From a Symptom-Based to a Person-Centered Approach in Treating Depressive Disorders in Adolescence: A Clinical Case Formulation Using the Psychodynamic Diagnostic Manual (PDM-2)’s Framework

Abstract

Background: Depressive disorders in adolescence are among the most challenging clinical syndromes to diagnostically identify and treat in psychotherapy. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2) proposes an integration between nomothetic knowledge and an idiographic understanding of adolescent patients suffering from depression to promote a person-centered approach. This single-case study was aimed at describing and discussing the clinical value of an accurate diagnostic assessment within the PDM-2 framework. Method: Albert, a 16-year-old adolescent with a DSM-5 diagnosis of major depressive disorder, was assessed using instruments from various perspectives: the Structured Clinical Interview for DSM-5; the Psychodynamic Chart-Adolescent of the PDM-2, and other clinician-report instruments; and the Shedler–Westen Assessment Procedure for Adolescents and Defense Mechanisms Rating Scale Q-sort, coded by external observers. Results: Albert’s assessment revealed impairments in various mental capacities, especially in regulating self-esteem. He presented a borderline personality organization at a high level and an emerging narcissistic personality syndrome. Conclusions: The case discussion showed the importance of providing clinically meaningful assessments to plan for effective treatments in youth populations. Especially, it is necessary to understand the adolescent’s unique characteristics in terms of mental and personality functioning and consider the developmental trajectories and adaptation processes that characterize this specific developmental period.

Psychodiagnostic Chart-Child (PDC-C): a valid and clinically sensitive diagnostic tool for patient-tailored intervention planning

“…Moreover, the findings suggest that the PDC-C can generate clinically meaningful diagnoses to inform individualized clinical interventions tailored to children’s core psychological features. Thus, in line with the literature (Bornstein & Gordon, 2012; Gordon & Bornstein, 2018 ; Tanzilli et al ., 2021b ), the present results provide empirical support for the clinical utility of the PDC-C as a valid assessment of psycho(patho)logical constructs.…”

“…Studies on the Psychodiagnostic Chart for adults (PDC - 2; Gordon & Bornstein, 2015 ) and adolescents (PDC-A; Malberg, Malone, Rossberg, & Speranza, 2017) have shown it to be a valid and reliable instrument for initial diagnoses, identifying treatment targets and tracking progress throughout and after treatment; they have also shown it to be applicable to various teaching and research contexts (see, Brabender & Whitehead, 2011 ; Gordon & Bornstein, 2018 ; Gordon et al ., 2013 ; Spektor et al ., 2015 ; Tanzilli et al ., 2021b ). However, to the best of our knowledge, no research has empirically explored the psychometric properties of the PDC - C and its use in child clinical populations.…”

Exploring the associations between psychodynamic constructs and psychopathology: A network approach

“…Yet, because only the global score was included in our network, our findings cannot identify which specific structural functions are most relevant in patients with depression or somatization. However, for clinical case formulations a more detailed understanding of the various aspects of personality functioning is required (Tanzilli et al, 2021).…”

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders

“…Additionally, the common ego-syntonic and reinforcing nature of several ED symptoms, as well as patients' lack of insight or even denial of the illness, may limit the ability of self-report measures to detect changes in symptoms throughout treatment. The PDC-2 has been used extensively to evaluate patients' treatment progress in single case studies, revealing its validity and utility as an effective tool to explore both symptom changes and "structural" changes in personality organization over time, according to patient narratives [64,65].…”

“…Both single cases and quantitative studies involving different clinical populations have shown that the PDC-2 supports the assessment of key dimensions of psychological functioning underlying observable symptoms, including defense mechanisms, mental functioning capacities, and personality styles or types [39,55,[64][65][66]. For instance, the single case study by Tanzilli et al [65] employed the PDC-2 to obtain a comprehensive picture of an adolescent patient with major depressive disorder through the lens of mental functioning and levels of personality organization. Specifically, a borderline personality organization was found to be associated with an impaired ability to engage in stable and satisfying intimate relationships and to regulate selfesteem, which, in turn, impacted on the psychodynamic psychotherapy outcome.…”