Chapter V

Mental and behavioural disorders

Behavioural and emotional disorders with onset usually occurring in childhood and adolescence

F90 Hyperkinetic disorders
A group of disorders characterized by an early onset (usually in the first five years of life), lack of persistence in activities that require cognitive involvement, and a tendency to move from one activity to another without completing any one, together with disorganized, ill-regulated, and excessive activity. Several other abnormalities may be associated. Hyperkinetic children are often reckless and impulsive, prone to accidents, and find themselves in disciplinary trouble because of unthinking breaches of rules rather than deliberate defiance. Their relationships with adults are often socially disinhibited, with a lack of normal caution and reserve. They are unpopular with other children and may become isolated. Impairment of cognitive functions is common, and specific delays in motor and language development are disproportionately frequent. Secondary complications include dissocial behaviour and low self-esteem.
Excludes: anxiety disorders ( F41.- )
mood [affective] disorders ( F30-F39 )
pervasive developmental disorders ( F84.- )
schizophrenia ( F20.- )
F90.0 Disturbance of activity and attention
Attention deficit:
· disorder with hyperactivity
· hyperactivity disorder
· syndrome with hyperactivity
Excludes: hyperkinetic disorder associated with conduct disorder ( F90.1 )
F90.1 Hyperkinetic conduct disorder
Hyperkinetic disorder associated with conduct disorder
F90.8 Other hyperkinetic disorders
F90.9 Hyperkinetic disorder, unspecified
Hyperkinetic reaction of childhood or adolescence NOS
Hyperkinetic syndrome NOS

F91 Conduct disorders
Disorders characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. Such behaviour should amount to major violations of age-appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring pattern of behaviour (six months or longer). Features of conduct disorder can also be symptomatic of other psychiatric conditions, in which case the underlying diagnosis should be preferred.

Examples of the behaviours on which the diagnosis is based include excessive levels of fighting or bullying, cruelty to other people or animals, severe destructiveness to property, fire-setting, stealing, repeated lying, truancy from school and running away from home, unusually frequent and severe temper tantrums, and disobedience. Any one of these behaviours, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not.

Excludes: mood [affective] ( F30-F39 )
pervasive developmental disorders ( F84.- )
schizophrenia ( F20.- )
when associated with:
· emotional disorders ( F92.- )
· hyperkinetic disorders ( F90.1 )
F91.0 Conduct disorder confined to the family context
Conduct disorder involving dissocial or aggressive behaviour (and not merely oppositional, defiant, disruptive behaviour), in which the abnormal behaviour is entirely, or almost entirely, confined to the home and to interactions with members of the nuclear family or immediate household. The disorder requires that the overall criteria for F91.- be met; even severely disturbed parent-child relationships are not of themselves sufficient for diagnosis.
F91.1 Unsocialized conduct disorder
Disorder characterized by the combination of persistent dissocial or aggressive behaviour (meeting the overall criteria for F91.- and not merely comprising oppositional, defiant, disruptive behaviour) with significant pervasive abnormalities in the individual's relationships with other children.
Conduct disorder, solitary aggressive type
Unsocialized aggressive disorder
F91.2 Socialized conduct disorder
Disorder involving persistent dissocial or aggressive behaviour (meeting the overall criteria for F91.- and not merely comprising oppositional, defiant, disruptive behaviour) occurring in individuals who are generally well integrated into their peer group.
Conduct disorder, group type
Group delinquency
Offences in the context of gang membership
Stealing in company with others
Truancy from school
F91.3 Oppositional defiant disorder
Conduct disorder, usually occurring in younger children, primarily characterized by markedly defiant, disobedient, disruptive behaviour that does not include delinquent acts or the more extreme forms of aggressive or dissocial behaviour. The disorder requires that the overall criteria for F91.- be met; even severely mischievous or naughty behaviour is not in itself sufficient for diagnosis. Caution should be employed before using this category, especially with older children, because clinically significant conduct disorder will usually be accompanied by dissocial or aggressive behaviour that goes beyond mere defiance, disobedience, or disruptiveness.
F91.8 Other conduct disorders
F91.9 Conduct disorder, unspecified
· behavioural disorder NOS
· conduct disorder NOS

