The patient may evidence a few or many patterns, which
may or may not be related. The PDM does not regard them as highly demarcated
biopsychosocial phenomena. These symptom patterns should be seen in the context of the
person's personality (P axis) and mental functioning (M axis).

CLASSIFICATION OF CHILD AND ADOLESCENT MENTAL HEALTH

DISORDERS
Profile of Mental Functioning for Children and Adolescents- MCA Axis
The classification of child and adolescent disorders begins with the MCA Axis- Profile of
Mental Functioning for Children and Adolescents. These are how the child or
adolescent’s mental functions deal with such experiences as relationships, emotions and
anxiety.
Child and Adolescent Personality Patterns and Disorders- PCA Axis
Next, the PDM looks at the emerging patterns of personality tendencies. These emerging
personality styles that may change or remain relatively stable throughout the course of
life. As with adults, we are asked to first assess the level of severity: “normal” emerging
personality patterns, moderately dysfunctional emerging personality patterns, and
severely dysfunctional emerging personality patterns. Then the PDM asks us to consider
the specific dysfunctional personality patterns: fearful of closeness/intimacy (schizoid);
suspicious/distrustful; sociopathic (antisocial); narcissistic; impulsive/explosive; self-
defeating; depressive; somatizing; dependent; avoidant/constricted, subtype-
counterphobic; anxious; obsessive-compulsive; histrionic; dysregulated; and mixed/other.

Child and Adolescent Symptom Patterns: The Subjective Experience- SCA Axis
Finally, the PDM considers the SCA axis- child and adolescent symptom patterns and
subjective experience. The SCA axis looks at symptom patterns in a developmental,
dynamic context and the fact that each child’s subjective experience of his or her
symptoms is unique. These include discerning healthy responses, developmental crises,
situational crises, and disorders of affect. The main symptoms categories are: anxiety
disorders; somatization (somatoform) disorders; affect/mood disorders (such as:
prolonged mourning/grief reaction, depressive disorders, bipolar disorders and
suicidality); disruptive behavior disorders; reactive disorders (such as: psychic trauma
and posttraumatic stress disorder); disorders of mental functioning (such as: psychotic
disorders and neuropsychological disorders); psychophysiologic disorders;
developmental disorders; and other disorders.

The Classification of Mental Health and Developmental Disorders in Infancy and Early
Childhood
The PDM classification of infant and early childhood disorders is unique and appropriate
to this age group. The primary diagnoses include the interactive disorders that involve
symptom patterns such as anxiety, depression and disruptive behaviors. Secondly, the
regulatory-sensory disorders which involve such symptoms regarding inattention, over
and under reactivity and sensory seeking. Thirdly are the neurodevelopmental disorders
of relating and communicating including the autism spectrum disorders.

RESEARCH FOUNDATION FOR THE PDM

The PDM devotes the latter half the book to the “Conceptual and Research Foundations
for a Psychodynamically based Classification System for Mental Health Disorders.”
These are valuable articles and references on the concepts and research that supports the
PDM’s classification system. These articles can also inform researchers to use constructs
and designs based on the PDM’s formulation of the whole person that would improve
external validity.
 References

Clemens, N. A. (2007). The psychodynamic diagnostic manual: A review. Journal of

Psychiatric Practice, 13(4), 258-260.

Ekstrom, S. (2007). Review of Psychodynamic Diagnostic Manual. The Journal of

Analytical Psychology, 52(1), 111-114.

Gordon, R.M. (2008). Early reactions to the PDM by Psychodynamic, CBT and Other
psychologists. Psychologist-Psychoanalyst, XXVI, 1, Winter, p.13.

Migone, P. (2006). La diagnosi in psicoanalisi: Present azione del PDM (Psychodynamic

Diagnostic Manual). [The psychoanalytic diagnosis: Presentation of the
Psychodynamic Diagnostic Manual (PDM).]. Psicoterapia e scienze umane,
40(4), 765-774.

PDM Task Force (2006). Psychodynamic Diagnostic Manual. Silver Spring, MD:
Alliance of Psychoanalytic Organizations.

Silvio, J. R. (2007). Review of Psychodynamic diagnostic manual. The Journal of the

American Academy of Psychoanalysis and Dynamic Psychiatry, 35(4), 681-685.

Key words: psychodynamic, psychoanalytic, personality, mental heath, nosology,

diagnostic, assessment

Robert M. Gordon, Ph.D., ABPP in Clinical Psychology and in Psychoanalysis in

Psychology
1259 S. Cedar Crest Blvd. 325
Allentown, Pa. 18103
rmgordonphd@rcn.com

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