Thirty years of operationalized psychodynamic diagnosis: a systematic review of empirical applications and research trends

Introduction This systematic review aimed to characterize the development and methodological features of applied empirical research using the Operationalized Psychodynamic Diagnosis (OPD) over the past three decades, with particular attention to changes in assessment modality, study design, research focus, and geographical distribution. Methods Eight databases were searched in February 2025 and updated in February 2026, without date or language restrictions. Applied empirical studies using the clinician-rated OPD system or OPD-derived measures were eligible; validation- and psychometric-only studies were excluded. Screening followed PRISMA 2020. Descriptive and narrative syntheses included stratified analyses across five-year publication periods. Methodological quality was explored using an adapted Newcastle–Ottawa Scale (NOS-AR). Results A total of 174 studies were included. Publication output increased markedly in recent years but remained concentrated in German-speaking countries, without a consistent proportional trend toward geographical diversification. Cross-sectional designs predominated ( n = 116, 66.7%), and non-probabilistic sampling was used in 159 studies (91.4%). Among 52 longitudinal studies, 36 (69.2%) were psychotherapy/treatment-outcome or pre–post studies, whereas prospective cohort/follow-up designs were less frequent ( n = 8, 15.4%); only six studies were randomized clinical trials. Axis IV was the most frequently investigated OPD dimension, alongside a marked recent expansion of OPD-derived self-report assessment. Psychodynamic characterization and clinical correlates constituted the primary research focus of 89 studies (51.1%) and 58.3% of studies published in 2021–2026, whereas treatment indication and clinical decision-making remained rare ( n = 6, 3.4%). Discussion The recent expansion of OPD research has been driven predominantly by dimensional characterization and clinical-correlate studies rather than by a proportional increase in prospective, interventional, or decision-oriented research. The accumulated evidence therefore more strongly supports the clinical relevance of OPD constructs than their incremental or decision-related clinical utility. Further prospective, comparative, interventional, and cross-cultural research is needed. Other: Protocol registration in PROSPERO (CRD42024614521). Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024614521 , identifier CRD42024614521.