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Book Review: Psychotherapy: Psychoanalytic Diagnostic Manual (PDM)

Psychotherapy Psychoanalytic Diagnostic Manual (PDM) PDM Task Force. Silver Spring (MD): The Alliance of Psychoanalytic Organizations; 2006. 857 p. CDN$40.00. Reviewer rating: Excellent The necessary brevity of this review makes it difficult to do justice to this important volume. PDM is a collaborative effort of the American Psychoanalytic Association, International Psychoanalytic Association, Division of Psychoanalysis (39) of American Psychological Association, American Academy of Psychoanalysis and Dynamic Psychiatry, and National Membership Committee on Psychoanalysis in Clinical Social Work. It "attempts to characterize an individual's full range of functioning-the depth as well as the surface of emotional, cognitive and social patterns."p1 This diagnostic framework describes healthy and disordered personality functioning; profiles of mental functioning, including patterns of relating, comprehending, and expressing feelings, coping with stress and anxiety, observing one's own emotions and behaviours, and forming moral judgements; and symptom patterns, including differences in each individual's personal, subjective experience of symptoms. The authors assert that mental health "comprises more than simply absence of symptoms'p2 involving one's overall functioning, including relationships; emotional depth, range and regulation; coping capacities; and self-observing capacities: the full range of cognitive, emotional, and behavioural capacities. They note an increasing tendency to define mental problems primarily on the basis of observable symptoms, behaviours, and traits, relegating overall personality functioning and levels of adaptation to a secondary position, and refer to mounting evidence of the complexity of mental functioning. PDM is divided into 3 parts. Part 1, Classification of Adult Mental Disorders, employs 3 dimensions. Personality Patterns and Disorders (P Axis) locates the person on a continuum from healthier to more disordered functioning, and describes the nature of characteristic ways he or she organizes mental functioning and engages the world. An introduction describes different levels of personality functioning. A list of contributing constitutional-maturational factors, central tension-preoccupation, central affects, characteristic pathogenic beliefs about self and others, and central ways of defending follows descriptions of each personality disorder. Personality disorders omitted from DSM-IV-TR are included. Mental Functioning (M Axis) offers a detailed description of emotional functioning, capacities that contribute to one's personality and overall level of health-pathology. Categories include capacity for regulation, attention and learning; capacity for relationships and intimacy; quality of internal experience; capacity for affective experience, expression, and communication; defensive patterns and capabilities; capacity to form internal representations; capacity for differentiation and integration; self-observing capacities; and sense of morality. Mental capacities are defined as optimal or reasonable for age and phase or with phase-specific conflicts or transient developmental challenges, or having mild, moderate, or major constrictions or alterations in mental functioning, or major defects in basic mental functions. Manifest Symptoms and Concerns (S Axis) presents symptom patterns in terms of the patient's personal experience of prevailing difficulties. The authors comment on psychodynamic understanding of each symptom pattern, including treatment implications. Symptom patterns are understood in the context of one's personality structure and mental functioning profile, not disorders in their own right but overt expressions of how patients characteristically cope with experience. Part 1 ends with 3 case descriptions illustrating how to apply the PDM profile. Part 2 concerns classification of child and adolescent mental health disorders. It is divided into 2 sections, one for children and adolescents and the other for infants and very young children. …