Dissociated Press

Dissociated Press Monday, December 10, 2007 TAANSTAFL, or GETTING RICH BY PICKING MULTIPLE POCKETS Mr. Dissociated and I are on Medicare. In addition, he has an HMO, and I have a state retiree supplemental policy. You'd think that would leave us pretty well-fixed on the medical front. Gee, all that insurance for nothing, and all that health care for nothing! Uninsured friends of our are a bit envious, and I can't blame them. But on the other hand.... Medicare is not "free." Part A is sort of free. It's built into the federal budget, and we pay for it with our taxes. Part B has a monthly premium, which goes up to $94.00 per month this year. For us, as for most people, it gets deducted from our Social Security benefits up front, so we never really see it and don't miss it. But it is nonetheless not free. My husband's HMO isn't free either, though it comes with no separate premium. Instead, the HMO collects his medicare premium from medicare as their premium. And my state retiree insurance, though it also has no separate premium, was also paid for, up front, in twenty-plus years of radically underpaid teaching as an adjunct in the state university and community college system. Which is how a lot of people's "employer-paid" health insurance gets paid for--in lower wages for the employee. These days, "employer-paid" health insurance and related benefits comprise from 25% to 40% of the total wage-benefit package. Since there ain't no such thing as a free lunch, this means that the employee's actual paycheck is roughly 25 to 40% smaller than it would be without these benefits. (Well, not necessarily. Big Business is perfectly capable of pocketing some of the difference if it gets the chance.) But, once the insurance policy or (more often) policies are purchased, that does not end the consumer's expenses. On the contrary, it's just the beginning. In the early days of managed care and health insurance planning, policy makers worried that, if people didn't have to pay anything out of pocket for their health care, they might make frivolous decisions and waste precious health care resources. There are always, undoubtedly, people who figure that, if something appears to be "free", there is no reason not to throw it around with wild abandon. But nobody has ever established how many such wastrels there are, or how much they will actually waste. We just figure, perhaps as an outgrowth of our puritan heritage, that if we don't attach some kind of cost or unpleasantry to an apparently free good, it will be wasted and ultimately devoured completely. ("Give," as Ayn Rand so authoritatively pronounced, "is a four-letter word.") This was the origin of the co-pay. People who had already paid, directly or in the form of diminished wages, a monthly premium for managed care, were now required to pay an additional small but not insignificant sum out of pocket on every occasion on which they actually used what they had already paid for. In the beginning, it was often a dollar for doctor visits, or for filling a prescription. Not as a revenue-raising device, but just to make people conscious that their health care wasn't "free." These days, Mr. Dissociated's co-pays (for example) have risen to ten dollars for primary care visits, and thirty dollars for specialist visits. Co-pays for prescription medications can range from four dollars (Wal-Mart's current loss leader) to well above one hundred, based on various arcane formulas. These co-pays are now a significant revenue source for the health care provider. Similarly, many health insurance policies carry a "deductible." That has nothing to do with income tax policy (more about that later.) It just means that the insurance you have already paid for doesn't cut in until you have spent a specified sum out of your own pocket for health care during a stated period, usually a year. The thinking behind the deductible is that people should expect to cover a certain amount of their own health care costs before dipping into the insurance benefits (which of course, they have already paid for. Forgive me for repeating this, but it's easy to forget.) The deductible was never calculated to be a nominal sum, unlike co-pays. It was intended to be what people should reasonably expect to pay out of pocket (on top of monthly premiums.) An increasing number of people have started buying secondary insurance policies to cover the increasing out-of-pocket costs posed by deductibles and co-pays. This is especially true of people on Medicare, who buy "Medigap" policies for that purpose. Which is yet another set of premiums paid for up front by the consumer. Conceivably at some point a tertiary insurance market could open up to cover what the primary and secondary sources don't. And so on. On top of all that, there are some other sources of payment for health care. The federal government pays 42% of all health care costs in the US, through Medicare, Medicaid, the VA, the Bureau of Indian Affairs, Champus/Tricare (for active duty military personnel and their families) and various programs to provide capital funding for hospitals, nursing homes, and medical schools. State and local governments pay for some hospital and clinic programs. In addition, various churches and other charitable organizations support hospitals and clinics, usually in conjunction with one or more governmental organizations. Ultimately, all of that money comes from the taxpayer, the individual donor, and the individual member of a church or other religious body in his or her capacity as donor. Supposedly, the ability of the various government and charitable agencies to consolidate all of these individual payments and use them to run the system results in economies of scale, so that the individual gets far more for his or her dollars than would have been possible if the money had all come directly out of millions of individual pockets to health care providers. How does the health care industry deal with this multiplicity of revenue sources, all ultimately coming out of my pocket and yours? Well, imagine that you are running a service plan for consumers. Say, you provide school books and other basic reading materials for children. You start out just getting paid a monthly book club fee directly by the children's parents. Since you are in business to make money, you raise the book club fee every so often, until people start dropping out of the club. You calculate the break-even point, where you are getting maximum revenue despite the dropouts, and that's your efficient market price. It may rise with inflation, or sink with lowered costs, but only within limits. But the kids don't seem to value the books, and often tear them up or lose them. So you institute a 25-cent co-pay, so the kids will take the program more seriously. Maybe you even refund it when the book comes back in good shape. As time goes on, you discover that most kids have their own allowances, and are actually willling to invest some of their own money in the program. So you stop refunding the co-pays. Then you raise them, bit by bit, until the kids start dropping out of the program, or borrow fewer books. You calculate that break-even point, and you have another efficient market price. So now you're getting the monthly book club fee from the parents, and the co-pay from the kids, both at the maximum market price. But you find out that there are families that can't afford the efficient market price, who would gladly become your customers if they could afford it. So you write a grant proposal for the US Department of Education, explaining how many more families you could serve if you only had some extra money. You luck out on your first try, and get your grant. Of course, that grant is paid for by the US taxpayer, including the families you are already serving, and the new ones you can now afford to serve. For those new families, you can offer a lower monthly book club fee, or maybe no fee at all at the start, and a lower, or refundable, co-pay for the children, or maybe none at all at the start. Over the years, however, you will try raising the "reduced"monthly fee, and the "reduced" co-pay a little at a time, until you run into more dropouts, telling you you have once again found the efficient market price for this particular segment of the market. But next year, your costs have gone up a bit. So you re-apply for the grant, asking for a bit more money, both for the expenses and families already funded, and for some new aspect of the program or a new set of families or a new type of media. What you end up getting is more than you got last year but less than you asked for this year. Which tells you that you have tapped out the US Department of Education source--found another efficient market price--and need to look elsewhere for more funds. So you write another grant application, this time to a private foundation, asking for funding to provide kids with educational computer software. Again you luck out, and get what you asked for. Next year, you re-apply, and get exactly what you got this year. Which tells you you need another source of revenue. Note that the private foundation gets a large portion of its revenue by virtue of being tax-exempt (see, I told you I'd get back to IRS.) The foundation pays no taxes, and the donors to it pay no taxes on their contributions to it. Which means that the rest of us taxpayers, including the families who benefit from the program, have to pay more taxes. Anybody who has ever worked in the non-profit sector can tell you that this elegant choreography can and often does go on for years. The more sources of revenue you can find, and dip further into until you find the market limit for each in turn, the more money you make for providing more or less the same service to more or less the same people. So that's how the health care system functions, and malfunctions. There are two possible ways out of it. One is to put all of the responsibility for finding, and paying for, health care directly on the shoulders of the consumer, and then subsidize him/her to the extent necessary to purchase an appropriate level of care. The consumer decides when a particular provider or course of treatment is "too expensive," given his or her total resources. A health care provider may not agree with the consumer's choice of when to stop. Indeed, the consumer may choose to avoid apparently expensive preventive care, and thereby incur even heavier treatment expenses later for a once-avoidable problem. The health care industry has brought these difficulties on itself by not giving the consumer a realistic cost-benefit analysis when asked for it. But the real problem, from an economic point of view, is that the subsidy received by the consumer is likely to result in a price increase of at least the same size from the health care industry, leaving the consumer to pay almost exactly what s/he had been paying before the subsidy. The most stellar example is the fact that the average American Medicare recipient is now paying slightly more for medical care out of pocket, both in absolute dollars adjusted for inflation, and in the proportion of his/her total income, as the average senior paid out of pocket for medical care before Medicare was instituted. Essentially, we have poured large amounts of water into the sand, and it is as dry as ever. Even if we reduce the number of income streams for medical care to two (Medicare and patient out-of-pocket), each will still be maximized, and the patient will be no better off than before. The other alternative is what its supporters call single payer. The taxpayer pays into the system, and government pays out what it defines as a reasonable sum for the various goods and services provided to the patient. There is only one stream of income. When the health care provider raises its prices beyond what the single payer deems reasonable, the single payer will take its business elsewhere. The provider will find its market-efficient price for that single payer, and get paid that much and no more. This minimizes the money spent on health care per unit of service, and thereby reduces the enormous burden health care currently imposes on the American economy. But.... Now we run into the problem common to all third-party payer systems: when the ultimate receiver of the goods and services in question does not decide what is to be paid for those goods and services, he has no incentive to minimize what is paid for them (much less to refuse to pay for really bad service), and no effective way to transmit his valuation of the goods and services received. At the same time, the provider of the goods and services has no incentive to please the receiver or keep its prices within his means. Third-party payment without price controls inevitably leads to hyper-inflation. It has, clearly, happened in health care, and it has happened in higher education. If the third party refuses to pay more than its means allow and forbids the provider to dun the recipient, the providers may drag their feet, or flee the system (or in some cases the profession or the country) rather than accept what they see as sub-market conditions. (They may define "sub-market" as either "less than the cost to me of providing the goods and services plus a profit sufficient to maintain an appropriate professional lifestyle", or "less than I could get from the same patients on the black market", that is, willing patients buying what willing providers will sell at a market-efficient price, off the books.) We see such scenarios in many countries with single-payer systems or price controls. Steering between these two extreme problems, a health care economy can approach perfection, but can never achieve it. The best possible system would have to include: 1) the fewest possible income streams 2) maximum possible input from patients