SENSIBLE DIAGNOSES FOR SENSIBLE CLINICIANS: THE NEW EDITION OF THE PSYCHODYNAMIC DIAGNOSTIC MANUAL (PDM-2)

The article analyzes psychodynamic clinical models focused on clinical case formulation and treatment planning, offers practitioners empirically grounded and clinically validated alternatives to such personality maps as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). The PDM-2 diagnostic model aims to provide a systematic description of healthy functioning and personality disorders; individual profiles of mental functioning (including patterns of relationships with other people, understanding and expressing feelings, overcoming stress and anxiety, regulating impulses, observing one's own emotions and behavior and forming moral judgments, etc.); as well as symptom patterns, including differences in each person's subjective experience of symptoms and in the subjective experiences of treating therapists.

From a Symptom-Based to a Person-Centered Approach in Treating Depressive Disorders in Adolescence: A Clinical Case Formulation Using the Psychodynamic Diagnostic Manual (PDM-2)’s Framework

Background: Depressive disorders in adolescence are among the most challenging clinical syndromes to diagnostically identify and treat in psychotherapy. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2) proposes an integration between nomothetic knowledge and an idiographic understanding of adolescent patients suffering from depression to promote a person-centered approach. This single-case study was aimed at describing and discussing the clinical value of an accurate diagnostic assessment within the PDM-2 framework. Method: Albert, a 16-year-old adolescent with a DSM-5 diagnosis of major depressive disorder, was assessed using instruments from various perspectives: the Structured Clinical Interview for DSM-5; the Psychodynamic Chart-Adolescent of the PDM-2, and other clinician-report instruments; and the Shedler–Westen Assessment Procedure for Adolescents and Defense Mechanisms Rating Scale Q-sort, coded by external observers. Results: Albert’s assessment revealed impairments in various mental capacities, especially in regulating self-esteem. He presented a borderline personality organization at a high level and an emerging narcissistic personality syndrome. Conclusions: The case discussion showed the importance of providing clinically meaningful assessments to plan for effective treatments in youth populations. Especially, it is necessary to understand the adolescent’s unique characteristics in terms of mental and personality functioning and consider the developmental trajectories and adaptation processes that characterize this specific developmental period.

Inter-rater Reliability and Construct Validity of the Lerner Defense Scale in Clinical and Non-clinical Groups

The current study investigated the inter-rater reliability and the construct validity of the Rorschach Lerner Defense Scale (LDS). In particular, it aimed to explore the inter-rater reliability, analyzing the most frequent coding mistakes in an attempt to improve the coding guidelines, and to investigate the ability of the scale to distinguish between individuals with neurotic-level and borderline-level personality organization, according to the Psychodynamic Diagnostic Manual-2 (PDM-2), and non-clinical subjects. Eighty clinical subjects and 80 non-clinical ones participated in the study. Among the clinical subjects, 40 have borderline-level personality organization and 40 have neurotic-level personality organization. Non-clinical subjects were drawn from an archival dataset of non-clinical individuals who previously participated in a Rorschach normative study. The LDS showed substantial inter-rater reliability; however, guidelines could be improved, specifically with regard to the threshold for coding Devaluation and Idealization at level 1. Furthermore, more examples should be included in the manual about the coding of Projective Identification and Denial. The LDS distinguished borderline-level subjects from both the non-clinical and neurotic groups with regard to Devaluation and Projective Identification, with borderline-level personality organization subjects reporting higher scores than either of the two other groups. Only the Denial scale discriminated between the non-clinical and neurotic group, with the latter reporting higher scores of high-level Denial.

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.

Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation

Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition. The reflective functioning scale and the defense mechanisms rating scale Q-sort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.

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.

The DSM’s Reconnection to Psychoanalytic Theory through the Alternative Model for Personality Disorders

Often believed to have Kraepelinian origins, the Diagnostic and Statistical Manual of Mental Disorders—5th Edition (DSM-5) defines personality disorders using a categorical, hierarchical taxonomic system. This system possesses many long-standing problems for clinical practice, including a large assortment of symptom combinations that contribute to problematic heterogeneity and likely impair diagnostic validity. The DSM diagnostic system was at one time heavily influenced by psychoanalytic theory (Shorter 2005). A desire for greater theoretical neutrality then encouraged a shift away from psychoanalytic theory, resulting in the problematic atheoretical model of personality pathology introduced in DSM-III (1980) and still used today. The Alternative Model for Personality Disorders (AMPD), introduced in DSM-5 (2013), is an attempt to reconcile many of the categorical model’s issues and directly parallels primary themes that characterize psychoanalytic models of personality. After a review of the historical development of DSM, three current systems for diagnosing personality pathology—the DSM-5’s categorical model (2013), its AMPD (2013), and the Psychodynamic Diagnostic Manual (2nd ed.; Alliance of Psychoanalytic Organizations 2017) are compared. The comparison illustrates how the AMPD brings psychoanalytic theory back into the DSM system and acknowledges the implications of a more psychoanalytic DSM.