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300 Neurotic disorders

          The distinction between neurosis and psychosis is difficult and remains
          subject to debate. However, it has been retained in view of its wide use.
          Neurotic disorders are mental disorders without any demonstrable organic basis
          in which the patient may have considerable insight and has unimpaired reality
          testing, in that he usually does not confuse his morbid subjective experiences
          and fantasies with external reality. Behavior may be greatly affected
          although usually remaining within socially acceptable limits, but personality
          is not disorganized. The principal manifestations include excessive anxiety,
          hysterical symptoms, phobias, obsessional and compulsive symptoms, and

300.0 Anxiety states

          Various combinations of physical and mental manifestations of anxiety, not
          attributable to real danger and occurring either in attacks or as a persisting
          state. The anxiety is usually diffuse and may extend to panic. Other
          neurotic features such as obsessional or hysterical symptoms may be present
          but do not dominate the clinical picture.
          Anxiety: Panic:
           neurosis attack
           reaction disorder
           reaction state
           state (neurotic)
           neurasthenia (300.5)
           psychophysiologic disorders (306.-)

300.1 Hysteria

          Mental disorders in which motives, of which the patient seems unaware, produce
          either a restriction of the field of consciousness or disturbances of motor or
          sensory function which may seem to have psychological advantage or symbolic
          value. It may be characterized by conversion phenomena or dissociative
          phenomena. In the conversion form the chief or only symptoms consist of
          psychogenic disturbance of function in some part of the body, e.g., paralysis,
          tremor, blindness, deafness, seizures. In the dissociative variety, the most
          prominent feature is a narrowing of the field of consciousness which seems to
          serve an unconscious purpose and is commonly accompanied or followed by a
          selective amnesia. There may be dramatic but essentially superficial changes
          of personality sometimes taking the form of a fugue [wandering state].
          Behavior may mimic psychosis or, rather, the patient's idea of psychosis.
          Astasia-abasia, hysterical Dissociative reaction of state
          Compensation neurosis Ganser's syndrome, hysterical
          Conversion hysteria Hysteria NOS
          Conversion reaction Multiple personality
          Excludes: adjustment reaction (309.-)
           anorexia nervosa (307.1)
           gross stress reaction (308.-)
           hysterical personality (301.5)
           psychophysiologic disorders (306.-)

300.2 Phobic state

          Neurotic states with abnormally intense dread of certain objects or specific
          situations which would not normally have that effect. If the anxiety tends to
          spread from a specified situation or object to a wider range of circumstances,
          it becomes akin to or identical with anxiety state, and should be classified
          as such (300.0)
          Agoraphobia Claustrophobia
          Animal phobias Phobia NOS
          Excludes: anxiety state (300.0)
           obsessional phobias (300.3)

300.3 Obsessive-compulsive disorders

          States in which the outstanding symptom is a feeling of subjective
          compulsion--which must be resisted--to carry out some action, to dwell on an
          idea, to recall an experience, or to ruminate on an abstract topic. Unwanted
          thoughts which intrude, the insistency of words or ideas, ruminations or
          trains of thought are perceived by the patient to be inappropriate or
          nonsensical. The obsessional urge or idea is recognized as alien to the
          personality but as coming from within the self. Obsessional actions may be
          quasi-ritual performances designed to relieve anxiety, e.g., washing the hands
          to cope with contamination. Attempts to dispel the unwelcome thoughts or
          urges may lead to a severe inner struggle, with intense anxiety.
          Anankastic neurosis Compulsive neurosis
          Excludes: obsessive-compulsive symptoms occurring in:
           endogenous depression (296.1)
           schizophrenia (295.-)
           organic states (e.g., encephalitis)

300.4 Neurotic depression

          A neurotic disorder characterized by disproportionate depression which has
          usually recognizably ensued on a distressing experience; it does not include
          among its features delusions or hallucinations, and there is often
          preoccupation with the psychic trauma which preceded the illness, e.g., loss
          of a cherished person or possession. Anxiety is also frequently present and
          mixed states of anxiety and depression should be included here. The
          distinction between depressive neurosis and psychosis should be made not only
          upon the degree of depression but also on the presence or absence of other
          neurotic and psychotic characteristics and upon the degree of disturbance of
          the patient's behavior.
          Anxiety depression Reactive depression
           Depressive reaction
           Neurotic depressive state
          Excludes: adjustment reaction with depressive symptoms (309.0)
           depression NOS (311)
           manic-depressive psychosis, depressed type (296.1)
           reactive depressive psychosis (298.0)

300.5 Neurasthenia

          A neurotic disorder characterized by fatigue, irritability, headache,
          depression, insomnia, difficulty in concentration, and lack of capacity for
          enjoyment [anhedonia]. It may follow or accompany an infection or exhaustion,
          or arise from continued emotional stress. If neurasthenia is associated with
          a physical disorder, the latter should also be coded.
          Nervous debility
          Excludes: anxiety state (300.0)
           neurotic depression (300.4)
           psychophysiological disorders (306.-)
           specific nonpsychotic mental disorders following organic brain
           damage (310.-)

300.6 Depersonalization syndrome

          A neurotic disorder with an unpleasant state of disturbed perception in which
          external objects or parts of one's own body are experienced as changed in
          their quality, unreal, remote or automatized. The patient is aware of the
          subjective nature of the change he experiences. Depersonalization may occur
          as a feature of several mental disorders including depression, obsessional
          neurosis, anxiety and schizophrenia; in that case the condition should not be
          classified here but in the corresponding major category.
          Derealization (neurotic)

300.7 Hypochondriasis

          A neurotic disorder in which the conspicuous features are excessive concern
          with one's health in general or the integrity and functioning of some part of
          one's body, or, less frequently, one's mind. It is usually associated with
          anxiety and depression. It may occur as a feature of severe mental disorder
          and in that case should not be classified here but in the corresponding major
          Excludes: hysteria (300.1)
           manic-depressive psychosis, depressed type (296.1)
           neurasthenia (300.5)
           obsessional disorder (300.3)
           schizophrenia (295.-)

300.8 Other neurotic disorders

          Neurotic disorders not classified elsewhere, e.g., occupational neurosis.
          Patients with mixed neuroses should not be classified in this category but
          according to the most prominent symptoms they display.
          Briquet's disorder Psychasthenia
          Occupational neurosis, Psychasthenic neurosis
           including writer's cramp

300.9 Unspecified

          To be used only as a last resort.
          Neurosis NOS Psychoneurosis NOS
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