and providers, and 3)the fewest possible middle-people. At the moment, of course, we seem to be heading in precisely the opposite direction on all three counts. Any bright ideas? posted by Edward L. Bernays boxcarro@gmail.com at 12:32 PM 0 comments Wednesday, December 05, 2007 BRITNEY, OBAMA, AND PORN-SPAMMING IN IRAQ I have been reliably informed that the above title should attract lots of hits. In fact, the only one of the above-listed items I'm going to be mentioning is Obama, because I have just for the fourth time seen Barack Obama compared to the late Adlai Stevenson. Most of the people making this comparison probably never even heard of Stevenson until last month. They're probably still pretty vague about when he lived or what he did. Which is partly, of course, because Stevenson is mainly famous for what he didn't do--namely, get elected President, despite running twice against Eisenhower in 1952 and 1956. The comparison with Obama, apparently, arose because Obama has made the mistake of appearing to be a literate nice guy. The last presidential candidate anybody can even vaguely remember who fit that description was, evidently, Stevenson. He was also, with one exception, the last governor of Illinois who didn't leave office one step ahead of the sheriff. So Obama needs to get himself some street cred. He needs to talk about America's self-interest, and advocate some kind of punitive or violent solution for some current problem, like capital punishment for at least a select group of illegal aliens. Or maybe he needs to invent a new problem, or a new group to hate. Martians, say. Real aliens--three heads, six purple tentacles, and no visa. You heard it here first. posted by Edward L. Bernays boxcarro@gmail.com at 3:36 PM 0 comments Saturday, October 27, 2007 Back to the Bell Curve James Watson, the co-discoverer of DNA, has made the news recently by saying, and then trying to unsay, that the natives of Africa and their descendants are almost certainly less intelligent than Europeans and their descendants. I'm perfectly happy to leave that part of the argument to the experts in genetics, who seem to be doing a fine job on their own. But in the course of his unfortunate pronouncement, Watson also referred to The Bell Curve as a fine book. I don't know as much as I should about genetics, but I know a lot about The Bell Curve, which I taught in a couple of college courses and reviewed for a small newspaper. So following is that review, somewhat fine-tuned and updated: The Bell Curve: an Idea Whose Time Has Come--and Gone Premises: 1) There exists such a thing as “g” (or “general intelligence”), which is heritable in considerable part 2) g can be accurately measured by several tests, including some of the ones to which children and adults in this country are most commonly exposed 3) To a considerable degree, g is immutable 4) Which is to say that Head Start and similar programs designed to increase g are a waste of money 5) g correlates, not only with academic and occupational success, but with numerous character traits essential to the maintenance of a civil society 6) People with low cognitive ability are out-breeding people with high cognitive ability in the US 7) Both the “cognitive elite” and the “cognitive underclass” are isolating themselves from the rest of society Conclusion: What society should do in response to these phenomena is to put the underclass on a relatively comfortable reservation, give them useful non-taxing work to do, and subject them to the discipline of a simplified legal system. I think I’ve got all of that right. But I’m not altogether sure, because my cognitive ability may have been seriously eroded by reading the book. It can’t be good for the reasoning faculties to spend hours absorbing a book that repeatedly says things like “The evidence shows intelligence is most likely 40 - 60% heritable,” and then draws political conclusions based on a presumed 100% heritability. Again and again, the authors lay out the scientific data, explain it, and then ignore it. Again and again, they tell us that statistical data about the behavior and characteristics of populations tells us nothing about individuals--and then they draw political conclusions based entirely on the presumption of individual incompetence and depravity. They caution us repeatedly that the available data are partial and unclear--and then draw political conclusions that would be only barely acceptable based on 100% certainty. And they do all this in a writing style which (speaking of cognitive ability) would earn them (and their editors and proofreaders, if any) no better than a C+ from a competent English composition teacher. For instance, on p. 145, the authors state “...the first decades of the [twentieth] century saw American high school education mushroom in size without having to dip much deeper into the intellectual pool....”, and, on p. 157 “...the long-term employment trend of [young men’s] employment has been downhill....” Arguably, this is really two books--a scientific treatise which (some scientists tell us) has serious faults in its collection and treatment of data, and a political treatise which purports to be based on the science, but in fact bears only the most tenuous relationship to it. Aside from its flimsy scientific basis, the political treatise has serious logical problems of its own, mainly resulting from the authors’ unwillingness to follow their own argument to its ultimate conclusions. For instance: they admit that, whatever g is, East Asians have more of it than white Americans. Granting the premise that g correlates with various socially necessary character traits, would a Japanese reader not be justified in attributing various Western character traits of which the Japanese have always disapproved--our individualism, sloppiness, imprecision, poor manners, and tendency to violence--to our deficiency in g, and proposing to put us on a reservation where we can stay out of the way of the people most qualified to do the world’s brainwork, the East Asians? Obviously, despite their repeated references to East Asian cognitive superiority, the authors don’t really believe in it, or they would have raised such questions. On the contrary, the whole book is suffused with a “we happy few” tone of self-congratulation, extending from authors to readers, and presuming that both, being most likely white American, are and deserve to be, the “cognitive elite.” The East Asians are merely a statistical blip located in an interesting but minimally consequential place. Secondly, if g is fundamentally genetic, why do the authors not confront the problem of cognitive sexual differentiation within ethnic groups? That is to say, the genetic endowment of the average woman of any given ethnic group is in most part identical to that of the average man in the same group. Black men are no blacker than black women. It would follow from that that the spread of measured g should be identical in men and women of the same ethnic group. In fact, it is not. The range is the same, but women cluster much more strongly in the center of that range. Genetics could not possibly account for that. The only genetic differences between men and women lie in the material on the sex chromosomes. We don’t, of course, know exactly what genes are to be found on those chromosomes, nor can we fully explain sexual differentiation in areas other than g. But if intelligence were mostly genetic, it would have to be sex-linked to account for the gender differences in g within ethnic groups. And those differences would then be much greater than in fact they are. If intelligence were sex-linked (assuming as usual that the male is the norm) women would barely be able to drool and breathe at the same time. Obviously this is not the case. The only hard data suggesting a major gender difference in intelligence is the well-established fact that women, generally speaking, marry men, whereas men, generally speaking, marry women. This can easily be accounted for by environmental factors. But seriously, folks--looking at the book from a purely textual/editorial viewpoint, the fact that it is the acknowledged work of two authors is significant, particularly since one of the authors is now deceased. It is tempting to hypothesize that Herrnstein (may he rest in peace) did all the science and Murray did all the politics, and that the latter never seriously read the former’s work. It would certainly explain the non-sequiturs with which the book is littered. But what concerns me most about the book is not the exiguous link between the scientific and political material, but the even scantier connection between the premises of the political argument and the concluding proposal supposedly drawn from them. If I seriously believed that the increasing isolation of the elite and the underclass from each other and the rest of society were a problem, I would not propose to remedy it by putting the underclass on a reservation. And Murray’s proposal that members of the underclass should be given some “valued place” in such a reservation means nothing at all without some concrete link to the real job market, which Murray never draws. This general shoddiness in the conclusory section suggests strongly that these are not Murray’s real conclusions at all, but only the ones he feels pressured to write to avoid being completely discredited by the sinister forces of political correctness. If Murray had the courage of his convictions, he would be advocating forced sterilization and genocide, which are in fact the only social policies that follow logically from his premises. Murray may intend his overt proposals to be taken seriously long enough to be tried and proved useless (the way General Motors first tried installing cumbersome and unworkable seatbelts after being mandated to by law), or he may have meant them as an in-group joke shared with the other members of the cognitive elite. But anyone as smart as Murray thinks he and his readers are should have no trouble figuring it out. Finally, Murray is actually missing a much more factually substantial bet, if he is really serious about wanting to find a variable that correlates with occupational and academic success, high socio-economic status, and most of the pro-social character traits he talks about. There actually is one, and we can measure it with absolute validity, with a lot less controversy and at negligible cost--namely physical height. Which is heritable up to a point, but can be strongly influenced by well-known environmental factors. Of course, using it for the purposes for which Murray proposes to use intelligence testing would eliminate a lucrative service industry, whose lobbyists may have influenced Murray to leave them alone. Intelligence, Merit, and Rank But, assuming it is possible to get past the literary and editorial drawbacks of the book, what happens when we look more closely at the thinking behind it? Murray and Herrnstein talk not only about “g” but about a closely related phenomenon, merit. They, and most of us, have taken for granted, without seriously examining it, the notion that there is some real quality called “merit”, which we can and should usably define, accurately measure, and appropriately reward. Only by doing so, we believe, can we encourage the achievements necessary to the survival of our society. This principle goes back at least as far as Plato’s Republic. Plato was willing to grant that merit might not be directly inherited and might even turn up among the children of the less meritorious. Nonetheless, once found out, the meritocrats should be encouraged to reproduce, preferably in conjunction with other meritocrats. Which suggests that Plato had already figured out most of the little we really know today about merit: that the children, and the parents, of meritorious people are more likely to possess similar merit, than those whose parents and children lack it. We still don’t know why. Which means we still don’t know how to increase the proportion of meritorious people in the population, should we choose to do so. Let’s begin with definition--is merit equivalent to intelligence? Neither term is especially precise, but merit generally includes attributes of character as well as ability. On the other hand, many authorities, including the authors of the Bell Curve, presume that intelligence usually correlates with positive character traits such as sexual morality and law-abidingness. They also presume that “intelligence”, whatever it is, is something our society needs more of. If they defined intelligence only in terms of intellectual competence, the ability to perform certain cognitive tasks, then they might pay more attention to making better use of the intelligent people we know we already have. But they generally presume that society would be better off if everyone were “intelligent”--which suggests again that they are really concerned with the characterological dimensions of “intelligence.” So, for the moment, let’s stick with “merit”, and presume that it includes both cognitive and characterological dimensions, which are visibly related to each other in some as-yet-unclear way. To the extent that we have elevated the testing of human abilities to a science, we are able to link certain test behavior in certain populations with certain other behavior patterns, including academic success and, in some cases, occupational competence. In larger populations, the same kinds of test performance may correlate with better socio-economic status and more conventional social behavior. As mentioned earlier, so does adult physical height, especially in males. (By the way, test performance in females is less closely linked to almost all other outcomes than it is in males.) If what we are looking for is a predictor of socio-economic success and