Eating pathology and Psychodynamic Diagnostic Manual (PDM-2) diagnostic assessment: Implications for treatment outcomes in a psychodynamic-oriented residential setting

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorical classification of eating disorders (ED) has faced substantial criticism due to its limited ability to assess patients’ individual characteristics and thereby evaluate the most appropriate treatment options. The current study aimed at exploring the validity of the Psychodynamic Diagnostic Manual (PDM-2) diagnostic approach to ED by evaluating the treatment outcomes of a psychodynamic-oriented residential intervention. At the start of treatment, a national sample of 73 female ED patients was evaluated using both the Structured Clinical Interview for DSM-5 (SCID-5-CV) and the Psychodiagnostic Chart-2 (PDC-2)—a PDM-2 derived clinician-rated tool. Participants were also asked to complete a self-report questionnaire on ED symptomatic impairment at treatment intake and discharge. Results showed the overall effectiveness of the psychodynamic residential treatment in terms of therapeutic change in ED-specific psychopathology. Even when controlling for baseline ED symptoms, higher levels of personality organization and a lower severity of personality pathology were found to predict lower levels of ED-specific psychopathology at discharge. Similarly, higher levels of overall mental functioning, as well as higher mentalizing capacity, identity integration, and self-coherence, were found to relate to better therapeutic outcomes. DSM-5 categories did not impact either pre–post change or symptomatic change at treatment termination. Results suggest that the PDM-2 diagnostic approach could promote a better conceptualization of potential maintenance factors to target in psychotherapy, generating a comprehensive perspective with maximal clinical utility.