Chapter V

Mental and behavioural disorders

Disorders of adult personality and behaviour

This block includes a variety of conditions and behaviour patterns of clinical significance which tend to be persistent and appear to be the expression of the individual's characteristic lifestyle and mode of relating to himself or herself and others. Some of these conditions and patterns of behaviour emerge early in the course of individual development, as a result of both constitutional factors and social experience, while others are acquired later in life. Specific personality disorders (F60.-), mixed and other personality disorders (F61.-), and enduring personality changes (F62.-) are deeply ingrained and enduring behaviour patterns, manifesting as inflexible responses to a broad range of personal and social situations. They represent extreme or significant deviations from the way in which the average individual in a given culture perceives, thinks, feels and, particularly, relates to others. Such behaviour patterns tend to be stable and to encompass multiple domains of behaviour and psychological functioning. They are frequently, but not always, associated with various degrees of subjective distress and problems of social performance.

F60 Specific personality disorders
These are severe disturbances in the personality and behavioural tendencies of the individual; not directly resulting from disease, damage, or other insult to the brain, or from another psychiatric disorder; usually involving several areas of the personality; nearly always associated with considerable personal distress and social disruption; and usually manifest since childhood or adolescence and continuing throughout adulthood.
F60.0 Paranoid personality disorder
Personality disorder characterized by excessive sensitivity to setbacks, unforgiveness of insults; suspiciousness and a tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous; recurrent suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner; and a combative and tenacious sense of personal rights. There may be excessive self-importance, and there is often excessive self-reference.
Personality (disorder):
· expansive paranoid
· fanatic
· querulant
· paranoid
· sensitive paranoid
Excludes: paranoia ( F22.0)
paranoia querulans ( F22.8)
· psychosis ( F22.0)
· schizophrenia ( F20.0)
· state ( F22.0)
F60.1 Schizoid personality disorder
Personality disorder characterized by withdrawal from affectional, social and other contacts with preference for fantasy, solitary activities, and introspection. There is a limited capacity to express feelings and to experience pleasure.
Excludes: Asperger's syndrome ( F84.5)
delusional disorder ( F22.0)
schizoid disorder of childhood ( F84.5)
schizophrenia ( F20.-)
schizotypal disorder ( F21)
F60.2 Dissocial personality disorder
Personality disorder characterized by disregard for social obligations, and callous unconcern for the feelings of others. There is gross disparity between behaviour and the prevailing social norms. Behaviour is not readily modifiable by adverse experience, including punishment. There is a low tolerance to frustration and a low threshold for discharge of aggression, including violence; there is a tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with society.
Personality (disorder):
· amoral
· antisocial
· asocial
· psychopathic
· sociopathic
Excludes: conduct disorders ( F91.-)
emotionally unstable personality disorder ( F60.3)
#F60.3 Emotionally unstable personality disorder
Personality disorder characterized by a definite tendency to act impulsively and without consideration of the consequences; the mood is unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is a tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored. Two types may be distinguished: the impulsive type, characterized predominantly by emotional instability and lack of impulse control, and the borderline type, characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts.
Excludes: dissocial personality disorder ( F60.2)
#F60.30 Impulsive type
Personality (disorder):
· aggressive
· explosive
#F60.31 Borderline type
#F60.38 Other emotionally unstable personality disorders
#F60.39 Emotionally unstable personality disorder, unspecified
F60.4 Histrionic personality disorder
Personality disorder characterized by shallow and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement and attention.
Personality (disorder):
· hysterical
· psychoinfantile
F60.5 Anankastic personality disorder
Personality disorder characterized by feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity. There may be insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder.
Personality (disorder):
· compulsive
· obsessional
· obsessive-compulsive
Excludes: obsessive-compulsive disorder ( F42.-)
F60.6 Anxious [avoidant] personality disorder
Personality disorder characterized by feelings of tension and apprehension, insecurity and inferiority. There is a continuous yearning to be liked and accepted, a hypersensitivity to rejection and criticism with restricted personal attachments, and a tendency to avoid certain activities by habitual exaggeration of the potential dangers or risks in everyday situations.
F60.7 Dependent personality disorder
Personality disorder characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others.
Personality (disorder):
· asthenic
· inadequate
· passive
· self-defeating
F60.8 Other specific personality disorders
Personality (disorder):
· eccentric
· "haltlose" type
· immature
· narcissistic
· passive-aggressive
· psychoneurotic
F60.9 Personality disorder, unspecified
Character neurosis NOS
Pathological personality NOS

F61 Mixed and other personality disorders
This category is intended for personality disorders that are often troublesome but do not demonstrate the specific pattern of symptoms that characterize the disorders described in F60.-. As a result they are often more difficult to diagnose than the disorders in F60.-.