lawful behavior, could we not save a lot of money and time (and eliminate a major service industry) by simply measuring and rewarding height, and doing everything we can to increase the height of the next generation? Since height correlates with good childhood nutrition and especially with high prenatal and childhood protein intake, we actually know how to achieve that end. Which gives us the opportunity to think about whether we want to. As Gilbert and Sullivan’s Duke of Barataria pointed out, when everybody is somebody, nobody is anybody. A society of people equally endowed with what we now define as merit would have no way to decide who takes out the garbage and who directs the fate of major corporations. In all likelihood, it would waste no time coming up with some other criterion--amount of melanin in the skin, for instance. Face it, what Murray and Herrnstein actually want is not a society in which everyone is more or less equally intelligent, but one in which there are slightly fewer unintelligent people and slightly more intelligent people than we now have, and in which that ratio remains constant over the generations. They are aghast at what they seem to consider a recent development--that the underclass is out-breeding the intelligentsia. So was Caesar Augustus. So were the eugenicists and their predecessors beginning in the 17th century. All of them are dealing with a phenomenon only secondarily related to intelligence: people who have enough access to resources to have some control over their own lives are likely to exercise that control, inter alia, in the area of family life, and specifically how many children they will rear. If they perceive children, or more than a few children, as a liability for any reason, they will therefore have fewer of them. While the people with less access to resources, and less control over their own lives, will have all the children they can, and raise all of those that survive. The vagaries of history and geography may make poor people and peasants more fertile (this also correlates with diet, to some extent) and infant mortality lower in some places than in others, while making the birth and rearing of upper-class children more or less expensive. An additional factor in some cultures has been the amount of personal involvement in child-rearing required of the upper-class mother. In most pre-20th-century cultures, upper-class women could and usually did have their children reared by lower-class women, which considerably decreased the disincentives of large families for them. But once lower-class women found ready employment in factory and service work, they were less likely to be willing to spend their lives raising other women’s children. Upper-class women are now required to invest a lot more time and energy rearing their own children than their grandmothers ever did. Which makes them far less inclined to do so more than once or twice. Apparently, Murray and Herrnstein, without ever talking about it explicitly, have already accepted that fact (unlike the earlier eugenicists, who wasted a good deal of energy trying to persuade upper-class women to have more children.) Murray and Herrnstein are concentrating on the other side of the equation exclusively: there will never be any more of Us, so we must do something to reduce the number of Them. On the other hand, how many fewer of Them do We really want? I suspect strongly that what Murray and Herrnstein really want isn’t a world full of Einsteins, but one in which it is possible to sign and send out one’s secretary’s letter without having to proofread it first, or in which one can hop in a cab and give the driver the address of one’s destination without having to instruct him on how to get there. And that, it seems to me, is a function not of the general level of intelligence in a society, but of where the market directs that intelligence. Just about all the really competent legal secretaries I have ever known were born before 1935. Younger women with the same interests and aptitudes went to law school instead--not because they were “too smart” to do secretarial work, but because they were smart enough to refuse to work for a secretary’s salary, and lucky enough to live in an era when they had other choices. Similarly, the omniscient and omnicompetent cabbie who could find any address in New York and deliver babies, was also either a full-time Yellow Cab employee with benefits, or an entrepreneur with a medallion of his own. Today, most cabbies are lessees who have to work the first 8 hours of their shift just to cover lease fees and insurance, and then make their own living in the next 5 hours or so. Anybody with the intelligence, the knowledge of English, and the citizenship or immigrant status to do anything else is doing it. In short, before we complain about the lack of intelligent people in our society, we should pay closer attention to what the intelligent people we do have are doing. In far greater proportions than in other industrialized countries, they are practicing law; if they are doing scientific research or engineering, they are very likely to be doing it for the military; they may even be high school dropouts if they are African-American or Hispanic (yes, Virginia, smart people drop out too. They also commit crimes, engender children out of wedlock, and in general engage in antisocial behavior.) If they are female and their parents never went to college, they may be cashiers or waitresses. In general, if their parents never went to college, smart people may be virtually indistinguishable from the people they grew up with, except perhaps that they have an unusual grasp of sports statistics, or the Civil War, or model boat-building or some other quirky autodidactic fascination. Murray and Herrnstein presume that current social realities make it possible for more of the highly intelligent to achieve the rank they “deserve”--but accepting at face value their caveat that data about populations tells us nothing about individuals, we have to presume that there is still a lot of cream on the bottom, where it is either totally wasted or, worse still, put to antisocial uses. And if we really want a greater role for intelligence in our society, shaking up the bottle is still a faster and less expensive way to do it than either the solutions The Bell Curve overtly proposes, or the ones the authors probably really had in mind. posted by Edward L. Bernays boxcarro@gmail.com at 5:28 PM 0 comments Wednesday, October 24, 2007 Nomads, Migrants, and People on the Move The Jewish annual round of scripture led us, last Saturday, to the part of Genesis where the Holy One tells Abraham to "get yourself out...from the land of your birth and from your father's house." This comes out of the blue to Abraham, and his swift and unquestioning compliance is one of the things that makes him a biblical hero. And, yes, at least until the end of Deuteronomy, the bible is a history of nomadism and migration. And of course, anyone steeped in the history of Europe from the classical age through the Turkish conquest of Constantinople knows that it is all about the migration of one tribe after another out of someplace in Asia into Europe. Migration is different from nomadism, though we tend to see them as identical. Nomadism is usually cyclical. Nomads usually go over the same track, often at the same times of year, and always with the same people, usually in the same order of march. There is nothing "rootless" about that kind of nomadism. The roots are just distributed over a wider area. Migration, on the other hand, means leaving a place forever, usually because it has suddenly become inhospitable, often because some other tribe has migrated into it, leading ultimately to a domino series of migrations, always straight out in one direction, rather than in the circular path of nomads. But, like nomadism, most migrations also involve a group of people who stay together on the march, rather than individuals. I think what we are experiencing now is different from both nomadism and migration in their historical sense, and that the change was brought about by the birth of the nation-state with its non-porous borders. Nation-states deal with individual immigrants, with varying degrees of competence and organization; they never deal with mass migrations. And within any given nation-state, mass migrations happen one person or family at a time (we find out they were "mass" only in retrospect, as with the Okies, and the Great Migration of African-Americans out of the South.) The Roma (and the Tinkers and the Travelers) are the only exceptions to this pattern, and they have become pariahs as a result. According to the Bureau of the Census, 40% of us do not live in the states where we were born. The median duration of residence (how long a person has lived at his/her current residence) was 4.7 years as of 1996 (the most recent data I could find in a hurry.) Older people, married people, people without children, people with a high school education or less, people with very little money, and people with lots of money tend to stay put longer than the rest of us. And people with lots of education tend to move around more than the rest of us. Hispanics moved more often than the rest of us, and 14% of us moved last year. The stats don't tell us much about why people move. Common sense tells us that a move can result from good things, like making more money and therefore being able to get a bigger house in a better neighborhood, and from bad things, like losing a job and being evicted or even becoming homeless. It can result in being farther away from one's extended family, or in moving back in with them. It can cause stress, or alleviate it. It can result in accumulating more "stuff," or in losing a large proportion of it (an aunt of mine used to say that three moves were the equivalent of one fire in terms of loss of household goods.) It can create a "home base" for an extended family or constellation of friends, or destroy one. We may be unduly nostalgic about "going home again." We Americans are, after all, a nation of runaways. We are the descendants of people who decided the Old Country was no longer a viable home for them. "Lighting out for the territories" is practically programmed into our genes. When the going gets tough, the tough get going--and they keep going until they are safely out of town. Recent DNA studies of human genetics only underline the fact that almost everybody belongs to a family that comes from someplace else, just as the earlier history of migrations only underlines the fact that almost every indigenous people gets to be indigenous only by displacing somebody else. We don't usually think about these issues much until they hit us on either the personal or the political level. Until, that is, somebody's elderly parent 2000 miles away becomes unable to live alone any more. Or until a nation formed by a bloody and forced migration out of Europe suddenly becomes a target for indignation and violence from the "locals," and its denizens are urged to "go back where you came from." A part of us yearns to do just that, to recover the places and people of our brightest memories, or maybe of the memories of our parents or grandparents. But another corollary to the harsh reality of life on the move is that if we do get a chance to go back, we are likely to find that those people and places have vanished, and only the vaguest outlines of the geography remain. The hospital I was born in closed down long since. The place I went to kindergarten has been paved over and turned into a shopping mall. The school building in which I attended first through seventh grade burned down, though a new school was erected on the same spot. My high school was torn down for condominiums. My college has been amalgamated into a larger university. The street on which I lived during my last year of college--not merely the building, the street--has disappeared. So far, all five of my graduate schools are still pretty much intact, but it is obviously only a matter of time before they too slide off into nothingness or radical transformation. After all, I spent most of my childhood in southern Florida, and there is a good chance that most of that state will be under water by the time I myself slide off into nothingness or radical transformation. And I'm one of the holdouts, the exceptions. My husband and I have been married to each other for 43 years, and have lived in the same place for 38 of them--almost half the time our building has been in existence. While we stayed put, most of our contemporaries were moving into "starter homes" and then having kids and moving on to larger homes in better school districts, and maybe getting divorced and moving apart, or following jobs around the country a couple of times, and are just about now starting to think about "downsizing" or retiring to someplace in the Sunbelt. The Buddhists may have the best handle on all this: Everything changes. Everything vanishes. Maybe nothing was really there in the first place. You may as well accept impermanence, because you yourself are impermanent too. Not only is there nothing to hold onto, you have no solid hand to hold onto it with. Or maybe the physicists have it right. We are, all of us, made of the first matter that was ever created. Everything changes, but nothing vanishes. Everything moves around, but nothing moves out. posted by Edward L. Bernays boxcarro@gmail.com at 12:50 PM 0 comments Sunday, October 21, 2007 CREATIVE RUMOR-MONGERING 101 Things we'd like to get more people to believe: The last three digits of Dick Cheney's Social Security Number are 666 It is possible to make a recreational drug out of broccoli, carrot peels, and dog manure Watching Reality TV brings on premature Alzheimer's Leonard Nimoy is the messiah Wearing