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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
depression.
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)
Excludes:
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
Anxiety-hysteria
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
category.
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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