Examples include:

  • mixed personality disorders with features of several of the disorders in F60.- but without a predominant set of symptoms that would allow a more specific diagnosis
  • troublesome personality changes, not classifiable to F60.- or F62.-, and regarded as secondary to a main diagnosis of a coexisting affective or anxiety disorder.
Excludes: accentuated personality traits ( Z73.1 )

F62 Enduring personality changes, not attributable to brain damage and disease
Disorders of adult personality and behaviour that have developed in persons with no previous personality disorder following exposure to catastrophic or excessive prolonged stress, or following a severe psychiatric illness. These diagnoses should be made only when there is evidence of a definite and enduring change in a person's pattern of perceiving, relating to, or thinking about the environment and himself or herself. The personality change should be significant and be associated with inflexible and maladaptive behaviour not present before the pathogenic experience. The change should not be a direct manifestation of another mental disorder or a residual symptom of any antecedent mental disorder.
Excludes: personality and behavioural disorder due to brain disease, damage and dysfunction ( F07.- )
F62.0 Enduring personality change after catastrophic experience
Enduring personality change, present for at least two years, following exposure to catastrophic stress. The stress must be so extreme that it is not necessary to consider personal vulnerability in order to explain its profound effect on the personality. The disorder is characterized by a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of "being on edge" as if constantly threatened, and estrangement. Post-traumatic stress disorder (F43.1) may precede this type of personality change.
Personality change after:
· concentration camp experiences
· disasters
· prolonged:
  · captivity with an imminent possibility of being killed
  · exposure to life-threatening situations such as being a victim of terrorism
· torture
Excludes: post-traumatic stress disorder ( F43.1 )
F62.1 Enduring personality change after psychiatric illness
Personality change, persisting for at least two years, attributable to the traumatic experience of suffering from a severe psychiatric illness. The change cannot be explained by a previous personality disorder and should be differentiated from residual schizophrenia and other states of incomplete recovery from an antecedent mental disorder. This disorder is characterized by an excessive dependence on and a demanding attitude towards others; conviction of being changed or stigmatized by the illness, leading to an inability to form and maintain close and confiding personal relationships and to social iso-lation; passivity, reduced interests, and diminished involvement in leisure activities; persistent complaints of being ill, which may be associated with hypochondriacal claims and illness behaviour; dysphoric or labile mood, not due to the presence of a current mental disorder or antecedent mental disorder with residual affective symptoms; and longstanding problems in social and occupational functioning.
F62.8 Other enduring personality changes
Chronic pain personality syndrome
F62.9 Enduring personality change, unspecified

F63 Habit and impulse disorders
This category includes certain disorders of behaviour that are not classifiable under other categories. They are characterized by repeated acts that have no clear rational motivation, cannot be controlled, and generally harm the patient's own interests and those of other people. The patient reports that the behaviour is associated with impulses to action. The cause of these disorders is not understood and they are grouped together because of broad descriptive similarities, not because they are known to share any other important features.
Excludes: habitual excessive use of alcohol or psychoactive substances ( F10-F19 )
impulse and habit disorders involving sexual behaviour ( F65.- )
F63.0 Pathological gambling
The disorder consists of frequent, repeated episodes of gambling that dominate the patient's life to the detriment of social, occupational, material, and family values and commitments.
Compulsive gambling
Excludes: excessive gambling by manic patients ( F30.- )
gambling and betting NOS ( Z72.6 )
gambling in dissocial personality disorder ( F60.2 )
F63.1 Pathological fire-setting [pyromania]
Disorder characterized by multiple acts of, or attempts at, setting fire to property or other objects, without apparent motive, and by a persistent preoccupation with subjects related to fire and burning. This behaviour is often associated with feelings of increasing tension before the act, and intense excitement immediately afterwards.
Excludes: fire-setting (by)(in):
· adult with dissocial personality disorder ( F60.2 )
· alcohol or psychoactive substance intoxication ( F10-F19 , with common fourth character .0)
· as the reason for observation for suspected mental disorder ( Z03.2 )
· conduct disorders ( F91.- )
· organic mental disorders ( F00-F09 )
· schizophrenia ( F20.- )
F63.2 Pathological stealing [kleptomania]
Disorder characterized by repeated failure to resist impulses to steal objects that are not acquired for personal use or monetary gain. The objects may instead be discarded, given away, or hoarded. This behaviour is usually accompanied by an increasing sense of tension before, and a sense of gratification during and immediately after, the act.
Excludes: depressive disorder with stealing ( F31-F33 )
organic mental disorders ( F00-F09 )
shoplifting as the reason for observation for suspected mental disorder ( Z03.2 )
F63.3 Trichotillomania
A disorder characterized by noticeable hair-loss due to a recurrent failure to resist impulses to pull out hairs. The hair-pulling is usually preceded by mounting tension and is followed by a sense of relief or gratification. This diagnosis should not be made if there is a pre-existing inflammation of the skin, or if the hair-pulling is in response to a delusion or a hallucination.
Excludes: stereotyped movement disorder with hair-plucking ( F98.4 )
F63.8 Other habit and impulse disorders
Other kinds of persistently repeated maladaptive behaviour that are not secondary to a recognized psychiatric syndrome, and in which it appears that the patient is repeatedly failing to resist impulses to carry out the behaviour. There is a prodromal period of tension with a feeling of release at the time of the act.
Intermittent explosive disorder
F63.9 Habit and impulse disorder, unspecified