fur makes women look fat It makes men look even fatter AT&T and Wal-Mart are actually wholly-owned subsidiaries of Al Quaeda Reading scientific reports causes cancer The GPS satellites are programmed to navigate your car to a takeoff port for the Klingon slave camps Wearing an aluminum foil hat makes your hair fall out When people close their eyes and raise their arms at evangelical church services, an usher goes around stealing their rings and watches Voting Republican causes erectile dysfunction and divorce Driving an SUV causes obesity Sexist men are lousy lovers Under-tipping causes gastric reflux posted by Edward L. Bernays boxcarro@gmail.com at 6:09 PM 0 comments Tuesday, October 02, 2007 Give Me Your Tired... of arguing over immigration. Like me. I guess it's better than arguing about poor Terry Schiavo, may she rest in peace. Or late-term abortions, or gay marriage. Immigration is actually a substantive issue with implications for the lives of ordinary Americans. Given that we are a nation of immigrants, we probably need to talk about it every so often. But it would be useful not to schedule that recurring debate in a presidential election bi-year (yes, let's admit it, the election campaign season now lasts two years.) Then we could actually talk about reality, rather than set up a field of straw men and take turns knocking them down. Conservatives claim to worry about terrorists sneaking in from Tijuana and Vancouver, while liberals think anybody who wants to set any kind of limits on immigration is an anti-Latino racist. Full disclosure: I'm a Latina, sort of. Both my parents were born in Cuba. Spanish was the language they told their secrets in. I'm more or less bilingual and bicultural. One of the great trials of my life is my current inability to find canned cascos de guayaba in any grocery store, even the ones in Latino neighborhoods. (I mention that here in hope that some reader can help me out with a well-placed comment.) Does that give me any kind of license to talk about immigration? Dunno. Most of my ruminations on the issue arise out of (a) recurring arguments with Mr. Dissociated, an Anglo with four immigrant grandparents, and (b) a long-standing family feud with INS (now ICE), which screwed around with my mother's citizenship and has thereby become my least favorite federal bureaucracy, ahead of even Selective Service. I used to practice a bit of immigration law--the simple stuff, green card and citizenship applications, re-entry permits and so on. Now none of it is simple, the stakes are very high, and I refer all inquiries about it from my clients to experts who practice nothing else and are very very good and very very expensive. And, as usual, I like to look at the history of the issue before coming down to current events. The history of immigration law is pretty short. There wasn't much of any immigration law before 1900 or so. People who found their current residence economically or politically uncomfortable just migrated. Wherever they migrated to, the locals might welcome them, or passively accept them, or ignore them, or riot against them, or massacre them. The quality of their reception, and the severity of the situation they had fled from in the first place, would determine whether the migrants would stay, go home, or move on to someplace else. But law had nothing to do with it. That changed as the United States suddenly realized that its population was becoming ethnically different from the way it had been in the era of its founding. We looked around at ourselves and discovered "we" were no longer the "us" we had been in 1776, or even 1865. That led to the establishment of Ellis Island and other screening ports, where immigrants were checked out for criminal records, moral character, and physical and mental health. There were racial restrictions. You had to be "white," whatever that meant. Not African or Chinese, at any rate. It was a binary system--you either passed inspection and got to stay, or failed and had to leave. Whichever happened, happened fast, at most within weeks, usually within minutes. When Mr. Dissociated, and many other who insist they aren't anti-Hispanic or even anti-immigrant, they're only anti-lawbreaking, talk about how their grandparents came here "legally," that's what they mean. Those grandparents were "white," more or less healthy, and unencumbered with criminal records. Bully for them. It was World War I that changed all that, all over the world. Two generations later, INS was interrogating my mother about how many of her "formative years" she had spent in the States. This was still something of an improvement on what happened to my paternal grandmother, born and brought up in Marietta, Georgia, a generation earlier, who lost her US citizenship automatically for marrying a Brit. In between, anarchist Emma Goldman's husband was deprived of his naturalization after his death, so that she could lose her citizenship and be deported to Russia. The legal system with which current would-be immigrants are expected to comply is cumbersome, complex, and arbitrarily and often abusively administered. It is underfunded and understaffed. Its personnel are badly undertrained in "people skills." Things that should take weeks take years. To add insult to injury, the process has now been made outrageously expensive by piling four- or five-figure processing fees on top of the costs of the high-powered legal representation that is now almost essential for most immigrants, and the usually-required trip back to the Old Country. And, worse still, immigration is the one area of our national legal system in which the influence of high-ranking people is openly available and routinely applied for the benefit of those who know the right people. That is, if all of your attempts to immigrate legally into the US have failed, but you know the right people, you can get naturalized by a special bill passed in Congress by your influential buddies, all open and above board, without so much as a "wink-wink nudge-nudge." But for the ordinary working immigrant trying to make a decent life in the US, compliance with the law is always difficult, usually expensive, and often impossible. Nonetheless, many conservative opponents of illegal immigration insist that illegal immigrants, specifically because they are violating the law, belong in the same circle of Hell as Al Capone. Which is fairly remarkable, since most Americans, regardless of their political leanings, aren't all that crazy about legality, except where they can use it as a lock on the moral high ground against people they don't like anyway. I found that out most recently when a dear friend of mine was killed by a truck that crashed into his van at an illegally high rate of speed, after running a red light, and with gravely defective brakes. Once it had been established that the trucker was not under the influence of alcohol or drugs, even the good sympathetic people we knew all said, "Speeding isn't a crime. Running a red light isn't a crime. Everybody does that. It was just an accident." So far, the State's Attorney of DuPage County, Illinois, seems to agree with them. Is it fair to conclude that most of the opponents of illegal immigration are really opposed to immigration in general regardless of legality, or even to the presence of ethnic Hispanics on our soil, regardless of their legality? Dunno. It's hard to tell, sometimes. When the same people declaim against illegal immigration and allowing anybody to speak Spanish in public, that does make one wonder. When they deplore illegal immigration, or immigration in general, because immigrants will take the bad jobs that "Americans won't do" and thereby drive down wages and working conditions for native-born and legal-immigrant workers, and because they will take good jobs that Americans deserve, and because they will take no jobs, and sponge off the American taxpayer instead, it's hard not to suspect some kind of prejudice at work. The poor immigrant can't win. And, on the other hand, the orthodox liberal position seems to be that anyone who comes to the US to improve his economic prospects has the right to do so, regardless of legality. Regardless of the effect on wages and working conditions? Dunno. The mostly-Hispanic United Farm Workers union used to oppose illegal immigration. Now, understandably, they are more worried about the general prejudice against illegal immigration/ immigration/Hispanic visibility. The newer labor unions (SEIU, UNITE HERE, and the American Federation of Teachers, for instance) seem to be heading in the same direction. The older, bread-and-butter unions have always opposed illegal immigration and been somewhat dubious even about legal immigration. But their influence is waning. So much for the bad arguments on the subject. Are there any good ones? If, as seems obvious to almost everybody, the current system is broken and fixing it will cost a lot of time and money, should it just be shelved in the meantime? Or should the whole idea of immigration regulation be thrown back into the dustbin of recent history? After all, the nations of the world got along without it pretty well for several thousand years. Broaching this argument, even tentatively, has gotten me some very strange bedfellows. Julian Simon, the conservative economist, for instance, who once wrote me a very flattering letter about an earlier article I wrote on the subject of immigration. He and his "let the market do everything" pals oppose regulating immigration because it prevents willing workers and willing employers from finding each other, and keeps wages "artificially" high for American workers. Or at least they used to. Now, "small government" conservatives like Simon seem to be parting ways with "big gun" conservatives. Republican orthodoxy has trouble deciding whether it's more important to keep wages low, give American workers somebody to hate, or keep potential terrorists out. They haven't thought this through At the same time, as mentioned earlier, Democratic orthodoxy isn't sure whether the rights of Hispanics not to be hassled are more important than maintaining the standard of living of American workers. They haven't thought this through either. One of my favorite speculative fiction novels has a character who comes from a planet where "you have not thought this through" is a deadly insult. We should be so lucky. posted by WiredSisters at 9:41 AM 0 comments Odd Lots # omigod I can't remember Jerry Ford, Gary Hart, and Vladimir Putin--what do they have in common that one wouldn't expect? posted by Dissociated Press at 9:37 AM 1 comments Sunday, August 05, 2007 MAINTENANCE Every ten years or so, some major public construction falls down or apart, and we spend a few weeks worrying about our decaying infrastructure. This time, it was the bridge in Minneapolis. One of the questions nobody seems to be asking is why so few people were killed--it would be nice to know that, so as to prevent loss of life in the next disaster. But the decaying infrastructure we have always with us. I recently finished Cullen Murphy's book Are We Rome? in which he points to physical decay and lack of maintenance as among the reasons for the decline and fall of Rome. I'm not at all sure I agree with that. The Romans were big on maintenance. Mostly it was done by private wealth, for private glory. The Romans posted plaques to people who maintained things like bridges, aqueducts, and roads. And as a result, Roman bridges, aqueducts, and roads lasted a long time. Some of them lasted a lot longer than ours. Some of them are still useable today. But we have very little respect for maintenance and the people who do it. Maintenance is what janitors do. And housewives. And ditch-diggers. We for sure don't post bronze plaques to them. We post bronze plaques to the people who build things, or have them built, in the first place. It would be interesting to create a map of buildings and other human constructions with indications of when they were built--kind of like the rings on a tree. It would obviously be different in different places. Many of Chicago's public improvements, like sewers, water works, electric generating plants, libraries, and public schools, were built at the end of the 19th century and early in the 20th. A lot of the public and private buildings in Chicago were built in the 1920s (including the one Mr. Dissociated and I live in.) There was another burst of residential building in the 1950s, and a spate of public buildings (universities and public office buildings, mostly) in the 1960s. The latter (mostly made of cast concrete with flat roofs, which I think is always a bad idea in cold wet northern climates) started falling apart within 15 years. I have taught in two of the schools in question and watched the process of decay close up, while regularly walking around the buckets catching the leaks whenever it rained. One of those schools rebuilt its entire front section, where the worst leakage was; the other moved a couple of blocks west and built an entire new campus (out of red brick, by the way) which just opened last month. Here in Chicago, our sewer and water systems are dangerously leaky but still functioning. Considering they're more than a century old, that's pretty good, but still scary. Apparently New York City's major systems are about the same age and in even worse condition. Nonetheless, when pundits bewail the conditions of our "older" cities, I have trouble taking them seriously. Our oldest city is still a whole lot younger than Rome, Athens, Jerusalem, or Benares. All of those cities have had their declines, and their rebirths. At the moment, most of them have functioning sewer and water systems. "Deferred maintenance" may be the curse of the modern world. It's less of a problem than it used to be for automobiles, now