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What do practitioners want in a diagnostic taxonomy? How do clinicians compare the Psychodynamic Diagnostic Manual (PDM) with the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD)?
The DSM and ICD are based on a medical model. The DSM, a product of the American Psychiatric Association, has been a topic of great controversy in recent years. While many psychologists and other mental health professionals are concerned (quite rightly) about the proposed changes in the DSM-5, it's important to place this debate in context by noting one important-but often neglected-truth: we are not required to use the DSM-5.
The only diagnostic taxonomy that we are required to use by law is the World Health Organization's ICD. All insurance companies that accept and process claims electronically must accept ICD-9-CM diagnosis codes; and soon, the ICD-10 will be required for insurance claims.
The DSM/ICD emphasis on symptoms rather than underlying processes stands in sharp contrast to the way most psychologists view patients. Although the American Psychological Association has not yet produced a psychologically based taxonomy of psychopathologies, the Alliance of Psychoanalytic Organizations did exactly that in 2006. In contrast to the ICD and DSM, the PDM (PDM Task Force, 2006) does not list symptom patterns in isolation, but considers the whole person as a complex individual with integrated-and sometimes conflicting-behavioral, emotional, cognitive, and social features.
As Bornstein (2011) noted, whereas the DSM tends to focus on surface behaviors and their associated mental states (e.g., thought patterns, affective responses), the PDM emphasizes underlying psychodynamic processes (e.g., implicit motives, conflicts, defenses), with more modest attention to expressed behavior. The PDM translates more readily into process-focused treatments and makes explicit the links between early causal factors and present-day symptoms. In t