Two New Diagnostic Manuals

Dr Griffith
January 2008
 
The Psychodynamic Diagnostic Manual
 
The Psychodynamic Diagnostic Manual is the result of intensive labor and collaborative effort of the American Psychoanalytic Association, International Psychoanalytic Association, Division of Psychoanalysis (39) of American Psychological Association, American Academy of Psychoanalysis and Dynamic Psychiatry, and National Membership Committee on Psychoanalysis in Clinical Social Work. The PDM is different than the Diagnostic and Statistical Manual (DSM) which has traditionally been used for diagnosis in mental health work. The DSM relies on descriptive psychiatry, a tradition began in the mid to later part of the 19th century, which is roughly the same time period that psychodynamic psychology was born, the basis of the PDM. 
 
The PDM is descriptive, but emphasizes a psychodynamic approach to understanding human coping and suffering. The PDM has separate sections for adults and children/teens. Three axes are used: one is for personality patterns, one is for profiling mental functioning and one is for describing the internal landscape (feelings, thoughts, and beliefs) of various psychological diagnoses. I find the later addition, the experience near approach of the PDM the most valuable for teaching. Counseling students bring work and life history to the classroom, but typically have not encountered real clients whose internal experience may be difficult to understand as compared and different to their own. Freud may have been the first to note that mental health exists on a continuum from healthy and functioning to dysfunctional. Often, students have some awareness that all mental suffering exists on such a continuum and I have observed that the PDM has helped them become more fully aware of these specific experiential differences and has the potential to help build empathy. There is no parallel to this in the DSM, which is objectively, not processed oriented. I have also used the PDM to help me understand the complexities and experiential dimension of people that I see for assessments. 
 
The PDM is large and some of its bulk is attributable to the scholarly papers in roughly the last third of the book. Also, be aware that the PDM is not ŇpurelyÓ psychodynamic. In describing the various diagnostic issues, the authors of the PDM help specific beliefs that are involved in depression, anxiety, personality disorders amongst others. Thus, the PDM also discusses issues relative to cognitive therapy as well. The PDM can be ordered at PDM1.org. 
 
The DM-ID The Diagnostic Manual, Intellectual Disabilities was published as a joint effort between the National Association for Dual Diagnosis and the American Psychiatric Association. The NADD is collegial group that is committed to understanding and treating people with cognitive impairments who also have a mental illness. People with both lower IQ and mental illness have many more challenges than people with either/or disabilities. The DM-ID is a unique and helpful text that clarifies many diagnostic and treatment issue or this population. 
 
People with intellectual disabilities often have verbal deficits that make it very difficult for them to describe their mental illness. The manual discusses (and has tables to assist clinicians) what observers need to look for relative to various diagnostic issues, for example, Major Depression. This manual also remains sensitive to the experiences of people with intellectual disabilities and in this respect, surpasses the Diagnostic and Statistical Manual (DSM) in its current form (4th revision). For example, in discussing Adjustment Disorders with people who suffer from intellectual disabilities (a disorder encountered when stress is overwhelming and leads to symptoms), the reader is alerted to the fact that for many people with intellectual disabilities, the process of trying to overcoming a stressor, may be more stressful than the original stress itself. People with intellectual disabilities may have to deal with caregivers who are less than responsive or optimal. They may be blocked by confusing obstacles in obtaining care. These are all issues that are highlighted as special considerations related to this population. 
 
Additionally, each level of cognitive disability is addressed in the ID-DM: mild, moderate, severe and profound. This manual offers objective, state of the art research for the clinic mental health professional responsible for caring for individuals with intellectual disabilities and their families. The DM-ID can be ordered at the NADD website at ŇtheNadd.org.Ó I would also highly recommend joining NADD as this group publishes a useful, but concise journal dealing with clinical and public policy issues. They also host trainings several times a year.