that warranties have become a lot longer. But proper maintenance of buildings is pretty rare. The condo the Dissociated family lives in (built sometime around 1920) is in surprisingly good condition except for the electrical system, which gets upgraded piecemeal from time to time, but has never been completely updated in at least 50 years. Our condo board does a good job; we have had repairs on the roof, the furnace, and the water heaters at regular intervals, and the windows were all replaced about 10 years ago. Amazingly, we have never had a special assessment--this all gets done out of our regular assessments. Which are, of course, a lot higher than those of most condo owners around here. That's what it takes to keep an 85-year-old building in good shape. I mention all this because most people, including but not limited to condo residents, aren't willing to do it. They manage the cosmetic basics, like painting, but ignore the rest until something breaks down (at which point it's really expensive to fix.) They go on fixing things piecemeal for as long as they can afford it, and then they dump the place. This system works reasonably well for cars, but it can be a disaster for buildings. The only good thing about it is that, as buildings, and neighborhoods, and city systems, and for that matter cars, get older and more rickety, they also get cheaper. Which is the only reason poor people in America have anyplace to live or anything to drive. This is the trickle-down theory of urban planning. No, I'm not being facetious. Some years ago, some local politician proposed an aggressive program of maintenance for buildings and systems in Chicago. He was immediately denounced by one of the alderman from a particularly down-and-dirty ward, for plotting to drive poor people out of the city. Similarly, I used to work for an organization called the Lawyers' Committee for Better Housing, representing local tenants. One of the landlord lawyers half-seriously suggested that we rename ourselves the Lawyers' Committee for More Expensive Housing, except that of course, we would lose our client population if we did. The market works. One of the ways in which it works is that poor people can afford only the housing etc. that nobody with more money would want. If we really did maintain our buildings properly, our cities would be surrounded by shantytowns. As I am fond of telling my students, this requires more thought. posted by Dissociated Press at 3:15 PM 0 comments RAGING GRANNIES, GRAY PANTHERS, AND OTHER VANGUARD TROOPS I turned 65 recently. It was an interesting experience. I now have Medicare, and Social Security, and a small state pension plus retiree health insurance from Illinois, and half-price passes for the bus and the train, and occasional cut-rate "senior special" meals at local eateries. It's not bad. But what I find especially attractive is that I now have very little to lose. I'm still working, but I could live without the income if I had to. My days are numbered--I have started listing my relatives from my parents' generation and their ages at death, so I've got a pretty good idea how much time I have left, and how much of it is actually "good time," during which I can do something useful. Gruesome? I don't think so. Like any other deadline, it helps me get organized. The generations after mine have all kinds of scary stuff hanging over them that I no longer have to worry about, or never did. Student loans, for instance. I'm a member of the last generation of lawyers to finish law school with no loans. My friends ten or twenty years younger are still paying theirs, and may well have to keep doing it long after they could otherwise have retired. The Supreme Court recently ruled that if you're getting Social Security and you've defaulted on your student loans, they can take the money from your benefits. Or trying to keep a splendid-looking resume--once you're past 50, nothing else on your resume matters. To hell with it. Yes, there are laws against age discrimination. There are all kinds of legal rights working people supposedly have. Try to get them enforced. Hoo ha. Sex appeal--who needs it? I keep myself neat and clean and attired suitably for the pursuit in which I am engaged at the moment. My husband loves me, and other guys occasionally still hit on me. Government wiretapping and eavesdropping--who cares? At the click of a google, the government can find out most of what it wants to know about me. As I prepare to settle into dignified obscurity, all they can accomplish by busting me is publicize the causes I have worked for. Sounds like a fair trade. I have increasing respect for organizations of radical seniors, like Raging Grannies, the Gray Panthers, and local groups like Chicago's Metro Seniors in Action. They aren't just fighting for Social Security and Medicare, they're fighting for a decent world for the next generation, because the System keeps the next generation too busy and intimidated to fight for itself. We are the last group left that has any time for amateur politics, and has nothing to lose by engaging in them. Elders of the world, unite. You have nothing to lose. posted by WiredSisters at 2:10 PM 0 comments About Me Edward L. Bernays boxcarro@gmail.com I believe in mixed messages and multiple loyalties. Anybody who can't handle more than one idea or one loyalty at a time is not morally competent to be let out without a leash. In keeping with this belief, I am an anarchist, socialist, religious Jew, feminist, and Marxist(Groucho)-Lennonist(John) View my complete profile Dissociated Press Previous Posts Dissociated Press Powered by Blogger  

Edward L. Bernays Edward L. Bernays 5 days ago Hey, I am a Diagnosed Chronic Schizophrenic since 1969, I was in & out of Mental State Hospitals until 1990. I have been on S.S.I. since 1977. I used to love crazy conspiracy's and collected a Huge Yahoo Groups on the original online community with Tonnes of Insane Stuff, lots from Short Wave Radio Nuts, and in 2022 Short Wave Stations have not changed it's all nuts and bigots, I had severe ideas of references, agoraphobia, and was afraid to go outside, but Now, age 74, I am severely Agoraphobic again Because of Covid-19 and in my Senior Housing we still have people dying ..Saturday the 6th, 4 days ago a lady I known dies of Covid-19. She lived upstairs. @ TheSneezingMonkey · 5 days ago Hey Edward. Thanks for sharing your incredible story. I'm so sorry to hear about the lady you knew dying from Covid-19 recently. It's a miserable disease and I hope we can develop a functioning medicine for it soon and just move on. Also, I find your story very fascinating. You got diagnosed with this awful illness in a time when very little was actually known about it. It must have been a wild journey through all those mental hospitals and various treatments that I'm sure you were exposed to. But....you're still here! And that's amazing! I'm so happy to get comments like yours, because they show that despite all the uncertainty, the fear, the wild stuff...you can pull through. And find your way to live with it. I think your story should give hope to many others. I also sympathised with a lot of conspiracy content in the early 2000's. I watched every documentary and dove into every story I could find. But nowadays, it's reached another level. Like you say...a lot of it is bigoted content and many people seem to struggle to differentiate what's real from what's just a 'good story'. Absurd and 'disconnected from reality conspiracies' have found their way into our every day life. And the comments under these videos illustrate that. But you seem like a really lovely guy who is able to see through a lot of it. So I hope you'll keep your head up high and get many more happy years to live through! I wish you all the best Edward! You're a great role model...Take care of yourself and those around you.

DSM-II DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

DSM-II
DIAGNOSTIC AND STATISTICAL
MANUAL
OF
MENTAL
DISORDERS
(Second Edition)
Prepared by
THE COMMITTEE ON NOMENCLATURE AND STATISTICS
OF THE AMERICAN PSYCHIATRIC ASSOCIATION
Published by
AMERICAN PSYCHIATRIC ASSOCIATION
1700 18th Street, N. W.
Washington, D. C. 20009
1968Copyright 1968
American Psychiatric Association
1700 Eighteenth Street, N.W.
Washington, D. C. 20009

Library of Congress Catalogue Number: 68-26515
This Manual may be ordered at $3.50 per copy from Publications Office,
American Psychiatric Association, 1700 18th Street, N.W., Washington, D. C.,
20009. There is a 10% discount for 10 copies or more, and 20% for 50 or more.
Also, a special library bound edition is available at $5.00 per copy.Committee on Nomenclature and Statistics, 1967
ERNEST M. GRUENBERG, Chairman
RICHARD L. JENKINS
LOTHAR B. KALINOWSKY
HENRIETTE KLEIN
BENJAMIN PASAMANICK
W. R. SLENGER
MORTON KRAMER, Consultant
ROBERT L. SPITZER, Consultant
LAWRENCE C. KOLB, Co-ordinating Chairman
EDWARD STAINBROOK, Representative of Council
Other Members of the Committee, 1946-1963
BALDWIN L. KEYES, 1947-1952
LAWRENCE C. KOLB, 1947-1950
and 1954-1960
NOLAN D. C. LEWIS, 1946-1948
Chairman, 1946-1948
JAMES V. MAY, 1937-1948
H. HOUSTON MERRITT, 1946-1948
GEORGE N. RAINES, 1948-1959
Chairman, 1948-1949
and 1951-1954
J. DAVIS REICHARD, 1946-1949
MABEL Ross, 1951-1957
ROBERT S. SCHWAB, 1949-1952
GEORGE S. SPRAGUE, 1945-1948
EDWARD A. STRECKER, 1948-1951
HARVEY J. TOMPKINS, 1950-1955
PAUL L. WHITE, 1946-1950
FRANZ ALEXANDER, 1947-1949
JOHN M. BAIRD, 1948-1951
ABRAM E. BENNETT, 1941-1946
GEORGE F. BREWSTER, 1946-1948
HENRY BRILL, 1958-1965
Chairman, 1960-1965
NORMAN Q. BRILL, 1946-1948
WALTER L. BRUETSCH, 1944-1949
JOHN M. CALDWELL, 1948-1951
J. P. S. CATHCART, 1941-1946
SIDNEY G. CHALK, 1947-1950
CLARENCE O CHENEY, 1942-1947
NEIL A. DAYTON, 1936-1950
JACOB H. FRIEDMAN, 1947-1949
MOSES M. FROHLICH, 1948-1960
Chairman, 1956-1960
ERNEST S. GODDARD, 1950-1966
JACOB KASANIN, 1944-1946
111ACKNOWLEDGEMENT
The undersigned, at the request of the President of the
American Psychiatric Association, served as consultants
to the APA Medical Director and approved the final form
of this Manual before publication. Dr. Paul T. Wilson of
the APA staff undertook extensive editorial revision of the
original manuscript and was notably successful in clarifying
and adding precision to the definitions of terms. He was
assisted by Mr. Robert L. Robinson. We are deeply grateful
to both.
Bernard C. Glueck, M. D.
Chairman
Robert L. Spitzer, M. D.
Morton Kramer, Sc. D.TABLE OF CONTENTS
Foreword by Ernest M. Gruenberg, M. D., Dr. P. H. vii
Introduction: The Historical Background of ICD-8
by Morton Kramer, Sc. D xi
Section 1 The Use of This Manual: Special Instructions 1
Section 2 The Diagnostic Nomenclature: List of Mental Disorders
and Their Code Numbers 5
Section 3 The Definitions of Terms 14
I. Mental Retardation 14
II. Organic Brain Syndromes
22
A. Psychoses Associated with Organic Brain Syndromes 24
B. Non-psychotic Organic Brain Syndromes
31
III. Psychoses not Attributed to Physical Conditions
Listed Previously 32
IV. Neuroses 39
V. Personality Disorders and Certain Other Non-psychotic
Mental Disorders ._ 41
VI. Psychophysiologic Disorders 46
VII. Special Symptoms
47
VIII. Transient Situational Distrubances
IX. Behavior Disorders of Childhood and Adolescence
X. Conditions Without Manifest Psychiatric Disorder and
Non-specific Conditions
XI. Non-diagnostic Terms for Administrative Use
48
49
51
52
Section 4 Statistical Tabulations 53
Section 5 Comparative Listing of Titles and Codes 64
Section 6 Detailed List of Major Disease Categories in ICD-8 83
VThis page intentionally left blankFOREWORD
Ernest M. Gruenberg, M.D., Dr. P.H.
Chairman, Committee on Nomenclature and Statistics
American Psychiatric Association
This second edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-II) reflects the growth of the concept that the people
of all nations live in one world. With the increasing success of the
World Health Organization in promoting its uniform International
Classification of Diseases, already used in many countries, the time
came for psychiatrists of the United States to collaborate in preparing
and using the new Eighth Revision of that classification (ICD-8) as ap-
proved by the WHO in 1966, to become effective in 1968. The rapid
integration of psychiatry with the rest of medicine also helped create a
need to have psychiatric nomenclature and classifications closely inte-
grated with those of other medical practitioners. In the United States
such classification has for some years followed closely the International
Classification of Diseases.
With this objective in view, the Council of the American Psychiatric
Association authorized its APA Committee on Nomenclature and Sta-
tistics to work closely with the Subcommittee on Classification of Mental
Disorders of the U. S. National Committee on Vital and Health Statis-
tics. The latter committee is advisory to the Surgeon General of the
Public Health Service and was entrusted with responsibility for develop-
ing U. S. revision proposals for ICD-8, including the Section on Mental
Disorders. Dr. Henry Brill, who was chairman of the APA Committee
from 1960-1965, served as a member of the U. S. Subcommittee on
Classification of Mental Disorders.
Dr. Brill also, it should be noted, served as Temporary Adviser to
the Subcommittee on the Classification of Diseases of the Expert
Committee on Health Statistics of the World Health Organization which
made the final recommendations on the form and content of the various
sections of the ICD. The final version of ICD-8 was adopted unani-
mously by the Nineteenth World Health Assembly in May, 1966, to
become effective in all member states in 1968. Thus, from the beginning
the United States representatives helped to formulate the Section on
Mental Disorders in ICD-8 on which this Manual is based.
