Psychodynamic Diagnostic Manual

This first dimension classifies personality patterns in two domains. First, it looks at the spectrum of personality types and places the person's personality on a continuum from unhealthy and maladaptive to healthy and adaptive. Second, it classifies how the person "organizes mental functioning and engages the world".[4]

The task force adds, "This dimension has been placed first in the PDM system because of the accumulating evidence that symptoms or problems cannot be understood, assessed, or treated in the absence of an understanding of the mental life of the person who has the symptoms".[4] In other words, a list of symptoms characteristic of a diagnosis does not adequately inform a clinician how to understand and treat the symptoms without proper context. By analogy, if a patient went to her physician complaining of watering eyes and a runny nose, the symptoms alone do not indicate the appropriate treatment. Her symptoms could be a function of seasonal allergies, a bacterial sinus infection, the common cold, or she may have just come from her grandmother's funeral. The doctor might treat allergies with an antihistamine, the sinus infection with antibiotics, the cold with zinc, and give her patient a Kleenex tissue after the funeral. All four conditions may have very similar symptoms; all four condition are treated very differently.

Next, the PDM provides a "detailed description of emotional functioning" which are understood to be "the capacities that contribute to an individual's personality and overall level of psychological health or pathology".[4] This dimension provides a "microscopic" examination of the patient's mental life by systematically accounting for their functional capacity to

• Process information
• Self-regulate
• Establish and maintain relationships
• Experience, organize, and express feelings and emotions at different levels
• Represent, differentiate, and integrate experience
• Utilize appropriate coping strategies and defense mechanisms
• Accurately observe oneself and others
• Form internal values and standards

The third dimension starts with the DSM-IV-TR diagnostic categories; moreover, beyond simply listing symptoms, the PDM "goes on to describe the affective states, cognitive processes, somatic experiences, and relational patterns most often associated clinically" with each diagnosis.[4] In this dimension, "symptom clusters" are "useful descriptors" which presents the patient's "symptom patterns in terms of the patient's personal experience of his or her prevailing difficulties".[4] The task force concludes, "The patient may evidence a few or many patterns, which may or may not be related, and which should be seen in the context of the person's personality and mental functioning. The multi dimensional approach... provides a systematic way to describe patients that is faithful to their complexity and helpful in planning appropriate treatments".[4]