F20 Schizophrenia

Minimum of one very clear symptom (and usually two or more if less clear-cut)
belonging to any one of the groups listed as (a) to (d) below, or symptoms from at least
two of the groups referred to as (e) to (h), should have been clearly present for most of
the time during a period of 1 month or more. Symptom (i) applies only to the diagnosis
of Simple Schizophrenia (F20.6), and duration of at least one year is required.

(a) Thought echo, thought insertion or withdrawal, and thought broadcasting;
(b) Delusions of control, influence, or passivity, clearly referred to body or limb
movements or specific thoughts, actions, or sensations; delusional perception;
(c) Hallucinatory voices giving a running commentary on the patient's behaviour, or
discussing the patient among themselves, or other types of hallucinatory voices
coming from some part of the body;
(d) Persistent delusions of other kinds that are culturally inappropriate and completely
impossible, such as religious or political identity, or superhuman powers and
abilities

(e) Persistent hallucinations in any modality, when accompanied either by fleeting or
half-formed delusions without clear affective content, or by persistent
over-valued ideas, or when occurring every day for weeks or months on end;
(f) Breaks or interpolations in the train of thought, resulting in incoherence or irrelevant
speech, or neologisms;
(g) Catatonic behaviour
(h) "Negative" symptoms not due to depression or to neuroleptic medication;
(i) A significant and consistent change in the overall quality of some aspects of personal
behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed
attitude, and social withdrawal.

F21 Schizotypal disorder

A disorder characterized by eccentric behaviour and anomalies of thinking and affect
which resemble those seen in schizophrenia, though no definite and characteristic
schizophrenic anomalies have occurred at any stage. There is no dominant or typical
disturbance, but any of the following may be present:
(a) Inappropriate or constricted affect (the individual appears cold and aloof);
(b) Behaviour or appearance that is odd, eccentric, or peculiar;
(c) Poor rapport with others and a tendency to social withdrawal;
(d) Odd beliefs or magical thinking, influencing behaviour and inconsistent with
sub cultural norms;
(e) Suspiciousness or paranoid ideas;
(f) Obsessive ruminations without inner resistance, often with dysmorphophobic,
sexual or aggressive contents;
(g) Unusual perceptual experiences including somatosensory (bodily) or other illusions,
depersonalization or derealization;
(h) Vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking,
manifested by odd speech or in other ways, without gross incoherence;
(i) occasional transient quasi-psychotic episodes with intense illusions, auditory or
other hallucinations, and delusion-like ideas, usually occurring without external
provocation.

The disorder runs a chronic course with fluctuations of intensity. Occasionally it
evolves into overt schizophrenia. There is no definite onset and its evolution and
course are usually those of a personality disorder. It is more common in individuals
related to schizophrenics and is believed to be part of the genetic "spectrum" of
schizophrenia.

Three or four of the typical features listed above should have been present,
continuously or episodically, for at least 2 years. The individual must never have met
criteria for schizophrenia itself.

F22 Persistent delusional disorders

Characterized by the development either of a single delusion or of a set of related
delusions which are usually persistent and sometimes lifelong. Other
psychopathology is characteristically absent, but depressive symptoms may be present
intermittently, and olfactory and tactile hallucinations may develop in some cases.
Onset is commonly in middle age but sometimes, particularly in the case of beliefs
about having a misshapen body, in early adult life. The content of the delusion, and the
timing of its emergence, can often be related to the individual's life situation, e.g.
persecutory delusions in members of minorities. Apart from actions and attitudes
directly related to the delusion or delusional system, affect, speech, and behaviour are
normal.
Diagnostic guidelines
Delusions constitute the most conspicuous or the only clinical characteristic. They must
be present for at least 3 months and be clearly personal rather than sub cultural.
Depressive symptoms or even a full-blown depressive episode (F32.-) may be present
intermittently, provided that the delusions persist at times when there is no
disturbance of mood.

