Transcript PDC-instructions - Mmpi

An Integration of the Psychodynamic
Diagnostic Manual (PDM), ICD and DSM
Robert M. Gordon and Robert F. Bornstein
Goal of the PDC
To offer a person-based nosology by
integrating the PDM, ICD and DSM for:
1. better diagnoses,
2. treatment formulations,
3. progress reports,
4. outcome assessment,
5. research on personality and
psychopathology.
USE
Our overarching aim is to make
psychodiagnoses more useful to the
practitioner by combining the symptomfocused ICD or DSM with the full range
and depth of human mental functioning
addressed by the PDM.
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.
PDC
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Short
Easy
Intuitive and Empirical
Categorical and Dimensional
Flexible
Reliable and Valid
(Gordon and Stoffey 2012 in press)
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.
PDC’s Taxonomy
Personality Structure
Personality Patterns
Mental Functioning
Symptoms
Cultural-Contextual Issues
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:
1. Rate each capacity using the 1-10 scale.
2. Review the definitions of personality structure (healthyneurotic, borderline and psychotic)
3. 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.
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
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 Structure
Based on the 7 ratings above, rate person’s overall personality structure from 1
(Psychotic) to 10 (Healthy)
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).
2. Personality Patterns or Disorders- Scoring
1. 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.
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
2. Personality Patterns or Disorders- Scoring
1. Then decide on the most dominant
personality pattern or disorder,
2. Rate the level of severity (1-10).
Ex: “Depressive 7”
3. MENTAL FUNCTIONING
Rate (1-10) the 9 different mental
capacities according to the level of
maturation or functioning.
3. Mental Functioning
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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
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
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.
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.
Thank you.