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Personality

Mental Capacities

A personality style describes the shape of a person: what they long for, what they fear, how they protect themselves. A level of organization describes how solid that shape is. Mental capacities ask a third, more practical question: what can this mind do, and how well does it do it under pressure? Can the person notice and name feelings? Think about what is going on in someone else’s head? Feel at home in their body? Keep a steady sense of their own worth when things go badly?

The Psychodynamic Diagnostic Manual (PDM-3) gathers these questions into what it calls the M Axis, a “profile of mental functioning” made of 13 basic capacities. Each is described from more compromised to more functional, and each can be rated on a five-point scale. The editors stress that both strengths and difficulties belong in the picture, because both shape what will help a person (Lingiardi, Muzi, & Bornstein, 2026, p. 709).

Nobody scores at the top on everything, and nobody’s profile is flat. Most people are strong in some capacities, shakier in others, and less steady in all of them when exhausted, frightened, or grieving. The manual itself borrows a line from Virginia Woolf as a caution against taking any profile too literally: “It is no use trying to sum people up” (p. 711). Reading about these capacities is a way of understanding minds, not a way of grading them.

What the Capacities Are

The M Axis describes basic psychological functions that sit close to what a clinician can actually observe: paying attention, regulating feelings, understanding minds, holding a coherent sense of self, relating to others, coping, and finding direction. The PDM-3 treats each capacity as the product of both nature and nurture: temperament, genetic and epigenetic predispositions, and basic traits on one side; learning, experience, and cultural and social context on the other (Lingiardi et al., 2026, p. 710).

The 13 capacities are meant to be distinct enough to be worth naming separately, but not truly separate. The authors describe mental functioning as an integrated whole that can be divided into neighboring categories for practical purposes, and they note that the level of one capacity can change the nature of others (p. 711). Weak affect regulation, for example, makes mentalizing harder, and poor mentalizing makes feelings harder to regulate.

Several features run through all 13 descriptions:

The M Axis sits between the manual’s other two adult axes. The P Axis describes personality: level of organization and style. The S Axis describes symptoms and how they are experienced. The M Axis is meant to bridge them, showing the psychological processes that underlie both a person’s symptoms and their subjective experience of those symptoms (Lingiardi et al., 2026, p. 710). For adults, the manual recommends getting a sense of personality first and then assessing mental functioning; for children, adolescents, and older adults it starts with mental functioning, because development or aging tends to be the more pressing question (Lingiardi & McWilliams, 2026a, p. 10).

The Thirteen Capacities

The PDM-3 groups the capacities into four domains. The descriptions below paraphrase the manual’s overview (Lingiardi et al., 2026, pp. 711–713).

Cognitive and Affective Processes

1. Attention and learning (executive functioning)
Focusing, planning, shifting between tasks, holding information in mind, filtering distractions, and learning from experience, especially when circumstances change.
2. Affect regulation and expression
Identifying, feeling, modulating, understanding, and expressing a wide range of emotions in ways that suit the situation and the culture.
3. Mentalization
Making sense of your own and other people’s behavior in terms of mental states such as needs, feelings, beliefs, and intentions, and using that understanding in relationships.

Identity and Relationships

4. Bodily experiences and representations
Conscious and unconscious perceptions, feelings, and attitudes about one’s body, and the implicit sense of the body as one’s own, with boundaries that separate self from world.
5. Differentiation and integration
Telling self from other, fantasy from reality, and past from present, while still connecting them, and holding a coherent, realistic identity.
6. Regulating self-esteem
A sense of personal worth that is neither unrealistically high nor unrealistically low, and confidence that varies sensibly from one situation to another.
7. Trust, empathy, and intimacy
Trusting with appropriate discrimination, understanding and responding to others’ feelings, and adjusting closeness and distance to each relationship.

Defense and Coping

8. Impulse regulation
Expressing needs and urges flexibly and appropriately, without either unmodulated impulsivity or rigid overcontrol.
9. Defensive functioning
The characteristic ways a person manages anxiety, shame, grief, and other painful inner states, from more adaptive to more reality-distorting.
10. Adaptation and resilience
Adjusting to unexpected change and coping creatively with uncertainty, loss, and adversity.

Insight and Self-Direction

11. Internal standards and ideals
A personal, coherent morality and set of ideals that guide choices, considered in the context of one’s culture.
12. Exploring one’s inner life
Reflecting on the sources of one’s own mental states and the links among feelings, motives, thoughts, and behavior, past and present; what used to be called psychological mindedness.
13. Agency and purpose
A felt sense of authorship over one’s actions, and a life narrative that gives experience coherence and meaning.

How They’re Rated

Each capacity is rated from 5 to 1. The chapter gives descriptive anchors for three points: 5 for healthy or optimal functioning, 3 for mild to moderate impairment, and 1 for major or severe impairment (Lingiardi et al., 2026, p. 711). The adult Psychodiagnostic Chart (PDC-3), the clinician form that operationalizes the manual, labels all five points: 5 healthy, 4 mild impairments, 3 moderate impairments, 2 major impairments, and 1 severe deficits (Gordon & Bornstein, 2025).