The WHO Nomenclature Regulations governing the use of the ICD
recognizes that countries may, under exceptional circumstances, modify
viiMENTAL DISORDERS
inclusions within a major diagnostic category, provided the basic con-
tent of that category is not changed. In preparing this Manual the
Committee had to make adjustments within a few of the ICD categories
to make them conform better to U.S. usage. Decisions were also made
regarding certain diagnoses which have not been generally accepted in
U. S. psychiatry. Some of these diagnoses have been omitted here;
others have been included and qualified as controversial. The diagnoses
at issue are: Psychosis with childbirth, Involutional melancholia, and
Depersonalization syndrome. Also this Manual suggests omitting cer-
tain specific categories and makes subdivisions in other categories,
assigning unused numbers in ICD-8 to the new subcategories.
In publishing the Manual the Association provides a service to the
psychiatrists of the United States and presents a nomenclature that is
usable in mental hospitals, psychiatric clinics, and in office practice. It
has, in fact, a wider usage because of the growth of psychiatric work
in general hospitals, both on psychiatric wards and in consultation
services to the patients in other hospital departments, and in com-
prehensive community mental health centers. It will also be used in
consultations to courts and industrial health services.
No list of diagnostic terms could be completely adequate for use in
all those situations and in every country and for all time. Nor can it
incorporate all the accumulated new knowledge of psychiatry at any one
point in time. The Committee has attempted to put down what it judges
to be generally agreed upon by well-informed psychiatrists today.
In selecting suitable diagnostic terms for each rubric, the Committee
has chosen terms which it thought would facilitate maximum com-
munication within the profession and reduce confusion and ambiguity to
a minimum. Rationalists may be prone to believe the old saying that
"a rose by any other name would smell as sweet"; but psychiatrists
know full well that irrational factors belie its validity and that labels of
themselves condition our perceptions. The Committee accepted the
fact that different names for the same thing imply different attitudes
and concepts. It has, however, tried to avoid terms which carry with
them implications regarding either the nature of a disorder or its causes
and has been explicit about causal assumptions when they are integral
to a diagnostic concept.
In the case of diagnostic categories about which there is current
controversy concerning the disorder's nature or cause, the Committee
has attempted to select terms which it thought would least bind the
judgment of the user. The Committee itself included representatives
VlllFOREWORD
of many views. It did not try to reconcile those views but rather to
find terms which could be used to label the disorders about which they
wished to be able to debate. Inevitably some users of this Manual will
read into it some general view of the nature of mental disorders. The
Committee can only aver that such interpretations are, in fact,
unjustified.
Consider, for example, the mental disorder labeled in this Manual as
"schizophrenia," which, in the first edition, was labeled "schizophrenic
reaction." The change of label has not changed the nature of the dis-
order, nor will it discourage continuing debate about its nature or
causes. Even if it had tried, the Committee could not establish agree-
ment about what this disorder is; it could only agree on what to call
it. In general, the terms arrived at by representatives of many countries
in the deliberations held under WHO auspices have been retained pref-
erentially, unless they seemed to carry unacceptable implications or
ambiguities.
The first edition of this Manual (1952) made an important contri-
bution to U. S. and, indeed, world psychiatry. It was reprinted twenty
times through 1967 and distributed widely in the U. S. and other
countries. Until recently, no other country had provided itself with an
equivalent official manual of approved diagnostic terms. DSM-I was
also extensively, though not universally, used in the U. S. for statistical
coding of psychiatric case records. In preparing this new edition, the
Committee has been particularly conscious of its usefulness in helping
to stabilize nomenclature in textbooks and professional literature.
A draft of this Manual, DSM-II, was circulated to 120 psychiatrists
in February 1967, with a request for specific suggestions to eliminate
errors and to improve the quality of the statements indicating the
proper usage of terms which the Manual describes. Many extremely
valuable replies were received. These were collated and studied by the
members of the Committee prior to its meeting in May 1967, at which
time the Committee formulated the present manuscript and submitted
it to the APA Executive Committee for approval. In December 1967
the APA Council gave it final approval for publication.
Throughout, the Committee has had the good fortune to have as
consultants Dr. Morton Kramer and Dr. Robert L. Spitzer. Dr. Kramer,
Chief of the Biometry Branch of the National Institute of Mental Health,
played a similarly vital role in the formulation of DSM-I. His intelligent
and sustained concern with the problems encountered has assured that
IXMENTAL DISORDERS
the preservation of statistical continuity has been considered at every
stage in the development of this Manual. He is specifically responsible
for the preparation of the Introduction following and Sections 4, and 5
of this Manual. Dr. Robert L. Spitzer, Director, Evaluation Unit,
Biometrics Research, New York State Psychiatric Institute, served as
Technical Consultant to the Committee and contributed importantly
to the articulation of Committee consensus as it proceeded from one
draft formulation to the next.
The present members of the Committee on Nomenclature and
Statistics owe a deep debt to former chairmen and members of the
Committee who provided the foundation upon which the second edition
was prepared. In the Foreword to DSM-I will be found an extensive
description of those who contributed to the first edition. Because this
second edition is, in fact, the product of the continuing endeavors
of the Committee's changing members, all members of the Committee
since 1946 are listed as authors.
As Chairman since 1965, the writer wishes to express his personal
deep appreciation to the hard-working members of the Committee and
its two consultants, all of whom participated vigorously and thoughtfully
in the Committee's deliberations and the formulation of the many draft
revisions that were required.
New York, N.Y.
March, 1968
xINTRODUCTION:
THE HISTORICAL BACKGROUND OF ICD-8
MORTON KRAMER, Sc.D.
Chief, Biometry Branch, National Institute of Mental Health
The Classification of Mental Disorders in the Sixth Revision of the
International Classification of Diseases (ICD-6) was quite unsatis-
factory for classifying many of the diagnostic terms that were introduced
in the first edition of this manual (DSM-I, 1952). For example, with
certain exceptions, ICD-6 did not provide rubrics for coding chronic
brain syndromes (associated with various diseases or conditions) with
neurotic or behavioral reactions or without qualifying phrases, nor did
it provide for the transient situational personality disorders. The ex-
ceptions were post-encephalitic personality and character disorders
among the chronic brain syndromes, alcoholic delirium among the
acute brain syndromes, and gross stress reaction among the transient
disorders.
Accordingly, in 1951, the U. S. Public Health Service established a
working party comprising the late Dr. George Raines, representing the
American Psychiatric Association, and three others from the Public
Health Service, Dr. Selwyn Collins, Mrs. Louise Bollo, and the author,
to develop a series of categories for mental disorders that could be
introduced into appropriate places in ICD-6 to adapt it for use in the
United States. 1
The shortcomings of ICD-6 (and of a seventh edition in 1955 which
did not revise the section on mental disorders), pointed up the unsuit-
ability of its use in the United States for compiling statistics on the
diagnostic characteristics of patients with mental disorders or for indexing
medical records in psychiatric treatment facilities. Moreover, the
section on mental disorders was not self-contained. Certain menta
disorders occurred in other sections of the ICD. General paralysis
was classified under syphilis, and post-encephalitic psychosis under the
late effects of acute infectious encephalitis, for example. Also, many ol
the psychoses associated with organic factors were grouped in a catch-al
category of psychoses with other demonstrable etiology.
1
See Appendix A, DSM-I. It reveals the extensive adjustments that had to b<
introduced into ICD-6 to make it usable in the U. S. for coding the diagnostu
terms contained in DSM-I.
XIMENTAL DISORDERS
The United States, however, was not the only country which found
the section on mental disorders in ICD-6 unsatisfactory. In 1959, Pro-
fessor E. Stengel, under the auspices of the World Health Organization,
published a study revealing general dissatisfaction in all WHO member
countries. 1 This finding, combined with the growing recognition of
mental disorders as a major international health concern, led WHO to
urge its member states to collaborate in developing a classification of
these disorders that would overcome the ICD's shortcomings and gain
general international acceptance. Such a classification was recognized
as indispensable for international communication and data collection.
To initiate the work of revising the ICD, the U. S. Public Health
Service then established a series of subcommittees of its National
Committee on Vital and Health Statistics, including a Subcommittee on
Classification of Mental Disorders. The National Committee is advisory
to the Surgeon General on technical matters and developments in the
field of vital and health statistics. The goal of all subcommittees was
to complete their recommendations in time for consideration by the
International Revision Conference, which WHO had scheduled for
July 1965.
The Subcommittee on Classification of Mental Disorders, appointed
by the National Committee on Vital and Health Statistics, comprised
Dr. Benjamin Pasamanick, Chairman, Dr. Moses M. Frohlich (then
chairman of the APA Committee on Nomenclature and Statistics),
Dr. Joseph Zubin, and the author. Later, Dr. Henry Brill was made
Chairman of the APA Committee and replaced Dr. Frohlich on the
Subcommittee. Dr. Leon Eisenberg, a child psychiatrist, was also
added to the Subcommittee.
Throughout, the Subcommittee worked very closely with Dr. Brill in
the latter's capacity as chairman of the APA Committee, and he actively
participated in developing the Draft Classification that was submitted
by the U. S. to the first meeting of the Subcommittee on Classification
of Diseases of the WHO Expert Committee on Health Statistics in
Geneva, Switzerland in November 1961. Dr. Brill was present at the
meeting as an adviser.
Following this meeting, the possibility and desirability occurred to
the U. S. Subcommittee of working with colleagues in the United
Kingdom to develop and agree upon a single classification of mental
1
Stengel, E. (1960), "Classification of Mental Diseases", Bull, of Wld. Hlth.
Org., 21, 601
XllINTRODUCTION
disorders. The counterpart committee in the U. K. readily agreed, and a
joint meeting with them was held in September 1962. Again, Dr. Brill
played a most constructive role in achieving agreement on a single
classification.
By April of 1963 it was possible to report this achievement to mental
health and hospital authorities in the United States and to solicit their
comments on the U. S.-U. K. draft which were uniformly constructive
and for the most part favorable.
Thus reinforced, the joint U. S.-U. K. proposal for a classification
of mental disorders was submitted to WHO in midsummer of 1963.
By this time, WHO had received seven other proposals, from Australia,
Czechoslovakia, the Federal Republic of Germany, France, Norway,
Poland, and the Soviet Union. WHO called a meeting in Geneva in
September 1963 to attempt the formulation of a single proposal. Dr.
Benjamin Pasamanick and the author came from the U. S. to attend the
meeting, which was attended by several European psychiatrists. It was
quite gratifying that the meeting elicited very considerable agreement
on the classification of schizophrenia; paranoid states; the psychoses
associated with infections, organic, and physical conditions; non-
psychotic conditions associated with infections, organic, and physical
conditions; mental retardation; physical disorders of presumably
psychogenic origin; special symptom reactions; addictions; and tran-
sient situational disturbances. The areas that still remained in dis-
agreement were the affective disorders, neurotic depressive reaction,
several of the personality disorders (paranoid, antisocial reaction, and
sexual deviation), and mental retardation with psychosocial deprivation.
