Psychodynamic diagnosis in adolescence: how to use PDM-2?

Adolescence is a transitional phase of growth and development characterized by great changes at the physical, cognitive, socio-emotional, and interpersonal level. Because of deep and continuous transformations that this age involves, clinicians are faced with several critical issues in providing a comprehensive and careful diagnostic assessment. Their highest priority when dealing with adolescents’ adjustment problems and psycho(patho)logical experiences is to take into account the labile and fluid nature of adolescents’ mental functioning to avoid the risks of misunderstanding or perhaps even misdiagnosing. The aim of this contribution is to provide an overview of the PDM-2’s innovative approach to diagnosis in adolescence. Overall, the new edition of the Psychodynamic Diagnostic Manual (PDM-2; Lingiardi & McWilliams, 2017) highlights the importance of adapting the diagnostic process to specific developmental stages, and provides a multidimensional and multiaxial approach to describe broadly the adolescent’s overall psychological functioning. The PDM-2’s diagnostic framework proposes an in-depth and systematic assessment of: (1) the profile of the adolescent’s mental capacities, emphasizing their dynamic and mutable nature (MA Axis); (2) the “emerging” personality organization and styles (PA Axis) that represent a meaningful diathesis for psychopathology ; and (3) the subjective experience of symptom patterns (SA Axis). The manual also highlights the critical role of transference and countertransference dimensions relative to distinct clinical syndromes. The implications of the PDM-2’s use for clinical practice will be discussed to clarify the value of a psychodynamically-oriented diagnosis useful for promoting accurate case formulations and planning patient-tailored treatments in adolescence