Developed by a Task Force selected by the presidents of the five major psychoanalytic organizations, the PDM covers adults, children and adolescents, and infants, emphasizing individual variations as well as commonalities. In focusing on the full range of mental functioning, the PDM complements the DSM and ICD efforts in cataloguing symptoms. It systematically describes:
- Healthy and disordered personality functioning
- Individual profiles of mental functioning , including patterns of relating, comprehending, and expressing feelings, coping with stress and anxiety, observing one's own emotions and behaviors, and forming moral judgments
- Symptom patterns , including differences in each individual's personal or subjective experience of his or her symptoms
The PDM is based on current neuroscience and treatment outcome studies (discussed in the research section) that demonstrate the importance of focusing on the full range and depth of emotional and social functioning. For example, research on the mind and brain and their development shows that the patterns of emotional, social, and behavioral functioning involve many interconnected areas working together, rather than in isolation. Treatment outcome studies point to the importance of dealing with the full complexity of emotional and social patterns and show that the therapeutic relationship is the major predictor of outcomes. They further show that treatments that focus on isolated symptoms or behaviors are not effective in sustaining gains or addressing complex personality patterns.
The PDM was developed on the premise that a clinically useful classification of mental health disorders must begin with an understanding of healthy mental functioning. Mental health involves more than simply the absence of symptoms. It involves a person's overall mental functioning, including relationships, emotional regulation, coping capacities, and self-observing abilities. Just as healthy cardiac functioning cannot be defined simply as an absence of chest pain, healthy mental functioning is more than the absence of observable symptoms of psycho pathology. It involves the full range of human cognitive, emotional, and behavioral capacities.
That a full conceptualization of health is the foundation for describing disorders may seem self-evident, and yet the mental health field has not developed its diagnostic procedures accordingly. In the last two decades, there has been an increasing tendency to define mental problems more and more on the basis of presenting symptoms and their patterns, with overall personality functioning and levels of adaptation playing a minor role. The whole person has been less visible than the various disorder constructs on which researchers attempt to find agreement. Recent reviews of this effort raise the possibility that such a strategy was misguided. Ironically, emerging evidence suggests that oversimplifying mental health phenomena in the service of attaining consistency of description (reliability) and capacity to evaluate treatment empirically (validity) may have compromised the laudable goal of a more scientifically sound understanding of mental health and psychopathology. Most problematically, reliability and validity data for many disorders are not as strong as the mental health community had hoped they would be. Allen Frances, MD, Chair of the DSM-IV American Psychiatric Association Task Force , commented in The New Yorker magazine (Spiegel, 2005) that the reliability hoped for has not been realized and that, in fact, the reliability among practicing clinicians is very poor. Consequently, in moving towards DSM-V, the APA Task Force is reported to be shifting towards a more dimensional, rather than purely categorical, approach.
The psychoanalytic tradition has a long history of examining overall human functioning in a searching and comprehensive way, with an emphasis on both dimensionality and context of mental problems. Nevertheless, the diagnostic precision and usefulness of psychoanalytic approaches have been compromised by at least two problems. First, until fairly recently, in an attempt to capture the full range and subtlety of human experience, psychodynamic accounts of mental processes have been expressed in competing theories and metaphors that have, at times, inspired more disagreement and controversy than consensus. Second, there has been difficulty distinguishing between speculative constructs on the one hand, and phenomena that can be observed or reasonably inferred on the other.
In recent years, however, having developed empirical methods to quantify and analyze complex mental phenomena, depth psychology has been able to offer clear operational criteria for a more comprehensive range of human social and emotional functioning, as described by Westen, Shevrin, Shedler, Blatt, Dahlbender and others in the PDM Research Section. The challenge has been to systematize these advances with a growing body of rich clinical experience in order to provide a widely usable framework for understanding and specifying complex and subtle mental phenomena.
The PDM uses a multi dimensional approach to describe the intricacies of the patient's functioning and ways of engaging in the therapeutic process. It begins with a classification of the spectrum of personality patterns and disorders found in individuals. It then describes a “profile of mental functioning” that permits a clinician to look in more detail at each of the patient's capacities. This is followed by a description of the patient's symptoms, but with a focus on the patient's internal experiences as well as surface behaviors. In this way, the PDM provides a comprehensive profile of an individual's mental life.
Spiegel, A. (2005). The dictionary of disorder: How one man revolutionized psychiatry. The New Yorker, 56-63.