ebook THE GUILFORD PRESS PSYCHODYNAMIC DIAGNOSTIC MANUAL Second Edition PDM-2

Psychodynamic Diagnostic Manual Second Edition PDM- 2

Edited by Vittorio Lingiardi Nancy McWilliams

THE GUILFORD PRESS New York London Copyright © 2017 Interdisciplinary Council on Developmental and Learning Disorders— Psychodynamic Diagnostic Manual Published by The Guilford Press A Division of Guilford Publications, Inc. 370 Seventh Avenue, Suite 1200, New York, NY 10001 www.guilford.com

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Last digit is print number: 9 8 7 6 5 4 3 2

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Library of Congress Cataloging-in-Publication Data Names: Lingiardi, Vittorio, 1960– editor. | McWilliams, Nancy, editor. Title: Psychodynamic diagnostic manual : PDM-2 / edited by Vittorio Lingiardi, Nancy McWilliams. Other titles: PDM-2 Description: Second edition. | New York : The Guilford Press, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016049804| ISBN 9781462530540 (pbk. : alk. paper) | ISBN 9781462530557 (hardcover : alk. paper) Subjects: | MESH: Mental Disorders—diagnosis | Mental Disorders—classification | Case Reports Classification: LCC RC455.2.C4 | NLM WM 141 | DDC 616.89001/2—dc23 LC record available at https://lccn.loc.gov/2016049804 In memory of Sidney J. Blatt, Stanley Greenspan, Robert S. Wallerstein

About the Editors

Vittorio Lingiardi, MD, is Full Professor of Dynamic Psychology and past Director (2006– 2013) of the Clinical Psychology Specialization Program in the Department of Dynamic and Clinical Psychology of the Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy. His research interests include diagnostic assessment and treatment of personality disorders, process–outcome research in psychoanalysis and psychotherapy, and gender identity and sexual orientation. He has published widely on these topics, including articles in The American Journal of Psychiatry, Contemporary Psychoanalysis, The International Journal of Psychoanalysis, Psychoanalytic Dialogues, Psychoanalytic Psychology, Psychotherapy, Psychotherapy Research, and World Psychiatry. Dr. Lingiardi is a recipient of the Ralph Roughton Paper Award from the American Psychoanalytic Asso- ciation. From 2013 to 2016, he served on the technical committee for the eligibility of the training programs of the psychotherapy private schools of the Italian Ministry of Educa- tion, University and Research.

Nancy McWilliams, PhD, ABPP, is Visiting Professor in the Graduate School of Applied and Professional Psychology at Rutgers, The State University of New Jersey, and has a private practice in Flemington, New Jersey. She is on the editorial board of Psychoanalytic Psychology and has authored three classic books on psychotherapy, including the award- winning Psychoanalytic Diagnosis, Second Edition: Understanding Personality Struc- ture in the Clinical Process. Dr. McWilliams is an Honorary Member of the American Psychoanalytic Association and a former Erikson Scholar at the Austen Riggs Center in Stockbridge, Massachusetts. She is a recipient of the Leadership and Scholarship Awards from Division 39 (Psychoanalysis) of the American Psychological Association (APA) and the Hans H. Strupp Award from the Appalachian Psychoanalytic Society, and delivered the Dr. Rosalee G. Weiss Lecture for Outstanding Leaders in Psychology for APA Division 42 (Psychologists in Independent Practice). She has demonstrated psychodynamic psycho- therapy in three APA educational videos and has spoken at the commencement ceremonies of the Yale University School of Medicine and the Smith College School for Social Work.

vii Chapter Editors

Robert F. Bornstein, PhD, Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York

Franco Del Corno, MPhyl, DPsych, President, Society for Psychotherapy Research— Italy Area Group, Italy

Francesco Gazzillo, PhD, Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy

Robert M. Gordon, PhD, ABPP, Institute for Advanced Psychological Training, Allentown, Pennsylvania

Vittorio Lingiardi, MD, Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy

Norka Malberg, PsyD, Yale Child Study Center, New Haven, Connecticut

Johanna C. Malone, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, Massachusetts

Linda Mayes, MD, Yale Child Study Center and Office of the Dean, Yale School of Medicine, New Haven, Connecticut

Nancy McWilliams, PhD, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey

Nick Midgley, PhD, Research Department of Clinical Education and Health Psychology, University College London, London, United Kingdom viii Chapter Editors ix

