F60 - F69 DISORDERS OF ADULT PERSONALITY AND BEHAVIOUR
F60 SPECIFIC PERSONALITY DISORDERS
G1. Evidence that the individual's characteristic and enduring patterns of inner experience and behaviour deviate markedly as a whole from the culturally expected and accepted range (or 'norm'). Such deviation must be manifest in more than one of the following areas:
(1) cognition (i.e. ways of perceiving and interpreting things, people and events; forming attitudes and images of self and others);
(2) affectivity (range, intensity and appropriateness of emotional arousal and response);
(3) control over impulses and need gratification;
(4) relating to others and manner of handling interpersonal situations.
G2. The deviation must manifest itself pervasively as behaviour that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).
G3. There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behaviour referred to under G2.
G4. There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
G5. The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from sections F0 to F7 of this classification may co-exist, or be superimposed on it.
G6. Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation (if such organic causation is demonstrable, use category F07).
Comments: The assessment of G1 to G6 above should be based on as many sources of information as possible. Although sometimes it is possible to obtain sufficient evidence from a single interview with the subject, as a general rule it is recommended to have more than one interview with the person and to collect history data from informants or past records.
It is suggested that sub-criteria should be developed to operationalize behaviour patterns specific to
different cultural settings concerning social norms, rules and obligations where needed (such as examples of unresponsibility and disregard of social norms in dissocial personality disorder).
The diagnosis of personality disorder for research purposes requires the identification of a subtype (more than one subtype can be coded if there is compelling evidence that the subject meets multiple sets of criteria).
F60.0 Paranoid personality disorder
A. The general criteria of personality disorder (F60) must be met.
B. At least four of the following must be present:
(1) Excessive sensitivity to setbacks and rebuffs.
(2) Tendency to bear grudges persistently, e.g. unforgiveness of insults, injuries or slights.
(3) Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous.
(4) A combative and tenacious sense of personal rights out of keeping with the actual situation.
(5) Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner.
(6) Persistent self-referential attitude, associated particularly with excessive self-importance.
(7) Preoccupation with unsubstantiated "conspiratorial" explanations of events around the subject or in the world at large.
F60.1 Schizoid personality disorder
A. The general criteria of personality disorder (F60) must be met.
B. At least four of the following criteria must be present:
(1) Few, if any, activities provide pleasure.
(2) Displays emotional coldness, detachment, or flattened affectivity.
(3) Limited capacity to express warm, tender feelings for others as well as anger.
(4) Appears indifferent to either praise or criticism of others.
(5) Little interest in having sexual experiences with another person (taking into account age).
(6) Almost always chooses solitary activities.
(7) Excessive preoccupation with fantasy and introspection.
(8) Neither desires, nor has, any close friends or confiding relationships (or only one).
(9) Marked insensitivity to prevailing social norms and conventions; if these are not followed this is unintentional.
F21 SCHIZOTYPAL DISORDE
A. The subject must have manifested, over a period of at least two years, at least four of the following, either continuously or repeatedly:
(1) Inappropriate or constricted affect, subject appears cold and aloof;
(2) Behaviour or appearance which is odd, eccentric or peculiar;
(3) Poor rapport with others and a tendency to social withdrawal;
(4) Odd beliefs or magical thinking influencing behaviour and inconsistent with subcultural norms;
(5) Suspiciousness or paranoid ideas;
(6) Ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents;
(7) Unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization;
(8) Vague, circumstantial, metaphorical, over-elaborate or often stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
(9) Occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusion-like ideas, usually occurring without external provocation.
B. The subject must never have met the criteria for any disorder in F20 (Schizophrenia).
F60.2 Dissocial personality disorder
A. The general criteria of personality disorder (F60) must be met.
B. At least three of the following must be present:
(1) Callous unconcern for the feelings of others.
(2) Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
(3) Incapacity to maintain enduring relationships, though having no difficulty to establish them.
(4) Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
(5) Incapacity to experience guilt, or to profit from adverse experience, particularly punishment.
(6) Marked proneness to blame others, or to offer plausible rationalizations for the behaviour bringing the subject into conflict with society.
Comments: Persistent irritability and the presence of conduct disorder during childhood and adolescence, complete the clinical picture but are not required for the diagnosis.
It is suggested that sub-crtieria should be developed to operationalize behaviour patterns specific to different cultural settings concerning social norms, rules and obligations where needed (such as examples of unresponsibility and disregard of social norms).