Although all differences still were not resolved, the general arrangement
and content of the classification that resulted from this meeting were
in accord with the U. S.-U. K. proposal.
The WHO Expert Subcommittee on Classification of Diseases then
met in October and November 1963 to consider the results of the
September meeting. At this point, the U. S. submitted a revised proposal.
It had become quite clear by now, for example, that there would be
little support for the U. S. terminology "Brain syndrome associated with
(a specific organic or physical disorder) with psychotic reaction."
Nevertheless, the classification of organic psychoses proposed by the
U. S. and the U. K. was acceptable to others if the phrase "Brain
syndrome" was dropped. The term "non-psychotic conditions associated
xiiiMENTAL DISORDERS
with organic or physical conditions" was acceptable, whereas "Brain
syndrome with organic or physical condition" was not. Accordingly,
some modifications of this order were proposed.
Two psychiatrists who acted as advisers at this Expert Committee
meeting were Dr. Henry Brill for the U. S. and Professor A. V.
Snezhnevsky, Director of the Institute of Psychiatry of the Academy of
Medical Sciences, for the U.S.S.R. They were invited to resolve some
controversial issues centering around three proposed diagnoses: anti-
social personality, reactive psychosis, and mental retardation with
psycho-social deprivation.
The report of this meeting and the proposed classification that resulted
from it were then submitted to the Expert Committee on Health Statis-
tics which met in Geneva in October 1964. Based on the report of this
meeting and further evaluation of specific needs within different
countries, the Secretariat of WHO drafted a final revision proposal
which included rubrics for the diagnoses antisocial personality, mental
retardation with psychosocial deprivation, and a separate category for
the various reactive psychoses. This draft was submitted to and ap-
proved unanimously by the International Revision Conference in July
1965. The recommendations of this conference were approved unani-
mously by the 19th World Health Assembly in May 1966.
Shortly after the International Revision Conference, Dr. Ernest
Gruenberg, who became Chairman of the APA Committee on Nomen-
clature and Statistics in 1965, prepared a special supplement for the
eighteenth printing of DSM-I (November 1965) in which he described
the plan for revision and reproduced the section on mental disorders of
the International Classification of Diseases as approved by the Con-
ference.
There is yet another important action to be cited. The WHO Expert
Subcommittee on Classification of Diseases, at its first meeting in
November 1961, recommended that WHO establish for international
use a glossary of operational definitions of the terms that would be
included hi the revised classification ICD-8. This was viewed as an
essential step in solving practical problems related to the classification
of those disorders for international purposes. Two years later, in
November 1963, the same committee further underscored its concern
by urging all participating countries to develop national glossaries as
xivINTRODUCTION
a first step toward achieving a single international glossary. Operational
definitions applicable in the U. S. appear in Section 3 in this Manual.
The United Kingdom has also prepared a set of operational definitions 1
and several other countries have them in progress. The WHO has
initiated plans to develop the international glossary.
In sum, the classification of mental disorders in ICD-8 on which this
Manual is based is clearly the product of an international collaborative
effort that started in 1957 and culminated in the International Revision
Conference of July 1965.
The U. S. recommendations presented by Dr. Henry Brill in Geneva
had considerable impact on the form and content of the final classifica-
tion. Those recommendations included the incorporation into the ICD
of a single section providing a comprehensive classification of mental
disorders and one that relates mental disorders associated with organic
and physical factors to other disease categories in the ICD. Also, a
series of categories that did not appear in ICD-6 were added, namely,
mental disorders not specified as psychotic associated with organic and
physical disorders, physical disorders of presumably psychogenic origin,
and transient situational disturbances. Finally, a much more complete
classification of mental retardation, based on recommendations of the
American Association on Mental Deficiency, was accepted.
The new classification may be considered an achievement of the first
order in international professional collaboration. It takes into account
established knowledge of etiology, and where such knowledge is not
available, it attempts to provide a middle ground to satisfy the needs
of psychiatrists of different schools of theoretical orientation. It also
is, manifestly, a compromise which will fully satisfy psychiatrists neither
in the U. S. nor in any other country. The WHO is fully aware of this
and already has programs under way looking to a still more satisfactory
classification in the ninth revision. 2 The achievement of ICD-8 and the
experience underlying it augurs well for ICD-9.
1
A Glossary of Mental Disorders, (1968), Prepared by the Subcommittee on
Classification of Mental Disorders of the Register General's Advisory Com-
mittee on Medical Nomenclature and Statistics. General Register Office, Studies
on Medical and Population Subjects No. 22, Her Majesty's Stationery Office,
London
2
Lin, T., (1967), "The Epidemiological Study of Mental Disorders by WHO", Soc.
Psychiat. 1, 204
xvThis page intentionally left blankSection1
THE USE OF THIS MANUAL: SPECIAL
INSTRUCTIONS
Abbreviations and Special Symbols
The following abbreviations and special symbols are used throughout
this Manual:
WHO
—The World Health Organization
ICD-8 —The International Classification of Diseases, Eighth Re-
vision, World Health Organization, 1968. For use in the
United States see: Eighth Revision International Classifi-
cation of Diseases Adapted for Use in the United States,
Public Health Service Publication No. 1693, U. S. Gov-
ernment Printing Office, Washington, D. C. 20402.
DSM-I —Diagnostic and Statistical Manual, Mental Disorders,
American Psychiatric Association, Washington, D. C.,
1952 (out of print).
DSM-II —This Manual: Diagnostic and Statistical Manual of Mental
Disorders, Second Edition, American Psychiatric Asso-
ciation, Washington, D. C., 1968.
[ ]
—The brackets indicate ICD-8 categories to be avoided in
the United States or used by record librarians only.
*
(( ) )
OBS
—Asterisk indicates categories added to ICD-8 for use in
the United States only.
—Double parentheses indicate ICD-8 terms equivalent to
U. S. terms.
—Organic Brain Syndrome(s), i.e. mental disorders caused
by or associated with impairment of brain tissue function.
The Organization of the Diagnostic Nomenclature
While this Manual generally uses the same diagnostic code numbers
as ICD-8, two groups of disorders are out of sequence: Mental re-
tardation and the Non-psychotic organic brain syndromes. Mental
retardation is placed first to emphasize that it is to be diagnosed when-
ever present, even if due to some other disorder. The Non-psychotic or-
12
MENTAL DISORDERS
ganic brain syndromes are grouped with the other organic brain syn-
dromes in keeping with psychiatric thinking in this country, which
views the organic brain syndromes, whether psychotic or not, as one
group. Furthermore, the diagnostic nomenclature is divided into ten
major subdivisions, indicated with Roman numerals, to emphasize
the way mental disorders are often grouped in the United States.
The Recording of Diagnoses
Every attempt has been made to express the diagnoses in the
clearest and simplest terms possible within the framework of modern
usage. Clinicians will significantly improve communication and re-
search by recording their diagnoses in the same terms.
Multiple Psychiatric Diagnoses
Individuals may have more than one mental disorder. For example, a
patient with anxiety neurosis may also develop morphine addiction. In
DSM-I, drug addiction was classified as a secondary diagnosis, but ad-
diction to alcohol, for example, could not be diagnosed in the pres-
ence of a recognizable underlying disorder. This manual, by contrast,
encourages the recording of the diagnosis of alcoholism separately even
when it begins as a symptomatic expression of another disorder. Like-
wise mental retardation is a separate diagnosis. For example, there are
children whose disorders could be diagnosed as "Schizophrenia, child-
hood type" and "Mental retardation following major psychiatric dis-
order."
The diagnostician, however, should not lose sight of the rule of parsi-
mony and diagnose more conditions than are necessary to account for
the clinical picture. The opportunity to make multiple diagnoses does
not lessen the physician's responsibility to make a careful differential
diagnosis.
Which of several diagnoses the physician places first is a matter of his
own judgment, but two principles may be helpful in making his de-
cision:
1. The condition which most urgently requires treatment should be
listed first. For example, if a patient with simple schizophrenia was
presented to the diagnostician because of pathological alcohol in-
toxication, then the order of diagnoses would be first, Pathological
intoxication, and second, Schizophrenia, simple type.
2. When there is no issue of disposition or treatment priority, the
more serious condition should be listed first.SPECIAL INSTRUCTIONS
3
It is recommended that, in addition to recording multiple disorders in
conformity with these principles, the diagnostician underscore the dis-
order on the patient's record that he considers the underlying one. Be-
cause these principles will not always be applied or used consistently,
statistical systems should account for all significant diagnoses recorded
in every case.
Qualifying Phrases and Adjectives
The ICD is based on a classification scheme which allots three digits
for the designation of major disease categories and a fourth digit for
the specification of additional detail within each category. DSM-II
has introduced a fifth digit for coding certain qualifying phrases that
may be used to specify additional characteristics of mental disorders.
This digit does not disturb the content of either the three- or four-digit
categories in the ICD section on mental disorders.
These terms are as follows:
(1.) In the brain syndromes a differentiation of acute and chronic
conditions may be provided by .xl acute and .x2 chronic. This will
help maintain continuity with DSM-I. These qualifying adjectives are
recommended only for mental disorders specified as associated with
physical conditions and are, of course, unnecessary in disorders seen
only in an acute or chronic form.
Those who wish to continue the distinction made in DSM-I between
"acute" and "chronic" organic brain syndromes must now add these
as qualifying terms. Note also that a recorded diagnosis which merely
indicates an organic brain syndrome and does not specify whether or
not it is psychotic will now be classified under Non-psychotic organic
brain syndromes.
(2.) The qualifying phrase, .x5 in remission, may also be used to
indicate a period of remission in any disorder. This is not synony-
mous with No mental disorder.
(3.) With a few exceptions, all disorders listed in parts IV through
IX may be classified as .x6 mild, .x7 moderate, and .x8 severe. But
exceptions must be made in coding Passive-aggressive personality,
Inadequate personality, and the two sub-types of Hysterical neurosis
because their basic code numbers have five digits. Antisocial person-
ality should always be specified as mild, moderate, or severe.
(4.) As explained on page 23, the qualifying phrase not psychotic
(.x6) may be used for the psychoses listed in section III when the4
MENTAL DISORDERS
patient's degree of disturbance is not psychotic at the time of
examination.
Associated Physical Conditions
Many mental disorders, and particularly mental retardation and the
various organic brain syndromes, are reflections of underlying physical
conditions. Whenever these physical conditions are known they should
be indicated with a separate diagnosis in addition to the one that speci-
fies the mental disorder found. A list of the major categories of physical
disorders included in ICD-8 appears in Section 6 of this Manual.Section 2
THE DIAGNOSTIC NOMENCLATURE:
List of Mental Disorders and Their Code Numbers
I. MENTAL RETARDATION
Mental retardation (310-315)
310 Borderline mental retardation
311 Mild mental retardation
312 Moderate mental retardation
313 Severe mental retardation
314 Profound mental retardation
315 Unspecified mental retardation
The fourth-digit sub-divisions cited below should be used with each
of the above categories. The associated physical condition should be
specified as an additional diagnosis when known.
