Eating Pathology and Psychodynamic Diagnostic Manual (PDM-2) Diagnostic Assessment: Implications for Treatment Outcomes in a Psychodynamic-Oriented Residential Setting

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorical classification of eating disorders (ED) has faced substantial criticism due to its limited ability to assess patients' individual characteristics and thereby evaluate the most appropriate treatment options. The current study aimed at exploring the validity of the Psychodynamic Diagnostic Manual (PDM-2) diagnostic approach to ED by evaluating the treatment outcomes of a psychodynamic-oriented residential intervention. At the start of treatment, a national sample of 73 female ED patients was evaluated using both the Structured Clinical Interview for DSM-5 (SCID-5-CV) and the Psychodiagnostic Chart-2 (PDC-2)-a PDM-2 derived clinician-rated tool. Participants were also asked to complete a self-report questionnaire on ED symptomatic impairment at treatment intake and discharge. Results showed the overall effectiveness of the psychodynamic residential treatment in terms of therapeutic change in ED-specific psychopathology. Even when controlling for baseline ED symptoms, higher levels of personality organization and a lower severity of personality pathology were found to predict lower levels of ED-specific psychopathology at discharge. Similarly, higher levels of overall mental functioning, as well as higher mentalizing capacity, identity integration, and self-coherence, were found to relate to better therapeutic outcomes. DSM-5 categories did not impact either pre-post change or symptomatic change at treatment termination. Results suggest that the PDM-2 diagnostic approach could promote a better conceptualization of potential maintenance factors to target in psychotherapy, generating a comprehensive perspective with maximal clinical utility. ⟪精神障碍诊断与统计手册(DSM-5)⟫对进食障碍(ED)的分类面临大量批评,这是由于其在评估患者个人特征从而评估最为适当的治疗方案上能力有局限性。本研究旨在探讨精神动力诊断手册(PDM-2)对ED的诊断方法的有效性,通过评估一个精神动力取向的住院干预的治疗结果。在治疗开始时,对全国性样本的73名女性ED患者进行了评估,使用了DSM-5(SCID-5-CV)结构化临床访谈,以及心理诊断图表-2(PDC-2)-一个PDM-2衍生的临床评估工具。参与者们还被要求完成一份关于在住院出院时的ED症状的自我报告问卷。结果显示了精神动力住院治疗在ED特定精神病理的治疗性改变方面的整体有效性。即使在控制ED症状底线时,我们发现,较高的人格组织水平和一个较低的人格病理严重性可预测出院时较低水平的ED特定精神病理。同样,较高水平的整体精神功能,以及较高的心智化能力、同一性整合、以及自我一致性被发现与更好的治疗效果有相关性。DSM-5的分类也没有影响前后的改变或治疗结束时的症状改变。结果表明,PDM-2诊断方法可以促进更好的概念化潜在维护心理治疗的目标因素,形成一个有最大临床效用的全面视角。