F92 Mixed disorders of conduct and emotions
A group of disorders characterized by the combination of persistently aggressive, dissocial or defiant behaviour with overt and marked symptoms of depression, anxiety or other emotional upsets. The criteria for both conduct disorders of childhood (F9l.-) and emotional disorders of childhood (F93.-) or an adult-type neurotic diagnosis (F40-F48) or a mood disorder (F30-F39) must be met.
F92.0 Depressive conduct disorder
This category requires the combination of conduct disorder (F91.-) with persistent and marked depression of mood (F32.-), as demonstrated by symptoms such as excessive misery, loss of interest and pleasure in usual activities, self-blame, and hopelessness; disturbances of sleep or appetite may also be present.
Conduct disorder in F91.- associated with depressive disorder in F32.-
F92.8 Other mixed disorders of conduct and emotions
This category requires the combination of conduct disorder (F91.-) with persistent and marked emotional symptoms such as anxiety, obsessions or compulsions, depersonalization or derealization, phobias, or hypochondriasis.
Conduct disorder in F91.- associated with:
· emotional disorder in F93.-
· neurotic disorder in F40-F48
F92.9 Mixed disorder of conduct and emotions, unspecified

F93 Emotional disorders with onset specific to childhood
Mainly exaggerations of normal developmental trends rather than phenomena that are qualitatively abnormal in themselves. Developmental appropriateness is used as the key diagnostic feature in defining the difference between these emotional disorders, with onset specific to childhood, and the neurotic disorders (F40-F48).
Excludes: when associated with conduct disorder ( F92.- )
F93.0 Separation anxiety disorder of childhood
Should be diagnosed when fear of separation constitutes the focus of the anxiety and when such anxiety first arose during the early years of childhood. It is differentiated from normal separation anxiety when it is of a degree (severity) that is statistically unusual (including an abnormal persistence beyond the usual age period), and when it is associated with significant problems in social functioning.
Excludes: mood [affective] disorders ( F30-F39 )
neurotic disorders ( F40-F48 )
phobic anxiety disorder of childhood ( F93 .1)
social anxiety disorder of childhood ( F93.2 )
F93.1 Phobic anxiety disorder of childhood
Fears in childhood that show a marked developmental phase specificity and arise (to some extent) in a majority of children, but that are abnormal in degree. Other fears that arise in childhood but that are not a normal part of psychosocial development (for example agoraphobia) should be coded under the appropriate category in section F40-F48.
Excludes: generalized anxiety disorder ( F41.1 )
F93.2 Social anxiety disorder of childhood
In this disorder there is a wariness of strangers and social apprehension or anxiety when encountering new, strange, or socially threatening situations. This category should be used only where such fears arise during the early years, and are both unusual in degree and accompanied by problems in social functioning.
Avoidant disorder of childhood or adolescence
F93.3 Sibling rivalry disorder
Some degree of emotional disturbance usually following the birth of an immediately younger sibling is shown by a majority of young children. A sibling rivalry disorder should be diagnosed only if the degree or persistence of the disturbance is both statistically unusual and associated with abnormalities of social interaction.
Sibling jealousy
F93.8 Other childhood emotional disorders
Identity disorder
Overanxious disorder
Excludes: gender identity disorder of childhood ( F64.2 )
F93.9 Childhood emotional disorder, unspecified

