The new “Adolescence” section of the Psychodynamic Diagnostic Manual (PDM-3): An overview on his main innovations and applications in clinical and empirical contexts

Abstract (max 1.000 parole) Introduction: The topic of diagnosis in adolescence is highly controversial. Unlike the most widely used nosographic systems internationally–-il Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 2022) and the International Classification of Diseases (ICD-11) (World Health Organization, 2019)— the Psychodynamic Diagnostic Manual (now in its third edition; Lingiardi, McWilliams, 2025) is the only taxonomy designed to promote accurate and inclusive clinical-diagnostic formulation of the adolescent. In PDM-3, the entire “Adolescence” section has undergone significant updating, revision, and expansion, aimed at strengthening the integration between a nomothetic and an idiographic approach, which appears to be indispensable for clinicians who work with patients aged 12 to 18 years and are confronted daily with the dynamism, fluidity, and instability of very complex psychological structures, mechanisms, and processes underlying various clinical conditions. Although the multi-axial structure (which involves first assessing the profile of mental functioning [MA Axis], then levels of personality organization and emerging personality styles/disorders [PA Axis], and finally symptom patterns and subjective experience [SA Axis]) has been retained, multiple are the changes and potential applications of this new section. This paper aims to illustrate the main innovations and then propose a reinterpretation of a study on the psychodynamic assessment of adolescents with depressive disorders in light of the new features proposed by the Manual. Methods: The study involved one hundred adolescents (58 with depressive disorders; 42 with other clinical conditions), who were assessed by their clinicians using the Psychodiagnostic Chart-Adolescent (PDC-A) of the Psychodynamic Diagnostic Manual (PDM) and the Therapist Response Questionnaire for Adolescents (TRQ-A). Results: Depressed adolescent patients exhibited marked traits of four personality subtypes (i.e., depressive, anxious-avoidant and phobic, narcissistic, and emotionally dysregulated) characterized by different levels of mental functioning and personality organization. These subtypes were predictably related to specific clinicians’ emotional responses, even when controlling for the intensity of depressive symptomatology. Patients with depressive or anxious-avoidant and phobic personality subtypes evoked more positive countertransference responses. In contrast, patients with narcissistic or borderline subtypes elicited strong and hard-to-face emotional responses in therapists. Conclusions: The contribution stresses the importance of psychodynamic assessment in the developmental age, which frames depressive disorders in the context of accurate emerging personality styles/disorders and mental functioning profiles. This approach, which also relies heavily on the clinician’s subjective experience in therapy, provides crucial information on how to specifically tailor interventions that more effectively meet the needs of adolescents with these heterogeneous and complex clinical conditions. Overall, the new PDM-3 emphasizes the relevance of a more comprehensive and global assessment of youth to gain insights into how adolescents with different personality pathologies and mental capacities perceive and navigate their subjective experiences of symptom patterns. A better understanding of young patients' unique and specific dynamics is essential for making "meaningful" diagnoses and planning more effective and individualized treatments at this developmental stage.