F30 Manic episode
Underlying characteristics of elevated mood, and an increase in the quantity and
speed of physical and mental activity
F30.0 Hypomania
lesser degree of mania
There is a persistent mild elevation of mood (for at least several days on end),
increased energy and activity, and usually marked feelings of well-being and
both physical and mental efficiency.
Increased sociability, talkativeness, over-familiarity, increased sexual energy, and
a decreased need for sleep are often present but not to the extent that they lead to
severe disruption of work or result in social rejection.
Irritability, conceit, and boorish behaviour may take the place of the more usual
euphoric sociability.
Concentration and attention may be impaired, thus diminishing the ability to
settle down to work or to relaxation and leisure, but this may not prevent the
appearance of interests in quite new ventures and activities, or mild over-
spending.
F30.1 Mania without psychotic symptoms
Mood is elevated out of keeping with the individual's circumstances and may
vary from carefree joviality to almost uncontrollable excitement. Elation is
accompanied by increased energy, resulting in overactivity, pressure of speech,
and a decreased need for sleep.
Normal social inhibitions are lost, attention cannot be sustained, and there is
often marked distractability.
Self-esteem is inflated and grandiose or over-optimistic ideas are freely
expressed.
Perceptual disorders may occur, such as the appreciation of colours as especially
vivid (and usually beautiful), a preoccupation with fine details of surfaces or
textures, and subjective hyperacusis.
The individual may embark on extravagant and impractical schemes, spend
money recklessly, or become aggressive, amorous, or facetious in inappropriate
circumstances.
In some manic episodes the mood is irritable and suspicious rather than elated.
The first attack occurs most commonly between the ages of 15 and 30 years, but
may occur at any age from late childhood to the seventh or eighth decade.
Diagnostic guidelines
The episode should last for at least 1 week and should be severe enough to disrupt
ordinary work and social activities more or less completely. The mood change should
be accompanied by increased energy and several of the symptoms referred to above
(particularly pressure of speech, decreased need for sleep, grandiosity, and excessive
optimism).
F30.2 Mania with psychotic symptoms
The clinical picture is that of a more severe form of mania as described in F30.1.
Inflated self-esteem and grandiose ideas may develop into delusions, and irritability
and suspiciousness into delusions of persecution. In severe cases, grandiose or
religious delusions of identity or role may be prominent, and flight of ideas and
pressure of speech may result in the individual becoming incomprehensible. Severe
and sustained physical activity and excitement may result in aggression or violence,
and neglect of eating, drinking, and personal hygiene may result in dangerous states of
dehydration and self-neglect.

F32 Depressive episode
In typical depressive episodes of all three varieties the individual usually suffers from
depressed mood, loss of interest and enjoyment, and reduced energy leading to
increased fatiguability and diminished activity. Marked tiredness after only slight
effort is common.
Other common symptoms are:
(a) Reduced concentration and attention;
(b) Reduced self-esteem and self-confidence;
(c) Ideas of guilt and unworthiness (even in a mild type of episode);
(d) Bleak and pessimistic views of the future;
(e) Ideas or acts of self-harm or suicide;
(f) Disturbed sleep
(g) Diminished appetite.
The lowered mood varies little from day to day, and is often unresponsive to
circumstances, yet may show a characteristic diurnal variation as the day goes on. In
some cases, anxiety, distress, and motor agitation may be more prominent at times
than the depression, and the mood change may also be masked by added features such
as irritability, excessive consumption of alcohol, histrionic behaviour, and
exacerbation of pre-existing phobic or obsessional symptoms, or by Hypochondriacal
preoccupations. For depressive episodes of all three grades of severity, a duration of at
least 2 weeks is usually required for diagnosis, but shorter periods may be reasonable if
symptoms are unusually severe and of rapid onset. Some of the above symptoms may
be marked and develop characteristic features that are widely regarded as having
special clinical significance.

F40 Phobic anxiety disorders
Anxiety is evoked only, or predominantly, by certain well-defined situations or
objects (external to the individual) which are not currently dangerous. These
situations or objects are characteristically avoided or endured with dread.
Phobic anxiety is indistinguishable subjectively, physiologically, and
behaviorally from other types of anxiety and may vary in severity from mild
unease to terror.
The individual's concern may focus on individual symptoms such as
palpitations or feeling faint and is often associated with secondary fears of dying,
losing control, or going mad.
The anxiety is not relieved by the knowledge that other people do not regard
the situation in question as dangerous or threatening. Mere contemplation of
entry to the phobic situation usually generates anticipatory anxiety.
Phobic anxiety often coexists with depression. Most phobic disorders other than social
phobias are more common in women than in men.
F41.0 Panic disorder [episodic paroxysmal anxiety]
The essential features are recurrent attacks of severe anxiety (panic) which are
not restricted to any particular situation or set of circumstances, and which are
therefore unpredictable.
As in other anxiety disorders, the dominant symptoms vary from person to
person, but sudden onset of palpitations, chest pain, choking sensations,
dizziness, and feelings of unreality (depersonalization or derealization) are
common.
There is also, almost invariably, a secondary fear of dying, losing control, or
going mad.
Individual attacks usually last for minutes only, though sometimes longer; their
frequency and the course of the disorder are both rather variable.
An individual in a panic attack often experiences a crescendo of fear and
autonomic symptoms which results in an exit, usually hurried, from wherever he
or she may be. If this occurs in a specific situation, such as on a bus or in a crowd,
the patient may subsequently avoid that situation.
Similarly, frequent and unpredictable panic attacks produce fear of being alone
or going into public places.
A panic attack is often followed by a persistent fear of having another attack.
Diagnostic guidelines
For a definite diagnosis, several severe attacks of autonomic anxiety should have
occurred within a period of about 1 month:
(a) in circumstances where there is no objective danger;
(b) without being confined to known or predictable situations; and
(c) with comparative freedom from anxiety symptoms between attacks (although
anticipatory anxiety is common).

F42 Obsessive-compulsive disorder
For a definite diagnosis, obsessional symptoms or compulsive acts, or both, must be
present on most days for at least 2 successive weeks and be a source of distress or
interference with activities. The obsessional symptoms should have the following
characteristics:
(a) They must be recognized as the individual's own thoughts or impulses;
(b) There must be at least one thought or act that is still resisted unsuccessfully, even
though others may be present which the sufferer no longer resists;
(c) The thought of carrying out the act must not in itself be pleasurable (simple relief of
tension or anxiety is not regarded as pleasure in this sense);
(d) The thoughts, images, or impulses must be unpleasantly repetitive.

