Monday, January 15, 2007

The Psychodynamic Diagnostic Manual

Five major psychoanalytic groups have unveiled a new manual that will improve the diagnosis and treatment of mental disorders AND convey a greater understanding of how such illness are experienced [1].

The Psychodynamic Diagnostic Manual is based on current neuroscience and treatment outcome studies that demonstrate the importance of focusing on the full range, whole-person approach in mental health. It provides a framework for improving comprehensive treatment approaches and understanding both the biological and psychological origins of mental health and illness.

The PDM was created to be used in addition to the "Diagnostic and Statistical Manual of Mental Disorders" and the "International Statistical Classification of Diseases and Related Health Problems". But what is great about this new diagnostic tool is how it will educate professionals about the "texture" and subjective experience of mental health.

The diagnostic framework formulated by the PDM 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.

*Symptom patterns, including differences in each individual's personal, subjective experience of symptoms.

I am all over this!

The Psychodynamic Diagnostic Manual

[1] American Psychoanalytic Association, International Psychoanalytical Association, American Psychological Association Division of Psychoanalysis (39), American Academy of Psychoanalysis, National Membership Committee on Psychoanalysis in Clinical Social Work.


Sarebear said...

This sounds awesome, especially, well, everything! Showing the healthy version of how a person thinks etc. and then the disordered version, that sounds cool!

Also about the subjective experience of it and stuff.

ALSO I think psychodynamic is set aside too much nowadays; I think there is much to be gained, myself anyway, from figuring myself out (because there's all this unanswered WHY that's been driving me nuts my whole life). Although of course CBT and other therapies are great, too, although CBT has been . . . limited, in my experience, for me, so far. Still chipping away at it, though!!

This sounds cool!

Wanda's Wings said...

Sound like a great new tool.

~Deb said...

I've always wondered this... Being the person who usually sits across from you Dr. Serani, I wondered through all their schooling and education if they can really relate fully to what people like me have. I have anxiety and panic attacks which ultimately trickles into depression. (All related) But, my question is, can it be viewed more like an AA director who hasn't ever touched alcohol before? I realize that your education and techniques that you have learned help us greatly, but always wondered about that question.

It's because of your line of work I'm somewhat sane! :)

Anonymous said...

This looks both comprehensive and highly logical, Deborah. Holistic approaches in your field invariably make much sense, and it's only a pity that there exists a sizable body of psychotherapists and counselors who don't seem to realize that.
I'm wondering, however, what impact cultural differences must have on any such analysis. In my addictions counseling days we dealt with a good number of Native Canadians in our client base and I found that standard models that applied to those of Anglo-Saxon heritage did not apply as directly to Natives, where the role of family (elders especially), sense of disgrace and shame, and other sociological factors were very contributory to depression and substance abuse.
Anyway, just some thoughts that came to me about a manual that I think will have great value.
Cheers, Ian

Anonymous said...

One presumes (or hopes) a greater evidential basis than DSM.

Anonymous said...

So, what do you think??? Does it surpass the DSM-IV? Will it be considered re: billing?

DocMel :)

Dawn said...

excellent!!! that's great news.

Anonymous said...


Well definitly the whole person approach is greatly needed; especially adding in "nutriceuticals" and nutrition..

(I can see the little m.d. cartoon with me saying, "But I AM a whole person" ;)

I wonder how they figure out "healthy"....what does define a healthy mind and who is the one to say so these days....

Anonymous said...

I'm glad, of update more realistic PDM has to be a good thing, right?

What makes me nervous is the label normal vs abnormal.

But I guess there has to be a line somewhere.

Deb S. said...

It sounds as if you are "all over this!" I think it's great that you are reviewing this research. Perhaps we'll hear more from you on this manual at a later time.

MeMe said...

Do you think, this book could revive psychodynamics??? I have had therapists who did not really caring at all about the dynamics of the mind. They just gave a pill and a bill, then sent me home.
I would love to read it myself. Since that is all I have to work with. Can't find a therapist high or low, anyway...
I do wonder about what the other commenters have said... who is the judge of healthy versus unhealthy and could the book be used for some T's to continue to put people in a box??? I know science is a trial and error type thingy, I just hope this new tool could broaden the horizons of professionals dedicated to caring for people with mental issues. Hmmm... sounds good.

Todd and in Charge said...

This certainly looks like an improvement in approach.

Anonymous said...

Cool, but which chapter is on me?


Anonymous said...

Anything which will help a heath care professional tell the difference between a potassium deficiency and an "episode" has got to be good news.

Anonymous said...

Or for that matter, ADHD and a gluten allergy.

Dream Writer said...

So much research, so much text, so much of everything these days...I was diagnosed with Bipolar 1 Disorder and now I have been battling with wondering if I am ALSO BPD....I have ALL the traits...

Are Bipolar and BPD Comorbid? Can a person have both?

I have so many WHY'S? So many questions and not enough answers....

Anonymous said...

That sounds fab :).