On the PDC-3, mental functioning is Section III, after level of personality organization and personality style. The clinician rates all 13 capacities and adds them up, giving a total between 13 and 65. The form places that total in one of seven bands (Gordon & Bornstein, 2025):

The chapter’s own summary table labels these bands M1 through M7 and maps them onto the levels of personality organization: M1 corresponds to healthy, M2 and M3 to neurotic, M4 through M6 to borderline, and M7 to psychotic (Lingiardi et al., 2026, p. 738). That table prints different cutoffs at three boundaries: 42–50 for M3, 36–41 for M4, and 22–35 for M5, a range that overlaps M6’s 21–27 (pp. 739–740). The bands above are the ones printed on the PDC-3 form and used in the manual’s online case illustrations.

A total is a rough summary. The manual asks clinicians to draw on more than one point of view: their own observations, the patient’s self-report, reports from people who know the patient, independent observers, and performance on less structured tasks (pp. 732–733). The attention and learning capacity is singled out as one where outside corroboration, such as neuropsychological testing or a partner’s report, strengthens the rating (p. 714). The chapter also points to established instruments that tap particular capacities, including the Shedler–Westen Assessment Procedure, the Adult Attachment Interview, the Reflective Functioning Scale, the Defense Mechanism Rating Scales, and the Structured Interview of Personality Organization (pp. 733–736).

The shape of a profile often says more than its sum. In one of the PDM-3’s online case illustrations, a man called Martin, struggling with severe obsessional anxiety, totals 34, in the “major impairments” band. Yet he is rated 4 on attention and learning and 4 on internal standards and ideals, alongside 2s on affect regulation, mentalization, and self-esteem. His therapist notes that his functioning varies with the capacity involved and the context (Lingiardi & McWilliams, 2026b, pp. 32, 36–37).

Capacities, Levels, and Styles

The PDM-3 describes the levels of personality organization as a general synthesis of these 13 capacities, and asks clinicians to consider them before deciding on a level (McWilliams & Shedler, 2026, p. 656). At the healthy level, most capacities are well developed and generally reliable. People at the neurotic level have many capacities at the high end but respond to certain stresses with a narrower range of responses (p. 657). At the borderline level, difficulties in integrating different aspects of identity become central (p. 659), and at the psychotic level, severe defects in basic functions come together with impaired reality testing (Lingiardi et al., 2026, p. 740).

The M Axis also explains why two people at the same level can look so different. The chapter gives the example of two patients both organized at the borderline level: one because of rigid ways of thinking and frequent reliance on immature defenses, the other because of impaired relationships, a poorly integrated sense of self, and midlevel defenses. The capacities describe what each person actually has to work with (Lingiardi et al., 2026, p. 710).

Personality styles color the capacities in characteristic ways. A few examples from the PDM-3:

None of these links is automatic. A style describes recurring themes; the capacities describe how flexibly and reliably a person can handle them.

History

The first Psychodynamic Diagnostic Manual appeared in 2006. Stanley Greenspan chaired its steering committee and task force, with Nancy McWilliams and Robert Wallerstein as associate chairs and five psychoanalytic organizations as sponsors (Stern, 2009).

The M Axis has roots in ego psychology, which had long assessed “ego strength,” a person’s capacity to acknowledge reality without falling back on primitive defenses such as denial (McWilliams, 2011, p. 29). Leopold Bellak, Marvin Hurvich, and Helen Gediman’s Ego Functions in Schizophrenics, Neurotics, and Normals (1973) operationalized 12 ego functions, among them reality testing, regulation and control of drives and affects, object relations, defensive functioning, synthetic-integrative functioning, and mastery-competence (Buchborn et al., 2023). Wallerstein, for his part, developed the Scales of Psychological Capacities to measure changes in character during psychotherapy, beyond symptoms and without allegiance to one school (Greenfield et al., 2013); the PDM-3 lists them among tools for adolescent self-esteem (Tanzilli & Malberg, 2026, p. 450). The manual’s infancy section is built on a biopsychosocial model of early development drawn from Greenspan’s work (Speranza & Steele, 2026, p. 22).

The number and names of the capacities have changed with each edition:

The PDM-3 also dropped the PDM-2’s long lists of assessment measures for each capacity, in favor of a short guide to well-established tools (Lingiardi et al., 2026, p. 711). Research on the system is growing. In a study of 285 psychotherapists using the PDM-2 to describe patients with Cluster B personality disorders, factor analysis supported the four-domain structure, and mentalization emerged as the most central capacity in the network (Gori et al., 2025). In a study of patients with eating disorders, higher overall mental functioning, identity integration, mentalizing capacity, and self-coherence were related to better treatment outcomes, while DSM-5 categories had no impact on symptom change (Lingiardi & McWilliams, 2026a, p. 12). The manual acknowledges that the charts for younger and older age groups still need their own validity and reliability studies (Lingiardi & McWilliams, 2026c, p. 1024).

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