F60.3 Emotionally unstable personality disorder
F60.30 Impulsive type
A. The general criteria of personality disorder (F60) must be met.
B. At least three of the following must be present, one of which is (2):
(1) A marked tendency to act unexpectedly and without consideration of the consequences.
(2) A marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized.
(3) Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions.
(4) Difficulty in maintaining any course of action that offers no immediate reward.
(5) Unstable and capricious mood.
F60.31 Borderline type
A. The general criteria of personality disorder (F60) must be met.
B. At least three of the symptoms mentioned above in criterion B (F60.30) must be present, and in addition at least two of the following:
(6) Disturbances in and uncertainty about self-image, aims and internal preferences (including sexual).
(7) Liability to become involved in intense and unstable relationships, often leading to emotional crises.
(8) Excessive efforts to avoid abandonment.
(9) Recurrent threats or acts of self-harm.
(10) Chronic feelings of emptiness.
F60.4 Histrionic personality disorder
A. The general criteria of personality disorder (F60) must be met.
B. At least four of the following must be present:
(1) Self-dramatization, theatricality, or exaggerated expression of emotions.
(2) Suggestibility, easily influenced by others or by circumstances.
(3) Shallow and labile affectivity.
(4) Continually seeks excitement and activities in which the subject is the centre of attention.
(5) Inappropriately seductive in appearance or behaviour.
(6) Overly concerned with physical attractiveness.
Comments: Egocentricity, self-indulgence, continuous longing for appreciation, lack of consideration for others, feelings that are easily hurt, and persistent manipulative behaviour complete the clinical picture, but are not required for the diagnosis.
F60.5 Anankastic personality disorder
Note: Often referred to as obsessive-compulsive personality disorder.
A. The general criteria of personality disorder (F60) must be met.
B. At least four of the following must be present:
(1) Feelings of excessive doubt and caution.
(2) Preoccupation with details, rules, lists, order, organization or schedule.
(3) Perfectionism that interferes with task completion.
(4) Excessive conscientiousness and scrupulousness.
(5) Undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships.
(6) Excessive pedantry and adherence to social conventions.
(7) Rigidity and stubbornness.
(8) Unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things.
F60.6 Anxious [avoidant] personality disorder
A. The general criteria of personality disorder (F60) must be met.
B. At least four of the following must be present:
(1) Persistent and pervasive feelings of tension and apprehension.
(2) Belief that oneself is socially inept, personally unappealing, or inferior to others.
(3) Excessive preoccupation about being criticized or rejected in social situations.
(4) Unwillingness to get involved with people unless certain of being liked.
(5) Restrictions in lifestyle because of need of security.
(6) Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection.
F60.7 Dependent personality disorder
A. The general criteria of personality disorder (F60) must be met.
B. At least four of the following must be present:
(1) Encouraging or allowing others to make most of one's important life decisions.
(2) Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes.
(3) Unwillingness to make even reasonable demands on the people one depends on.
(4) Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself.
(5) Preoccupation with fears of being left to take care of oneself.
(6) Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.
F63 HABIT AND IMPULSE DISORDERS
F63.0 Pathological gambling
A. Repeated (two or more) episodes of gambling over a period of at least one year.
B. These episodes do not have a profitable outcome for the person, but are continued despite personal distress and interference with personal functioning in daily living.
C. The person describes an intense urge to gamble which is difficult to control, and reports that he or she is unable to stop gambling by an effort of will.
D. The person is preoccupied with thoughts or mental images of the act of gambling or the circumstances surrounding the act.
F63.1 Pathological fire-setting [pyromania]
A. Repeated (two or more) acts of, fire-setting without apparent motive.
B. The person describes an intense urge to set fire to objects, with a feeling of tension before the act and relief afterwards.
C. The person is pre-occupied with thoughts or mental images of fire-setting or of the circumstances surrounding the act (e.g. with fire engines, or with calling out the fire brigade).
F63.2 Pathological stealing [kleptomania]
A. Repeated (two or more) acts in which the person steals without any apparent motive of gain to the individual or another person.
B. The person describes an intense urge to steal with a feeling of tension before the act with relief afterwards.
F63.3 Trichotillomania
A. Noticeable hair-loss due to a persistent and recurrent failure to resist impulses to pull out hairs.
B. The person describes an intense urge to pull out hairs with a mounting tension before and a sense of relief afterwards.
C. Absence of a pre-existing inflammation of the skin; not in response to a delusion or hallucination.
F63.8 Other habit and impulse disorders
This category should be used for other kinds of persistently repeated maladaptive behaviour that are not secondary to a recognized psychiatric syndrome, and in which it appears that there is repeated failure 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.
