从症状到主观和身体体验：精神动力诊断手册（PDM-2）在进食障碍的诊断和治疗监测中的贡献。
From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders.
机构信息
Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy.
出版信息
Eat Weight Disord. 2023 Mar 30;28(1):35. doi: 10.1007/s40519-023-01562-3.
PURPOSE
Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring.
METHODS
Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment.
RESULTS
Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns.
CONCLUSIONS
The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients' full range of functioning-including their deep and surface-level emotional, cognitive, interpersonal, and social patterns-to improve patient-tailored interventions.
LEVEL OF EVIDENCE
Level V, narrative review.
目的
由于理论和描述性的进食障碍（ED）概念在评估患者的主观特征和体验方面能力有限，因此受到了广泛的批评，而这些特征和体验是确定最合适治疗方案所必需的。本文概述了支持精神动力诊断手册（PDM-2）在诊断评估和治疗监测方面潜在作用的临床和实证文献。
方法
在讨论了当前 ED 诊断模型最相关的缺点之后，本文描述了 PDM-2 的原理和结构，并探讨了支持 ED 患者主观体验核心 PDM-2 维度（即情感状态、认知过程、关系模式、躯体/身体体验和状态）的证据，以及它们与 ED 诊断和治疗的相关性。
结果
总的来说，回顾的研究支持这些主观体验模式在 ED 中的诊断重要性，强调了它们作为心理治疗中潜在的诱发或维持因素的作用。越来越多的多学科证据也表明，身体和躯体体验是 ED 患者诊断和临床管理的核心。此外，有证据表明，基于 PDM 的评估可以更密切地监测治疗过程中患者的进展，包括主观体验和症状模式。
结论
该研究表明，当前的 ED 诊断框架将受益于增加一个以人为中心的视角，不仅考虑症状，还考虑患者的全面功能，包括他们的深层和表面情感、认知、人际关系和社会模式，以改善针对患者的干预措施。
证据水平
等级 V，叙述性综述。
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