Hope all is well with you Deb and that nasty weather isn't coming your way :(.

Nancy said...

Any little bit of info is a plus. I hope this will bring a healthier approach to some doc's. Like "meme" said a "pill and a bill" does little to help the problems of many people. MH issues or diagnosis's are mislabeled so many time, a new tool can only help.
Keep us posted and thanks for your encouraging words.

Anonymous said...

Sounds like an awesome book. I can see why you would be all over it!

Heidi said...

Well this is definatly good news and a great asset!

Dr. Deborah Serani said...

Dear Sare,
I am a psychoanalyst by training and utilize a rather ecclectic approach to therapy. But psychodynamic treatment holds the most important tenets for change. Keep going with your inner journey!

Dear Wanda,
It is and WILL be very helpful, but only if it is used. Right?

Dear Deb,
Analysts MUST go through at least 300 hours of their own therapy before they are certified. Not all psychotherapists have been in therapy, which to me, is so sad. I believe knowing what it is like to be a patient and to know one's own self makes for a great therapist. I always shudder when I discover a colleague never was in therapy.

Dear Ian,
Culture and tradition help to understand the whole person. I think you are raising an important question. This new manual is only a step in that direction. I hope the future will hold even more!

Dear Dr. Dork,
I will be getting my PDM this week. I'll let ya know!

Dear Docmel,
I doubt very much that the PDM will be included for billing purposes because psychodynamic and psychoanalytic psychotherapies are considered TABOO to insurance companies. For the most part insight oriented therapy cannot have a time limit imposed on it. People become aware at their own rate.

Dear Dawn,
It'll be helpful!

Dear Mom,
Good question. I'll be reading the PDM as soon as I get it later this week. I'll keep you posted.

Dear Tai,
'Tis true! I dislike the labeling thing as well. But, helping to delineate WHAT is going on helps to treat illness and disease. So, I'm flexible in that regard.

Dear Deb,
I'll probably write a review about it. I'll letcha know.

Dear Meme,
Gee, where I come from psychodynamics is verrrry big. But I guess living in NY, where analysis is a very accepted treatment, makes me think this is the way it is everywhere. I hope the PDM will allow others to see how psychodynamic psychotherapy works! Everyone has issues. There is nothing as a perfect person. But when thoughts, feelings or behaviors interfere and permeate in nearly all aspects of one's life, that is considered not-the-average. It is hard to justify who delineates the line. I soooo get that. But when you see a person suffering, it becomes clear that something needs to be done to help. That's how I see things, at least.

Dear Todd,
It's a good thing. I hope Martha doesn't mind me stealing her catch-phrase.

Dear Godwhacker,
I think we are all in the pages somewhere!

Dear Stag,
I hope that this manual will help in seeing a person as a unique individual. Where a professional can take into account all that makes up their patient. So yes, I agree with your take on this.

Dear Dream,
Well.....yes. You can have a "mood disorder" and a "personality disroder". Please forgive the classifications - that is how they are described. A careful diagnositc interview could help determine if both BiP and BPD are there. Often, one or both can be missed. BiP and BPD CAN have similar symptoms. So it is important to get a thorough diagnosis.

Dear CLare,
Doing okay here. We encountered an ice storm when we were up in Albany NY this weekend. Nasty, but got home safely!

Dear Nancy,
I consider one of my stengths to be diagnosis. I dig deeply in understanding the patient and look at each person who comes into my office as a unique individual. I look at the Mental, physical, spiritual and cultural aspects. I think the PDM is endorsing this approach as well. I'll keep you posted on it as I get the PDM this week.

Dear Mysti,
I was ALL OVER it and bought it as SOON as I learned it was out!!!!!!!

Dear Heidi,
I think it is a great addition toward understanding the whole person. But it'll only be useful if professionals use it. I hope they do.


Dreaming again said...

I could have sworn I commented on this ... I'm sure I said something clever ..but tonight, it's not there.

Hope you're having a good week, and a warmer week than we are here in Oklahoma!!!

Anonymous said...

great late night reading *yawn* cant wait to get my hands on this one hehehee

Nancy said...

I hope you did not think my comment was implying you were not a kind and compasionate physician.
I was only trying to say that some doc's don't go the extra mile to do whats best for the patient and every tool or idea can only help.
sorry if i offended you

Anonymous said...

Sounds interesting, Deb. When you get your hands on it, any chance of a review?

Dr. Deborah Serani said...

Dear Dreaming,
That is really weird if you left a comment and blogger didn't record it. Hmmmm.....I wonder if this has happened to anyone else?

Dear JIP,
You made me giggle.

Dear Nancy,
No. No. No worries. Your comments echo my own feelings that sometimes professionals don't go the extra mile. I so know what you mean.


Dear HP,
Just got it in the mail today. Looks REALLY interesting. I'll be reading it and letting you know.


Anonymous said...

Fantastic - please tell us what you think when you come back up for air!

Dr. Deborah Serani said...

Dear Candace,
Will do.