Overview of the PDM
The text that emerged consists of sections on adults, children and adolescents, and infants and toddlers, followed by the compilation of solicited papers. The first 2 sections are divided into chapters on personality differences (level and type of personality organization), profile of mental functioning (components of mental health such as reality testing, ego strength, affect tolerance, self and object constancy, self-esteem, moral sense, authenticity, mentalization, and reflective functioning), and characteristic subjective experiences (affective, cognitive, somatic, and interperson-al) of patients with DSM-diagnosed disorders. There are 3 extensive case formulations at the end of each section and there are clinical vignettes throughout. The longer case narratives illustrate how patients with similar DSM-diagnosed conditions may require significantly different treatments depending on their unique characteristics and situations.

In the infancy section, there are detailed descriptions of early problems in different realms (eg, interactive disorders, regulatory-sensory processing disorders, sensory modulation difficulties, sensory discrimination difficulties, neurodevelopmental disorders of relating and communicating). These rich and specific depictions suggest the limitations of more reductionistic, currently popular childhood diagnoses, such as attention-deficit/hyperactivity disorder and Asperger syndrome, and have clear practical utility for clinicians treating preschoolers and their families.

So far, the clinical community's most positive responses to the PDM concern the infancy section. Negative reactions include the complaint that this putatively developmental text lacks a section on the elderly, an omission that will be corrected in the next edition. (Remarkably, it did not occur to anyone on the steering committee—most of whom are older than 60 years—to include a section on geropsychiatry. Denial is evidently not the exclusive prerogative of our patients!)

Citations of empirical and clinical literature pervade the PDM, but the solicited papers (called "Conceptual and Research Foundations"), which make up about half the manual, provide its overall epistemological grounding. These essays are stand-alone articles—most are excellent summaries of their topic areas and are especially useful for therapists in training—that cumulatively undermine the perception that there is no science behind the psychodynamic and humanistic therapies.

A hypothetical clinical illustration
What does the PDM add to clinical assessment? Consider a patient complaining of long-standing episodes of severe anxiety unrelated to identifiable triggers. At presentation, she discloses a trauma history, bouts of bingeing and purging, regular marijuana use, anorgasmia, fainting spells, periods of amnesia, and recurrent physical afflictions (eg, unexplained headaches, back pain, menstrual pain, GI bloating). Describing her condition in DSM terms would require several "comorbid" diagnoses and rule-outs, perhaps including generalized anxiety disorder, bulimia nervosa, cannabis abuse, and posttraumatic stress disorder or amnestic disorder not otherwise specified. The general impression might be of someone with somatization disorder, but the patient reports only 3 pain syndromes, not the 4 required for this diagnosis. This collection of labels captures little that a therapist needs to know to help such a patient.

Via the PDM framework, a more holistic picture might emerge. In terms of personality (P Axis), this woman would be seen as organized psychologically at the borderline level (discriminated from the DSM's borderline personality disorder), with notable problems in affect regulation, self and object constancy, and self-esteem that she has handled with compulsive and addictive behaviors, dissociation, and a characterological tendency to somatize. In the personality section, characteristics of persons in the borderline range are summarized, and therapeutic implications are discussed (eg, clear contracts, structure, here-and-now focus, weathering affect storms). Patients who somatize are described phenomenologically in a narrative and then in terms of their constitutional/maturational patterns and characteristic preoccupations, affects, pathogenic beliefs, and defenses. The manual suggests the importance of such dimensions in psychotherapy.

The patient's profile of mental functioning (M Axis) might reveal her as someone with strengths in regulation, attention, and learning, but with notable deficits in quality of internal experience; capacity for relationships and intimacy; and affective experience, expression, and communication. Such an assessment orients a therapist to certain areas of treatment emphasis.

Finally, the therapist could hone his or her empathic attunement to the patient's problems by consulting the section on the subjective experience of symptoms (S Axis) in the areas of anxiety, eating disorders, substance abuse, and trauma. For example, with respect to eating disorders, affective states noted in the PDM include feelings of being starved for care; feelings of failure, shame, and ineffectiveness; and fear of abandonment, aggression, and loss of control. Cognitive patterns include a sense of being inadequate, incompetent, and unloved, as well as a preoccupation with being young. Somatic states include numbness, confusion about bodily sensations, inability to judge the stomach's fullness, and a sense of physical emptiness that may express a more inchoate psychological emp-tiness. Issues of control and perfectionism, secrecy about the eating disorder, compliance, and ingratiation may affect relationships.

Conclusion
The PDM deals very little with etiology but deals extensively with the phenomenology of psychopathology. Its language is accessible; jargon is minimal. Although the authors felt they should acknowledge their collective bias by titling the manual "psychodynamic," they tried to make it readable by and useful to practitioners of other orientations, such as biological, cognitive-behavioral, and family systems perspectives.

The PDM is available online at www.pdm1.org. for $35. Through self-publishing, the steering committee was able to make it affordable for students and beginning therapists. The authors invite criticisms and suggestions from the mental health community. The manual is a work in progress that will be only as valuable as it is clinically and pedagogically useful.