F94 Disorders of social functioning with onset specific to childhood and adolescence
A somewhat heterogeneous group of disorders that have in common abnormalities in social functioning which begin during the developmental period, but which (unlike the pervasive developmental disorders) are not primarily characterized by an apparently constitutional social incapacity or deficit that pervades all areas of functioning. In many instances, serious environmental distortions or privations probably play a crucial role in etiology.
F94.0 Elective mutism
Characterized by a marked, emotionally determined selectivity in speaking, such that the child demonstrates a language competence in some situations but fails to speak in other (definable) situations. The disorder is usually associated with marked personality features involving social anxiety, withdrawal, sensitivity, or resistance.
Selective mutism
Excludes: pervasive developmental disorders ( F84.- )
schizophrenia ( F20.- )
specific developmental disorders of speech and language ( F80.- )
transient mutism as part of separation anxiety in young children ( F93.0 )
F94.1 Reactive attachment disorder of childhood
Starts in the first five years of life and is characterized by persistent abnormalities in the child's pattern of social relationships that are associated with emotional disturbance and are reactive to changes in environmental circumstances (e.g. fearfulness and hypervigilance, poor social interaction with peers, aggression towards self and others, misery, and growth failure in some cases). The syndrome probably occurs as a direct result of severe parental neglect, abuse, or serious mishandling.
Use additional code, if desired, to identify any associated failure to thrive or growth retardation.
Excludes: Asperger's syndrome ( F84.5 )
disinhibited attachment disorder of childhood ( F94.2 )
maltreatment syndromes ( T74.- )
normal variation in pattern of selective attachment
sexual or physical abuse in childhood, resulting in psychosocial problems ( Z61.4-Z61.6 )
F94.2 Disinhibited attachment disorder of childhood
A particular pattern of abnormal social functioning that arises during the first five years of life and that tends to persist despite marked changes in environmental circumstances, e.g. diffuse, nonselectively focused attachment behaviour, attention-seeking and indiscriminately friendly behaviour, poorly modulated peer interactions; depending on circumstances there may also be associated emotional or behavioural disturbance.
Affectionless psychopathy
Institutional syndrome
Excludes: Asperger's syndrome ( F84.5 )
hospitalism in children ( F43.2 )
hyperkinetic disorders ( F90.- )
reactive attachment disorder of childhood ( F94 .1)
F94.8 Other childhood disorders of social functioning
F94.9 Childhood disorder of social functioning, unspecified

F95 Tic disorders
Syndromes in which the predominant manifestation is some form of tic. A tic is an involuntary, rapid, recurrent, nonrhythmic motor movement (usually involving circumscribed muscle groups) or vocal production that is of sudden onset and that serves no apparent purpose. Tics tend to be experienced as irresistible but usually they can be suppressed for varying periods of time, are exacerbated by stress, and disappear during sleep. Common simple motor tics include only eye-blinking, neck-jerking, shoulder- shrugging, and facial grimacing. Common simple vocal tics include throat-clearing, barking, sniffing, and hissing. Common complex tics include hitting oneself, jumping, and hopping. Common complex vocal tics include the repetition of particular words, and sometimes the use of socially unacceptable (often obscene) words (coprolalia), and the repetition of one's own sounds or words (palilalia).
F95.0 Transient tic disorder
Meets the general criteria for a tic disorder but the tics do not persist longer than 12 months. The tics usually take the form of eye-blinking, facial grimacing, or head-jerking.
F95.1 Chronic motor or vocal tic disorder
Meets the general criteria for a tic disorder, in which there are motor or vocal tics (but not both), that may be either single or multiple (but usually multiple), and last for more than a year.
F95.2 Combined vocal and multiple motor tic disorder [de la Tourette]
A form of tic disorder in which there are, or have been, multiple motor tics and one or more vocal tics, although these need not have occurred concurrently. The disorder usually worsens during adolescence and tends to persist into adult life. The vocal tics are often multiple with explosive repetitive vocalizations, throat-clearing, and grunting, and there may be the use of obscene words or phrases. Sometimes there is associated gestural echopraxia which may also be of an obscene nature (copropraxia).
F95.8 Other tic disorders
F95.9 Tic disorder, unspecified

