I'm struggling with seeing how the PDM 'description' of ODD differs from a fairly typical characterization of borderline personality disorder (with respect to difficulties with emotion regulation in particular).

In the beginning... Different diagnostics systems proliferated. The DSM III was revolutionary in that it attempted a classification based on operationalized descriptions of symptoms in a way that theorists of radically different theoretical orientation could accept and agree on the presence or absence of symptoms. This as opposed to controversy over whether a given person REALLY had anxiety, for example, if anxiety was characterized as difficulties negotiating the oedipal phase by one theorist, or if anxiety REALLY existed, if one didn't believe in the oedipal phase.

The Psychodynamics Diagnostics Manual is meant to be a 'revolutionary alternative' to the DSM, but I really don't think that it is. Firstly, because either DSM and / or ICD diagnostics MUST be provided for health insurance reimbursement / publically funded treatment and as long as that remains the case those systems will be preferable over the PDM. Secondly, because the PDM is (as the name suggests) PSYCHODYNAMIC in its constructs and its presumed etiologies / rationales for the symptoms. It is thus unlikely to be accepted by either medically inclined practitioners (the majority of psychiatrists) or by the psychotherapists who are big on their 'evidence based medicine' (ie CBT based approaches). That is basically to say... That it will be rejected by the two leading paradigms in mental disorder. Thirdly, the PDM simply isn't that revolutionary. I got quite excited about it initially as it promised to provide a system that was dimensional rather than categorical (where the DSM and ICD are categorical even though they both regard this to be a 'heuristic' rather than something capturing the reality of the situation). While the section on personality disorders in the PDM is fairly different from the DSM and ICD (endorsing personality 'disorders' that are of different types and endorsing different - psychodynamic - explanations of them) for the most part the PDM simply copies the diagnostic categories (and the diagnostic codes) from the DSM / ICD.

That being said, I have a lot of sympathy for modern (read 'current') forms of psychodynamic theory.

It used to be fashionable to see disorders in a wholistic fashion. The thought is that... The whole person was a little out of whack, basically. Treatments were thus comperably wholistic. So... A kid has difficulty attending... What might be responsible for that? Are they getting a diet that is optimal for them (e.g., preservatives and additives and artificial flavourings and artificial sweeteners such as corn syrup DO tend to result in hyperactivity). Are they getting enough physical exercise (e.g., kids who are active WILL have trouble sitting still and listening to instructions when their body is screaming out to them to DO SOMETHING and to get those endorphins (which help prevent crankiness, irritability, and agression) flowing). Are they having realistic expectations placed on them (it can be hard to set expectations / demands that are within the child's capacity). Are they being reinforced appropriately for positive behaviour and not being reinforced (even inadvertently) for acting up? There are a whole bunch of contributing things....

The medical model encourages us to disregard the person - indeed, the slogan is that 'people aren't schizophrenic - rather a person has (the affliction) of schizophrenia. This is meant to be important for 'reducing stigma' - but really, it seems more to do with the medicalization of more wholistic problems, to me. The thought that there is some part of the person that is defective or malfunctioning in some way. The thought that the best treatment for that part of the person is the fairly 'direct' inverventions of medications in particular...

This disorder is of concern because... It is a precursor for a diagnosis of 'antisocial personality disorder' (that can't be diagnosed in children). When we pathologize children that young... I really do think we are often giving them a life sentence... It should be very much a last resort IMHO - very much a last resort... To be employed well after every other possible intervention has been tried... Trouble is that with our %#@&#! up health system... Not likely... Very often the only way to get help is to have a diagnosis. There are many people with a diagnosis who are denied help, even (try finding help for a child with this diagnosis, I'll bet the majority of clinicians will run in the opposite direction if they can). Oh for the good old days where when a parent / child pair were struggling... People simply stepped in to help. Oh for the good old days where class sizes were much lower so individual children got the attention they so genuinely needed and deserved. Oh for the good old days where grandparents were part of the family and stepped in to help younger members who were struggling with their kids. Oh for the good old days where communities were smallish and people stepped in to help one another rather than being overwhelmed by living in large urban areas that are overcrowded.

The good old days are largely a myth, of course... But then... How many children suffered from ADD / hyperactivity / oppositional defiant disorder in the good old days?