Robert M. Gordon and Robert F. Bornstein

1. Psychodiagnostic Chart (PDC)An Integration of the Psychodynamic Diagnostic Manual (PDM), ICD and DSM Robert M. Gordon and Robert F. Bornstein

2. Goal of the PDC To offer a person-based nosology by integrating the PDM, ICD and DSMfor: • better diagnoses, • treatment formulations, • progress reports, • outcome assessment, • research on personality and psychopathology.

3. USE Our overarching aim is to make psychodiagnoses more useful to the practitioner by combining the symptom-focused ICD or DSM with the full range and depth of human mental functioning addressed by the PDM.

4. How to Use The clinician must perform (or have access to) diagnostic interview data and psychological assessment data to derive optimal ratings. We recognize that this is not always feasible, and in many instances the clinician will code an initial impression, then re-assess as additional information accrues. If this is used for progress notes, there will be opportunities to re-assess and revise the person’s diagnosis as well. The validity of this chart can be enhanced with the integration of relevant psychological tests.

5. PDC • Short • Easy • Intuitive and Empirical • Categorical and Dimensional • Flexible • Reliable and Valid (Gordon and Stoffey 2012 in press)

6. Scoring For consistency and ease of scoring, all dimensional ratings go from most disturbed (1) to healthy (10). We advise against using ratings of “10” except in unusual circumstances.

7. PDC’s Taxonomy

8. 1. PERSONALITY STRUCTURE Psychotic-Borderline-Neurotic-Healthy We start with the overall personality structure or severity, ranging from psychotic to healthy. The PDM uses seven mental capacities to assess structure. Three steps are involved: • Rate each capacity using the 1-10 scale. • Review the definitions of personality structure (healthy- neurotic, borderline and psychotic) • Using your clinical judgment (not an empirical average score), indicate the overall level of personality structure. For example, a “3” would be a low functioning borderline structure; an “8” would be a high functioning neurotic structure.

9. 1. Level of Personality Structure- the 7 capacities Please rate each capacity from 1 to 10; ratings range from Most Disturbed (1) to Most Healthy (10).1. Identity: ability to view self in complex, stable, and accurate ways 2. Object Relations: ability to maintain intimate, stable, and satisfying relationships 3. Affect Tolerance: ability to experience the full range of age-expected affects 4. Affect Regulation: ability to regulate impulses and affects with flexibility in using defenses or coping strategies 5. Superego Integration: ability to use a consistent and mature moral sensibility 6. Reality Testing: ability to appreciate conventional notions of what is realistic 7. Ego Resilience: ability to respond to stress resourcefully and to recover from painful events without undue difficulty

10. 1. Level of Personality Structure- Look over the Categories Healthy Personality- characterized by 9-10 scores, life problems never get out of hand and enough flexibility to accommodate to challenging realities. Neurotic Level- characterized by mainly 6-8 scores, rigidity and limited range of defenses and coping mechanisms, basically a good sense of identity, healthy intimacies, good reality testing, fair resiliency, fair affect tolerance and regulation, favors repression. Borderline Level- characterized by mainly 3-5 scores, recurrent relational problems, difficulty with affect tolerance and regulation, poor impulse control, poor sense of identity, poor resiliency, favors primitive defenses such as denial, splitting and projective identification. Psychotic Level- characterized by mainly 1-2 scores, delusional thinking, sometimes hallucinations, poor reality testing and mood regulation, extreme difficulty functioning in work and relationships.Now Rate the Overall Personality StructureBased on the 7 ratings above, rate person’s overall personality structure from 1 (Psychotic) to 10 (Healthy)

11. 2. Dominant Personality Patterns or Disorders These are relatively stable ways of thinking, feeling, behaving and relating to others. Normal level temperaments and traits (e.g., extroversion) do not involve impairment, while personality disorders involve impairment at the neurotic, borderline, or severe (psychotic) level. You may substitute ICD or DSM personality disorders for those of the PDM. If the person does not have a personality disorder, but a maladaptive trait or personality style, then rate the trait or style as “mild” (e.g., obsessional traits-8).

12. 2. Personality Patterns or Disorders- Scoring • Review the P axis in the PDM for the personality patterns most descriptive of your client (or use the Psychodynamic Diagnostic Prototypes-PDP). 2. Begin by checking off as many descriptors that may apply.

13. PDM Categories- Check as Many as Describe Your Client: Schizoid Paranoid Psychopathic (antisocial); Subtypes - passive/parasitic or aggressive Narcissistic; Subtypes - arrogant/entitled or depressed/depleted; Sadistic (and intermediate manifestation, sadomasochistic) Masochistic (self-defeating); Subtypes - moral masochistic or relational masochistic Depressive; Subtypes - introjective or anaclitic; Converse manifestation - hypomanic Somatizing Dependent (and passive-aggressive versions of dependent); Converse manifestation - counterdependent Phobic (avoidant); Converse manifestation - counterphobic Anxious Obsessive-compulsive; Subtypes - obsessive or compulsive Hysterical (histrionic); Subtypes - inhibited or demonstrative/ flamboyant Dissociative

14. 2. Personality Patterns or Disorders- Scoring • Then decide on the most dominant personality pattern or disorder, • Rate the level of severity (1-10). Ex: “Depressive 7”

15. 3. MENTAL FUNCTIONING Rate (1-10) the 9 different mental capacities according to the level of maturation or functioning.

16. 3. Mental Functioning • Every Person has strengths and weaknesses apart from diagnostic categories. This dimension helps us have a more detailed picture of a person’s mental function. • Rate each mental function on the 1-10 scale where 1=severe defect and 10= optimal

17. 3. Mental Functioning- Rate Each 1-10 1. Capacity for Attention, Memory, Learning, and Intelligence 2. Capacity for Relationships and Intimacy (including depth, range, and consistency) 3. Quality of Internal Experience (level of confidence and self-regard) 4. Affective Comprehension, Expression, and Communication 5. Level of Defensive or Coping Patterns(use a single number not a range) 1-2: Psychotic level (e.g., delusional projection, psychotic denial, psychotic distortion) 3-5: Borderline level (e.g., splitting, projective identification, idealization/devaluation, denial, acting out) 6-8: Neurotic level (e.g., repression, reaction formation, rationalization, displacement, undoing) 9-10: Healthy level (e.g., anticipation, sublimation, altruism, and humor) 6. Capacity to Form Internal Representations (sense of self and others are realistic and guiding) 7. Capacity for Differentiation and Integration (self, others, time, internal experiences and external reality are all well distinguished) 8. Self-Observing Capacity (psychological mindedness) 9. Realistic sense of Morality

18. 4. ICD, DSM or PDM Manifest Symptoms and Concerns Write in as many as 4 symptoms and rate the degree of severity (1= severe and 10= mild) Here you may use the symptoms that may be the focus of the person’s chief complaint. Most commonly it will be a mood or anxiety disorder, substance abuse, adjustment disorder, or interpersonal crisis.

19. 5. Cultural, Contextual, and Other Relevant Considerations This is a qualitative section where the practitioner may write how cultural or contextual factors may contribute to the symptoms, and/or degree of suffering.

20. Thank you.