F64 Gender identity disorders
F64.0 Transsexualism
A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex.
F64.1 Dual-role transvestism
The wearing of clothes of the opposite sex for part of the individual's existence in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual excitement accompanying the cross-dressing.
Gender identity disorder of adolescence or adulthood, nontranssexual type
Excludes: fetishistic transvestism ( F65.1 )
F64.2 Gender identity disorder of childhood
A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual's own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behaviour in boys is not sufficient. Gender identity disorders in individuals who have reached or are entering puberty should not be classified here but in F66.-.
Excludes: egodystonic sexual orientation ( F66.1 )
sexual maturation disorder ( F66.0 )
F64.8 Other gender identity disorders
F64.9 Gender identity disorder, unspecified
Gender-role disorder NOS

F65 Disorders of sexual preference
Includes: paraphilias
F65.0 Fetishism
Reliance on some non-living object as a stimulus for sexual arousal and sexual gratification. Many fetishes are extensions of the human body, such as articles of clothing or footwear. Other common examples are characterized by some particular texture such as rubber, plastic or leather. Fetish objects vary in their importance to the individual. In some cases they simply serve to enhance sexual excitement achieved in ordinary ways (e.g. having the partner wear a particular garment).
F65.1 Fetishistic transvestism
The wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex. Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. It can occur as an earlier phase in the development of transsexualism.
Transvestic fetishism
F65.2 Exhibitionism
A recurrent or persistent tendency to expose the genitalia to strangers (usually of the opposite sex) or to people in public places, without inviting or intending closer contact. There is usually, but not invariably, sexual excitement at the time of the exposure and the act is commonly followed by masturbation.
F65.3 Voyeurism
A recurrent or persistent tendency to look at people engaging in sexual or intimate behaviour such as undressing. This is carried out without the observed people being aware, and usually leads to sexual excitement and masturbation.
F65.4 Paedophilia
A sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age.
F65.5 Sadomasochism
A preference for sexual activity which involves the infliction of pain or humiliation, or bondage. If the subject prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. Often an individual obtains sexual excitement from both sadistic and masochistic activities.
F65.6 Multiple disorders of sexual preference
Sometimes more than one abnormal sexual preference occurs in one person and there is none of first rank. The most common combination is fetishism, transvestism and sadomasochism.
F65.8 Other disorders of sexual preference
A variety of other patterns of sexual preference and activity, including making obscene telephone calls, rubbing up against people for sexual stimulation in crowded public places, sexual activity with animals, and use of strangulation or anoxia for intensifying sexual excitement.
F65.9 Disorder of sexual preference, unspecified
Sexual deviation NOS

F66 Psychological and behavioural disorders associated with sexual development and orientation
Note: Sexual orientation by itself is not to be regarded as a disorder.
F66.0 Sexual maturation disorder
The patient suffers from uncertainty about his or her gender identity or sexual orientation, which causes anxiety or depression. Most commonly this occurs in adolescents who are not certain whether they are homosexual, heterosexual or bisexual in orientation, or in individuals who, after a period of apparently stable sexual orientation (often within a longstanding relationship), find that their sexual orientation is changing.
F66.1 Egodystonic sexual orientation
The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.
F66.2 Sexual relationship disorder
The gender identity or sexual orientation (heterosexual, homosexual, or bisexual) is responsible for difficulties in forming or maintaining a relationship with a sexual partner.
F66.8 Other psychosexual development disorders
F66.9 Psychosexual development disorder, unspecified

F68 Other disorders of adult personality and behaviour
F68.0 Elaboration of physical symptoms for psychological reasons
Physical symptoms compatible with and originally due to a confirmed physical disorder, disease or disability become exaggerated or prolonged due to the psychological state of the patient. The patient is commonly distressed by this pain or disability, and is often preoccupied with worries, which may be justified, of the possibility of prolonged or progressive disability or pain.
Compensation neurosis
F68.1 Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]
The patient feigns symptoms repeatedly for no obvious reason and may even inflict self-harm in order to produce symptoms or signs. The motivation is obscure and presumably internal with the aim of adopting the sick role. The disorder is often combined with marked disorders of personality and relationships.
Hospital hopper syndrome
Münchhausen's syndrome
Peregrinating patient
Excludes: factitial dermatitis ( L98.1 )
person feigning illness (with obvious motivation) ( Z76.5 )
F68.8 Other specified disorders of adult personality and behaviour
Character disorder NOS
Relationship disorder NOS

F69 Unspecified disorder of adult personality and behaviour