(Bornstein, R.F. and Gordon, R.M. 2012, in press, What Do Practitioners Want in a Diagnostic
Taxonomy? Comparing the PDM with DSM and ICD. Division Review: A Quarterly
Psychoanalytic Forum)
What Do Practitioners Want in a Diagnostic Taxonomy?
Comparing the PDM with DSM and ICD
Robert F. Bornstein and Robert M. Gordon
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 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 International Classification of Diseases (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
Psychodynamic Diagnostic Manual (PDM Task Force, 2006) does not list
symptom patterns in isolation, but considers the whole person as a complex
individual with integrated—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 this way the PDM provides the clinician with a more heuristic and clinically
useful picture of the patient, not just the patient’s pathology.
We believe that DSM and ICD diagnoses should be integrated with PDM
process-focused data to enhance case conceptualization and treatment planning.
To facilitate this sort of integration we developed a clinician-friendly coding
form—the Psychodiagnostic Chart (PDC)—that allows the practitioner to
combine DSM and ICD diagnostic data with PDM-derived information regarding
level of personality organization, overall mental functioning, and other salient
psychological variables. (You can obtain copies of the PDC from either of us;
email rmgordonphd@rcn.com, or bornstein@adelphi.edu.)
The impetus for the PDC came from Gordon’s (2009) survey data, which
suggested that practicing clinicians of various theoretical orientations find the
PDM useful in conceptualizing patients. To address questions of what
practitioners want in a diagnostic taxonomy, and how practitioners compare the
PDM with the DSM and ICD, we conducted a follow-up study, recruiting expert
practitioners from various state psychology listservs, the Division 39 website, and
other psychology websites. We asked them to: 1) use the PDC with at least one
patient, and then 2) complete an online survey evaluating key features of the
PDM, DSM, and ICD. Fifty practitioners have taken the survey to date, with 80%
of respondents having doctorates and 20% masters degrees; 54% were women.
Half of the respondents identified themselves as Psychodynamic (50%); the rest
were Eclectic (22%), Cognitive-Behavioral (12%), Humanistic/Existential (10%),
Systems (4%), and Other (2%).
Practitioners rated on 7-point scales how useful various PDM-derived diagnostic
dimensions were in understanding one’s patients, and we contrasted these
ratings with practitioners’ ratings of information derived from DSM and ICD (1 =
Not at All Helpful; 7 = Very Helpful). Some preliminary findings:

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68% rated PDM Personality Structure as “helpful-very helpful.”
58% rated PDM Mental Functioning as “helpful-very helpful.”
44% rated PDM Dominant Personality Patterns or Disorders as “helpfulvery helpful.”
In contrast:
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18% rated DSM GAF scores as “helpful-very helpful.”
14% rated ICD or DSM symptoms as “helpful-very helpful.”
Additional analyses suggested that the utility of the PDM is not limited to analytic
therapists: Practitioners with other theoretical orientations rated PDM derived
constructs as positively as did psychodynamic practitioners. Thus, the PDM may
be useful to clinicians from an array of theoretical perspectives. Moving forward,
the PDC may help facilitate use of the PDM in clinical and research settings, and
allow clinicians to integrate DSM/ICD and PDM data more easily. As work
begins on the PDM-2, such assessment tools promise to play a central role in
enhancing psychodynamic assessment, diagnosis, and treatment.
References
Bornstein, R. F. (2011). From symptom to process: How the PDM alters goals
and strategies in psychological assessment. Journal of Personality Assessment,
93, 142-150.
Gordon, R. M. (2009). Reactions to the Psychodynamic Diagnostic Manual
(PDM) by psychodynamic, CBT, and other non-psychodynamic psychologists.
Issues in Psychoanalytic Psychology, 31, 55-62.
PDM Task Force. (2006). Psychodynamic Diagnostic Manual. Silver Spring,
MD: Alliance of Psychoanalytic Organizations.