The Psychodynamic Diagnostic Manual-2 (PDM-2). Promises and hopes

The publication of first edition of the Psychodynamic Diagnostic Manual (PDM Task Force, 2006) met with considerable international appreciation and have enhanced the debate about the usefulness of diagnostic systems in the psychodynamic community. After eleven years, the PDM-2 (Lingiardi, McWilliams, 2017), sponsored by 10 organizations, has just been published in the USA and it will be published in Italy in 2018. It offers a diagnostic framework that characterizes an individual’s full range of functioning - the depth as well as the surface of emotional, cognitive, interpersonal, and social patterns. The aim of this contribution is to describe the PDM-2’s structure and its main innovations. In particular, the most important changes are: a) significant revisions to all chapters, reflecting a decade of clinical and empirical advances; b) an enhanced developmental perspective that considers the specific tasks of different phases (from infancy and early childhood to adulthood); c) a separate section on Later Life, not included in other widely used diagnostic systems; d) a detailed descriptions of recommended assessment instruments, plus reproducible diagnostic tools; e) the inclusion of case illustrations and PDM-2 profiles; f) a description of the therapeutic implications for psychotic level of personality organization; g) greater attention to cultural issues, and to both the clinicians’ and patients’ subjectivity; h) in-depth comparisons to DSM-5 and ICD-10. Too often clinicians feel compelled to “choose” between oversimplified diagnostic labels and idiosyncratic or unreliable diagnostic procedures, missing the dynamic and relational aspects of the diagnostic process. In this way, diagnosing stops making sense. Thus, the PDM-2 represents an essential counterweight to the symptom focused emphasis of DSM-5 and ICD-10, providing a more nuanced, clinically relevant and patient-centered framework for conceptualizing normal and pathological functioning.