Emanuela Mundo, MD, Residency Program in Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy

John Allison O’Neil, MD, Department of Psychiatry, McGill University and St. Mary’s Hospital, Montréal, Québec, Canada

Daniel Plotkin, MD, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California

Larry Rosenberg, PhD, Child Guidance Center of Southern Connecticut, Stamford, Connecticut

Jonathan Shedler, PhD, University of Colorado School of Medicine, Denver, Colorado

Anna Maria Speranza, PhD, Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy

Mario Speranza, MD, PhD, Department of Psychiatry, Versailles General Hospital, and Faculty of Medicine and Health Sciences, University of Versailles Saint Quentin en Yvelines, Versailles, France

Sherwood Waldron, MD, Psychoanalytic Research Consortium, New York, New York Consultants

Consultants who are also Chapter Editors appear in the “Chapter Editors” list.

Allan Abbass, MD, Halifax, Nova Scotia, Canada Christine A. Courtois, PhD, Washington, D.C. John S. Auerbach, PhD, Gainesville, Florida Jacques Dayan, MD, PhD, Rennes, France Fabia E. Banella, MA, Rome, Italy Martin Debbané, PhD, Geneva, Switzerland Tessa Baradon, MA, London, United Kingdom Ferhan Dereboy, MD, Aydin, Turkey Jacques Barber, PhD, Garden City, New York Kathryn DeWitt, PhD, Stanford, California Kenneth Barish, PhD, Hartsdale, New York Diana Diamond, PhD, New York, New York Thomas Barrett, PhD, Chicago, Illinois Jack Drescher, MD, New York, New York Mark Blais, PsyD, Boston, Massachusetts Karin Ensink, PhD, Québec City, Québec, Canada Corinne Blanchet-Collet, MD, Paris, France Janet Etzi, PsyD, Philadelphia, Pennsylvania Anthony Bram, PhD, ABAP, Giovanni Foresti, MD, PhD, Pavia, Italy Lexington, Massachusetts Sara Francavilla, DPsych, Milan, Italy Line Brotnow, MSc, Paris, France Glen O. Gabbard, MD, Houston, Texas Emanuela Brusadelli, PhD, Milan, Italy Michael Garrett, MD, Brooklyn, New York Giuseppe Cafforio, DPsych, Aosta, Italy Federica Genova, PhD, Rome, Italy Mark Carter, MA, MSc, London, United Kingdom Carol George, PhD, Oakland, California Irene Chatoor, MD, Washington, D.C. William H. Gottdiener, PhD, Richard Chefetz, MD, Washington, D.C. New York, New York Manfred Cierpka, MD, Heidelberg, Germany Brin Grenyer, PhD, Sydney, Australia John F. Clarkin, PhD, White Plains, New York Salvatore Gullo, PhD, Rome, Italy Antonello Colli, PhD, Urbino, Italy George Halasz, MS, MRCPsych, Melbourne, Australia x Consultants xi