F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence
A heterogeneous group of disorders that share the characteristic of an onset in childhood but otherwise differ in many respects. Some of the conditions represent well-defined syndromes but others are no more than symptom complexes that need inclusion because of their frequency and association with psychosocial problems, and because they cannot be incorporated into other syndromes.
Excludes: breath-holding spells ( R06.8 )
gender identity disorder of childhood ( F64.2 )
Kleine-Levin syndrome ( G47.8 )
obsessive-compulsive disorder ( F42.- )
sleep disorders due to emotional causes ( F51.- )
F98.0 Nonorganic enuresis
A disorder characterized by involuntary voiding of urine, by day and by night, which is abnormal in relation to the individual's mental age, and which is not a consequence of a lack of bladder control due to any neurological disorder, to epileptic attacks, or to any structural abnormality of the urinary tract. The enuresis may have been present from birth or it may have arisen following a period of acquired bladder control. The enuresis may or may not be associated with a more widespread emotional or behavioural disorder.
Enuresis (primary)(secondary) of nonorganic origin
Functional enuresis
Psychogenic enuresis
Urinary incontinence of nonorganic origin
Excludes: enuresis NOS ( R32 )
F98.1 Nonorganic encopresis
Repeated, voluntary or involuntary passage of faeces, usually of normal or near-normal consistency, in places not appropriate for that purpose in the individual's own sociocultural setting. The condition may represent an abnormal continuation of normal infantile incontinence, it may involve a loss of continence following the acquisition of bowel control, or it may involve the deliberate deposition of faeces in inappropriate places in spite of normal physiological bowel control. The condition may occur as a monosymptomatic disorder, or it may form part of a wider disorder, especially an emotional disorder (F93.-) or a conduct disorder (F91.-).
Functional encopresis
Incontinence of faeces of nonorganic origin
Psychogenic encopresis
Use additional code, if desired, to identify the cause of any coexisting constipation.
Excludes: encopresis NOS ( R15 )
F98.2 Feeding disorder of infancy and childhood
A feeding disorder of varying manifestations usually specific to infancy and early childhood. It generally involves food refusal and extreme faddiness in the presence of an adequate food supply, a reasonably competent caregiver, and the absence of organic disease. There may or may not be associated rumination (repeated regurgitation without nausea or gastrointestinal illness).
Rumination disorder of infancy
Excludes: anorexia nervosa and other eating disorders ( F50.- )
· difficulties and mismanagement ( R63.3 )
· problems of newborn ( P92.- )
pica of infancy or childhood ( F98.3 )
F98.3 Pica of infancy and childhood
Persistent eating of non-nutritive substances (such as soil, paint chippings, etc.). It may occur as one of many symptoms that are part of a more widespread psychiatric disorder (such as autism), or as a relatively isolated psychopathological behaviour; only the latter is classified here. The phenomenon is most common in mentally retarded children and, if mental retardation is also present, F70-F79 should be selected as the main diagnosis.
F98.4 Stereotyped movement disorders
Voluntary, repetitive, stereotyped, nonfunctional (and often rhythmic) movements that do not form part of any recognized psychiatric or neurological condition. When such movements occur as symptoms of some other disorder, only the overall disorder should be recorded. The movements that are of a non self-injurious variety include: body-rocking, head-rocking, hair-plucking, hair-twisting, finger-flicking mannerisms, and hand-flapping. Stereotyped self-injurious behaviour includes repetitive head-banging, face-slapping, eye-poking, and biting of hands, lips or other body parts. All the stereotyped movement disorders occur most frequently in association with mental retardation (when this is the case, both should be recorded). If eye-poking occurs in a child with visual impairment, both should be coded: eye-poking under this category and the visual condition under the appropriate somatic disorder code.
Stereotype/habit disorder
Excludes: abnormal involuntary movements ( R25.- )
movement disorders of organic origin ( G20-G25 )
nail-biting ( F98.8 )
nose-picking ( F98.8 )
stereotypies that are part of a broader psychiatric condition ( F00-F95 )
thumb-sucking ( F98.8 )
tic disorders ( F95.- )
trichotillomania ( F63.3 )
F98.5 Stuttering [stammering]
Speech that is characterized by frequent repetition or prolongation of sounds or syllables or words, or by frequent hesitations or pauses that disrupt the rhythmic flow of speech. It should be classified as a disorder only if its severity is such as to markedly disturb the fluency of speech.
Excludes: cluttering ( F98.6 )
tic disorders ( F95.- )
F98.6 Cluttering
A rapid rate of speech with breakdown in fluency, but no repetitions or hesitations, of a severity to give rise to diminished speech intelligibility. Speech is erratic and dysrhythmic, with rapid jerky spurts that usually involve faulty phrasing patterns.
Excludes: stuttering ( F98.5 )
tic disorders ( F95.- )
F98.8 Other specified behavioural and emotional disorders with onset usually occurring in childhood and adolescence
Attention deficit disorder without hyperactivity
Excessive masturbation
F98.9 Unspecified behavioural and emotional disorders with onset usually occurring in childhood and adolescence