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 All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editors and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. LIMITED DUPLICATION LICENSE These materials are intended for use only by qualified mental health professionals. The publisher grants to individual purchasers of this book nonassignable permission to reproduce all materials for which photocopying permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual clients. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, file-sharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, webinars, or therapy groups, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. 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