The S Axis in PDM-2. Symptom Patterns: The Subjective Experience

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Abstract

In this paper we address the main innovations included in the Subjective Experience chapter (S Axis) of the PDM-2, that is, its conceptualization of adult symptom patterns. We include some comparison between, and discussion of, ICD-10, DSM-5, and PDM-2. A primary goal of the PDM is to consider both biological and psychological susceptibility factors in shaping specific symptom patterns in adults; we pursue this goal by considering specific sections; for example, suicidal behaviors. We discuss the core PDM-2 innovations: a better definition of the subjective experience of symptoms and symptom patterns, the inclusion of (and the assessment guidelines for) suicide and suicidal and parasuicidal behavior, the inclusion of the subjective experience of the therapist when encountering a specific subject with specific symptom patterns, and the addition of the description of some nonpathological conditions that may require clinical attention (i.e., demographic minorities, lesbian, gay, and bisexual populations, and gender incongruent populations). With respect to the gender incongruent subjects, we note as a significant step forward the depathologization of this condition, formerly termed “gender identity disorder” and now, in DSM-5, termed “gender dysphoria.” We make a case for the value of including a section on nonpathological conditions in a psychodynamically oriented diagnostic manual. Finally, we discuss the implications and limitations of such PDM-2 innovations with respect to clinical settings and future clinical research purposes.

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