F45 Somatoform disorders
The main feature is repeated presentation of physical symptoms, together with
persistent requests for medical investigations, in spite of repeated negative findings and
reassurances by doctors that the symptoms have no physical basis. If any physical
disorders are present, they do not explain the nature and extent of the symptoms or the
distress and preoccupation of the patient. Even when the onset and continuation of the
symptoms bear a close relationship with unpleasant life events or with difficulties or
conflicts, the patient usually resists attempts to discuss the possibility of psychological
causation; this may even be the case in the presence of obvious depressive and anxiety
symptoms. The degree of understanding, either physical or psychological, that can be
achieved about the cause of the symptoms is often disappointing and frustrating for
both patient and doctor. In these disorders there is often a degree of attention-seeking
(histrionic) behaviour, particularly in patients who are resentful of their failure to
persuade doctors of the essentially physical nature of their illness and of the need for
further investigations or examinations.

F45.0 Somatization disorder
A definite diagnosis requires the presence of all of the following:
(a) At least 2 years of multiple and variable physical symptoms for which no adequate
physical explanation has been found;
(b) Persistent refusal to accept the advice or reassurance of several doctors that there is
no physical explanation for the symptoms;
(c) Some degree of impairment of social and family functioning attributable to the
nature of the symptoms and resulting behaviour.

F45.2 Hypochondriacal disorder
For a definite diagnosis, both of the following should be present:
(a) Persistent belief in the presence of at least one serious physical illness underlying the
presenting symptom or symptoms, even though repeated investigations and
examinations have identified no adequate physical explanation, or a persistent
preoccupation with a presumed deformity or disfigurement;
(b) Persistent refusal to accept the advice and reassurance of several different doctors
that there is no physical illness or abnormality underlying the symptoms.

F45.3 Somatoform autonomic dysfunction
Definite diagnosis requires all of the following:
(a) Symptoms of autonomic arousal, such as palpitations, sweating, tremor, flushing,
which are persistent and troublesome;
(b) Additional subjective symptoms referred to a specific organ or system;
(c) Preoccupation with and distress about the possibility of a serious (but often
unspecified) disorder of the stated organ or system, which does not respond to repeated
explanation and reassurance by doctors;
(d) No evidence of a significant disturbance of structure or function of the stated system
or organ.



F60 Specific personality disorders
Conditions not directly attributable to gross brain damage or disease, or to another
psychiatric disorder, meeting the following criteria:
(a) Markedly disharmonious attitudes and behaviour, involving usually several areas of
functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking,
and style of relating to others;
(b) The abnormal behaviour pattern is enduring, of long standing, and not limited to
episodes of mental illness;
(c) The abnormal behaviour pattern is pervasive and clearly maladaptive to a broad
range of personal and social situations;
(d) The above manifestations always appear during childhood or adolescence and
continue into adulthood;
(e) The disorder leads to considerable personal distress but this may only become
apparent late in its course;
(f) The disorder is usually, but not invariably, associated with significant problems in
occupational and social performance.

F60.0 Paranoid personality disorder
Personality disorder characterized by:
(a) Excessive sensitiveness to setbacks and rebuffs;
(b) Tendency to bear grudges persistently, e.g. refusal to forgive insults and injuries or
slights;
(c) Suspiciousness and a pervasive tendency to distort experience by misconstruing the
neutral or friendly actions of others as hostile or contemptuous;
(d) A combative and tenacious sense of personal rights out of keeping with the actual
situation;
(e) Recurrent suspicions, without justification, regarding sexual fidelity of spouse or
sexual partner;
(f) Tendency to experience excessive self-importance, manifest in a persistent self-
referential attitude;
(g) Preoccupation with unsubstantiated "conspiratorial" explanations of events both
immediate to the patient and in the world at large.
F60.1 Schizoid personality disorder
Personality disorder meeting the following description:
(a) Few, if any, activities provide pleasure;
(b) Emotional coldness, detachment or flattened affectivity;
(c) Limited capacity to express either warm, tender feelings or anger towards others;
(d) Apparent indifference to either praise or criticism;
(e) Little interest in having sexual experiences with another person (taking into account
age);
(f) Almost invariable preference for solitary activities; (g)excessive preoccupation with
fantasy and introspection;
(h) Lack of close friends or confiding relationships (or having only one) and of desire for
such relationships;
(i) Marked insensitivity to prevailing social norms and conventions.

F60.6 Anxious [avoidant] personality disorder
Personality disorder characterized by:
(a) Persistent and pervasive feelings of tension and apprehension;
(b) Belief that one is socially inept, personally unappealing, or inferior to others;
(c) Excessive preoccupation with being criticized or rejected in social situations;
(d) Unwillingness to become involved with people unless certain of being liked;
(e) Restrictions in lifestyle because of need to have physical security;
(f) Avoidance of social or occupational activities that involve significant interpersonal
contact because of fear of criticism, disapproval, or rejection.
Associated features may include hypersensitivity to rejection and criticism.