Nakia Hamlett, PhD, New Haven, Connecticut J. Christopher Perry, MPH, MD, Montréal, Québec, Canada Alexandra Harrison, MD, Cambridge, Massachusetts Humberto Persano, MD, PhD, Buenos Aires, Argentina Mark J. Hilsenroth, PhD, Garden City, New York Eleonora Piacentini, PhD, Rome, Italy Leon Hoffman, MD, New York, New York Piero Porcelli, PhD, Castellana Grotte (Bari), Italy Per Høglend, MD, Oslo, Norway John H. Porcerelli, PhD, Steven K. Huprich, PhD, Wichita, Kansas Bloomfield Hills, Michigan Marvin Hurvich, PhD, New York, New York Timothy Rice, MD, New York, New York Lawrence Josephs, PhD, Garden City, New York Judith Rosenberger, PhD, LCSW, Horst Kächele, MD, PhD, Berlin, Germany New York, New York Richard Kluft, MD, Bala Cynwyd, Pennsylvania Babak Roshanaei-Moghaddam, MD, Guenther Klug, MD, Munich, Germany Tehran, Iran Brian Koehler, PhD, New York, New York Jeremy D. Safran, PhD, New York, New York Melinda Kulish, PhD, Boston, Massachusetts Ionas Sapountzis, PhD, Garden City, New York Jonathan Lachal, MD, PhD, Paris, France Lea Setton, PhD, Panama City, Panama Michael J. Lambert, PhD, Provo, Utah Golan Shahar, PhD, Beersheba, Israel Douglas W. Lane, PhD, Seattle, Washington Theodore Shapiro, MD, New York, New York Alessandra Lemma, MA, MPhil, DClinPsych, Caleb Siefert, PhD, Dearborn, Michigan London, United Kingdom George Silberschatz, PhD, Howard Lerner, PhD, Ann Arbor, Michigan San Francisco, California Marianne Leuzinger-Bohleber, PhD, Gabrielle H. Silver, MD, New York, New York Frankfurt, Germany Steven Spitz, PhD, New York, New York Karin Lindqvist, MSc, Stockholm, Sweden Miriam Steele, PhD, New York, New York Henriette Loeffler-Stastka, MD, Vienna, Austria Michelle Stein, PhD, Boston, Massachusetts Loredana Lucarelli, PhD, Cagliari, Italy Matthew Steinfeld, PhD, New Haven, Connecticut Patrick Luyten, PhD, Brussels, Belgium William Stiles, PhD, Miami, Ohio Eirini Lympinaki, MSc, Athens, Greece Danijela Stojanac, MD, New Haven, Connecticut Janet A. Madigan, MD, New Haven, Connecticut John Stokes, PhD, New York, New York Sandra Maestro, MD, Pisa, Italy Annette Streeck-Fischer, MD, PhD, Steven Marans, PhD, New Haven, Connecticut Berlin, Germany Matthias Michal, MD, Mainz, Germany Karl Stukenberg, PhD, Cincinnati, Ohio Robert Michels, MD, Ithaca, New York Guido Taidelli, MD, Milan, Italy Hun Millard, MD, New Haven, Connecticut Annalisa Tanzilli, PhD, Rome, Italy Kevin Moore, PsyD, Philadelphia, Pennsylvania Pratyusha Tummala-Narra, PhD, Boston, Massachusetts Seymour Moscovitz, PhD, New York, New York Kirkland Vaughans, PhD, Garden City, New York Filippo Muratori, MD, Pisa, Italy Fred Volkmar, MD, New Haven, Connecticut Laura Muzi, PhD, Rome, Italy Charles H. Zeanah, MD, New Orleans, Louisiana Ronald Naso, PhD, Stamford, Connecticut Alessandro Zennaro, PhD, Turin, Italy John C. Norcross, PhD, Clarks Summit, Pennsylvania Alessia Zoppi, PhD, Urbino, Italy Massimiliano Orri, PhD, Paris, France PDM-2 Honorary Scientific Committee

John S. Auerbach, PhD Otto F. Kernberg, MD Anthony W. Bateman, MA, FRCPsych Alessandra Lemma, MA, MPhil, DClinPsych Sidney J. Blatt, PhD (deceased) Marianne Leuzinger-Bohleber, PhD Eve Caligor, MD Henriette Loeffler-Stastka, MD Richard A. Chefetz, MD Karlen Lyons-Ruth, PhD Marco Chiesa, MD, FRCPsych Patrick Luyten, PhD John F. Clarkin, PhD William A. MacGillivray, PhD Reiner W. Dahlbender, MD Robert Michels, MD Jared DeFife, PhD Joseph Palombo, MA Diana Diamond, PhD J. Christopher Perry, MPH, MD Jack Drescher, MD John H. Porcerelli, PhD Peter Fonagy, PhD, FBA Jeremy D. Safran, PhD Glen O. Gabbard, MD Allan N. Schore, PhD John G. Gunderson, MD Arietta Slade, PhD Mark J. Hilsenroth, PhD Mary Target, PhD Mardi J. Horowitz, MD Robert J. Waldinger, MD Steven K. Huprich, PhD Robert S. Wallerstein, MD (deceased) Elliot L. Jurist, PhD Drew Westen, PhD Horst Kächele, MD, PhD xii PDM-2 Sponsoring Organizations

American Academy of Psychoanalysis and Dynamic Psychiatry

American Association for Psychoanalysis in Clinical Social Work

American Psychoanalytic Association

Association Européenne de Psychopathologie de l’Enfant et de l’Adolescent

Confederation of Independent Psychoanalytic Societies

Division of Psychoanalysis (39), American Psychological Association

International Association for Relational Psychoanalysis & Psychotherapy

International Psychoanalytical Association

International Society of Adolescent Psychiatry and Psychology

Italian Group for the Advancement of Psychodynamic Diagnosis

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