Assessing psychopathology from a structural perspective: A psychodynamic model

This article presents a guide for conceptualizing psychological difficulties across the broad spectrum of personality and symptom disorders. A psychodynamic model is used to organize these disorders along a structural continuum of severity. The authors propose that seven key indices of personality functioning be evaluated: cognition, affect, self-object relations, interpersonal relations, defenses, superego functioning, and primary dynamics. The results are then employed to determine where the patient should be placed along a continuum of nine diagnostic categories of ego development and their associated disorders. These include "normal," neurotic trait, and neurotic symptom organization; high-, mid-, and low-level borderline organization; and affective, cognitive-affective, and cognitive psychotic organization. An accurate evaluation of the seven variables will permit a more precise formulation of the nature and severity of the patient's difficulties, which will hopefully result in more accurate and appropriate treatment planning. Examples of the application of this model to a common symptom complaint are provided.