Specificities of Mental Functioning and Referential Process in Body Dysmorphic Disorder: A Single Case Study Using the Psychodynamic Diagnostic Manual (PDM-2).

Christopher Christian, Alice Fiorini Bincoletto, Rachele Mariani, Attà Negri, Vittorio Lingiardi, Annalisa Tanzilli

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Article in Journal of psycholinguistic research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Christopher ChristianSchool of Medicine, Department of Psychiatry, Yale University, New Haven, CT, USA. Christopher.Christian@yale.edu.ORCID http://orcid.org/0000-0002-3389-9206

Alice Fiorini BincolettoDepartment of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.ORCID http://orcid.org/0000-0002-9697-7216

Rachele MarianiDepartment of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.ORCID http://orcid.org/0000-0001-5952-3525

Attà NegriDepartment of Human and Social Sciences, University of Bergamo, Bergamo, Italy.ORCID http://orcid.org/0000-0003-3968-6444

Vittorio LingiardiDepartment of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.ORCID http://orcid.org/0000-0002-1298-3935

Annalisa TanzilliDepartment of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.ORCID http://orcid.org/0000-0002-6098-2304

Funding

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6 · The paper itself

Abstract

This study aimed to accurately diagnose a patient with body dysmorphic disorder (BDD) and explore challenges to symbolization in the early and middle stages of psychotherapy through an analysis of language used by both therapist and patient. The patient was assessed using the Psychodynamic Chart in the Psychodynamic Diagnostic Manual and the Referential Process language measures, which were applied to the early and middle treatment sessions. At the beginning of treatment, the patient presented with comorbid somatizing and schizoid personality disorders, and strong obsessive and anxiety-avoidant traits. He displayed significant impairments in capacity for mentalization; affective range; communication and understanding; self-esteem regulation; and relational intimacy. The patient met criteria for severe BDD. His speech showed a markedly abstract and intellectualized linguistic style that indicated great difficulty in connecting emotional experience to images and words. The therapist's interventions were adapted to this style and were characterized by continuous prompts and suggestions aimed at linking elements and supporting a symbolizing process in order to integrate emotional activation in narratives. This therapeutic action, which we labeled "aided symbolization" promoted a slow but significant process of change with improvement in overall mental functioning. The clinical implications of these results are discussed.

Indexed as

Body Dysmorphic DisordersMentalizationPsychotherapy, PsychodynamicAdultHumansMaleSelf ConceptAssessmentBody dysmorphic disorderPDC-2PDM-2Psychodynamic treatmentReferential process

Identifiers

PMID40553242

DOI10.1007/s10936-025-10162-4

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