.0 Following infection or intoxication
.1 Following trauma or physical agent
.2 With disorders of metabolism, growth or nutrition
.3 Associated with gross brain disease (postnatal)
.4 Associated with diseases and conditions due to (unknown)
prenatal influence
.5 With chromosomal abnormality
.6 Associated with prematurity
.7 Following major psychiatric disorder
.8 With psycho-social (environmental) deprivation
.9 With other [and unspecified] condition
II. ORGANIC BRAIN SYNDROMES
(Disorders Caused by or Associated With Impairment of Brain
Tissue Function) In the categories under IIA and IIB the associated
physical condition should be specified when known.
56
MENTAL DISORDERS
II-A. PSYCHOSES ASSOCIATED WITH
SYNDROMES (290-294)
ORGANIC BRAIN
290 Senile and pre-senile dementia
.0 Senile dementia
.1 Pre-senile dementia
291 Alcoholic psychosis
.0 Delirium tremens
.1 Korsakov's psychosis (alcoholic)
.2 Other alcoholic hallucinosis
.3 Alcohol paranoid state ((Alcoholic paranoia))
.4* Acute alcohol intoxication*
.5* Alcoholic deterioration*
.6* Pathological intoxication*
.9 Other [and unspecified] alcoholic psychosis
292
.0
.1
.2
.3
.9
Psychosis
Psychosis
Psychosis
Psychosis
Psychosis
Psychosis
fection
associated with intracranial infection
with general paralysis
with other syphilis of central nervous system
with epidemic encephalitis
with other and unspecified encephalitis
with other [and unspecified] intracranial in-
293
.0
.1
.2
.3
.4
Psychosis associated with other cerebral condition
Psychosis with cerebral arteriosclerosis
Psychosis with other cerebrovascular disturbance
Psychosis with epilepsy
Psychosis with intracranial neoplasm
Psychosis with degenerative disease of the central nervous
system
.5 Psychosis with brain trauma
.9 Psychosis with other [and unspecified] cerebral condition
294
.0
.1
.2
Psychosis associated with other physical condition
Psychosis with endocrine disorder
Psychosis with metabolic or nutritional disorder
Psychosis with systemic infectionTHE NOMENCLATURE
.3 Psychosis
alcohol)
.4 Psychosis
.8 Psychosis
[.9 Psychosis
7
with drug or poison intoxication (other than
with childbirth
with other and undiagnosed physical condition
with unspecified physical condition]
II-B NON-PSYCHOTIC ORGANIC BRAIN SYNDROMES (309)
309 Non-psychotic organic brain syndromes ((Mental disorders
not specified as psychotic associated with physical conditions))
.0 Non-psychotic OBS with intracranial infection
[.1 Non-psychotic OBS with drug, poison, or systemic intoxi-
cation]
.13* Non-psychotic OBS with alcohol* (simple drunken-
ness)
.14* Non-psychotic OBS with other drug, poison, or sys-
temic intoxication*
.2 Non-psychotic OBS with brain trauma
.3 Non-psychotic OBS with circulatory disturbance
.4 Non-psychotic OBS with epilepsy
.5 Non-psychotic OBS with disturbance of metabolism, growth
or nutrition
.6 Non-psychotic OBS with senile or pre-senile brain disease
.7 Non-psychotic OBS with intracranial neoplasm
.8 Non-psychotic OBS with degenerative disease of central
nervous system
.9 Non-psychotic OBS with other [and unspecified] physical
condition
[.91* Acute brain syndrome, not otherwise specified*]
[.92* Chronic brain syndrome, not otherwise specified*]
IK. PSYCHOSES NOT ATTRIBUTED TO PHYSICAL CONDI-
TIONS LISTED PREVIOUSLY (295-298)
295
.0
.1
.2
Schizophrenia
Schizophrenia, simple type
Schizophrenia, hebephrenic type
Schizophrenia, catatonic type
.23* Schizophrenia, catatonic type, excited*
.24* Schizophrenia, catatonic type, withdrawn*8
MENTAL DISORDERS
.3 Schizophrenia, paranoid type
.4 Acute schizophrenic episode
.5 Schizophrenia, latent type
.6 Schizophrenia, residual type
.7 Schizophrenia, schizo-affective type
.73* Schizophrenia, schizo-affective type, excited*
.74* Schizophrenia, schizo-affective type, depressed*
.8*
Schizophrenia, childhood type*
.90* Schizophrenia, chronic undifferentiated type*
.99* Schizophrenia, other [and unspecified] types*
296 Major affective disorders ((Affective psychoses))
.0 Involutional melancholia
.1 Manic-depressive illness, manic type ((Manic-depressive
psychosis, manic type))
.2 Manic-depressive illness, depressed type ((Manic-depres-
sive psychosis, depressed type))
.3 Manic-depressive illness, circular type ((Manic-depressive
psychosis, circular type))
.33* Manic-depressive illness, circular type, manic*
.34* Manic-depressive illness, circular type, depressed*
.8 Other major affective disorder ( (Affective psychoses, other))
[.9 Unspecified major affective disorder]
[Affective disorder not otherwise specified]
[Manic-depressive illness not otherwise specified]
297
Paranoid states
.0 Paranoia
.1 Involutional paranoid state ((Involutional paraphrenia))
.9 Other paranoid state
298 Other psychoses
.0 Psychotic depressive reaction ((Reactive depressive psy-
chosis))
[.1 Reactive excitation]THE NOMENCLATURE
9
[.2 Reactive confusion]
[Acute or subacute confusional state]
[.3 Acute paranoid reaction]
[.9 Reactive psychosis, unspecified]
[299 Unspecified psychosis]
[Dementia, insanity or psychosis not otherwise specified]
IV. NEUROSES (300)
300 Neuroses
.0 Anxiety neurosis
.1 Hysterical neurosis
.13* Hysterical neurosis, conversion type*
.14* Hysterical neurosis, dissociative type*
.2 Phobic neurosis
.3 Obsessive compulsive neurosis
.4 Depressive neurosis
.5 Neurasthenic neurosis ((Neurasthenia))
.6 Depersonalization neurosis ((Depersonalization syndrome))
.7 Hypochondriacal neurosis
.8 Other neurosis
[.9 Unspecified neurosis]
V. PERSONALITY DISORDERS AND CERTAIN OTHER NON-
PSYCHOTIC MENTAL DISORDERS (301—304)
301
Personality disorders
.0 Paranoid personality
.1 Cyclothymic personality ((Affective personality))
.2 Schizoid personality
.3 Explosive personality
.4 Obsessive compulsive personality ((Anankastic personality))
.5 Hysterical personality
.6 Asthenic personality
.7 Antisocial personality
.81* Passive-aggressive personality*
.82* Inadequate personality*10
MENTAL DISORDERS
.89* Other personality disorders of specified types*
[.9 Unspecified personality disorder]
302 Sexual deviations
.0 Homosexuality
.1 Fetishism
.2 Pedophilia
.3 Transvestitism
.4 Exhibitionism
.5* Voyeurism*
.6* Sadism*
.7* Masochism*
.8 Other sexual deviation
[.9 Unspecified sexual deviation]
303 Alcoholism
.0
.1
.2
.9
Episodic excessive drinking
Habitual excessive drinking
Alcohol addiction
Other [and unspecified] alcoholism
304 Drug dependence
.0 Drug dependence, opium, opium alkaloids and their de-
rivatives
.1 Drug dependence, synthetic analgesics with morphine-like
effects
.2 Drug dependence, barbiturates
.3 Drug dependence, other hypnotics and sedatives or "tran-
quilizers"
.4 Drug dependence, cocaine
.5 Drug dependence, Cannabis sativa (hashish, marihuana)
.6 Drug dependence, other psycho-stimulants
.7 Drug dependence, hallucinogens
.8 Other drug dependence
[.9 Unspecified drug dependence]THE NOMENCLATURE
11
VI. PSYCHOPHYSIOLOGIC DISORDERS (305)
305 Psychophysiologic disorders ((Physical disorders of presum-
ably psychogenic origin))
.0 Psychophysiologic skin disorder
.1 Psychophysiologic musculoskeletal disorder
.2 Psychophysiologic respiratory disorder
.3 Psychophysiologic cardiovascular disorder
.4 Psychophysiologic hemic and lymphatic disorder
.5 Psychophysiologic gastro-intestinal disorder
.6 Psychophysiologic genito-urinary disorder
.7 Psychophysiologic endocrine disorder
.8 Psychophysiologic disorder of organ of special sense
.9 Psychophysiologic disorder of other type
VII. SPECIAL SYMPTOMS (306)
306
.0
.1
.2
.3
.4
.5
.6
.7
.8
.9
Special symptoms not elsewhere classified
Speech disturbance
Specific learning disturbance
Tic
Other psychomotor disorder
Disorders of sleep
Feeding disturbance
Enuresis
Encopresis
Cephalalgia
Other special symptom
VIII. TRANSIENT SITUATIONAL DISTURBANCES (307)
307* Transient situational disturbances 1
1
The terms included under DSM-1I Category 307*, "Transient situational dis-
turbances," differ from those in Category 307 of the ICD. DSM-II Category 307*,
"Transient situational disturbances," contains adjustment reactions of infancy
(307.0*), childhood (307.1*), adolescence (307.2*), adult life (307.3*), and
late life (307.4*). ICD Category 307, "Transient situational disturbances,"
includes only the adjustment reactions of adolescence, adult life and late life.
ICD 308, "Behavioral disorders of children," contains the reactions of infancy
and childhood. These differences must be taken into account in preparing
statistical tabulations to conform to ICD categories.12
MENTAL DISORDERS
.0*
.1*
.2*
.3*
.4*
Adjustment
Adjustment
Adjustment
Adjustment
Adjustment
reaction
reaction
reaction
reaction
reaction
of infancy*
of childhood*
of adolescence*
of adult life*
of late life*
IX. BEHAVIOR DISORDERS OF CHILDHOOD AND ADOLES-
CENCE (308)
308 Behavior disorders of childhood and adolescence 2 ((Be-
havior disorders of childhood))
.0* Hyperkinetic reaction of childhood (or adolescence)*
.1* Withdrawing reaction of childhood (or adolescence)*
.2* Overanxious reaction of childhood (or adolescence)*
.3* Runaway reaction of childhood (or adolescence)*
.4* Unsocialized aggressive reaction of childhood (or ado-
lescence ) *
.5* Group delinquent reaction of childhood (or adolescence)*
.9* Other reaction of childhood (or adolescence)*
X. CONDITIONS WITHOUT MANIFEST PSYCHIATRIC DIS-
ORDER AND NON-SPECIFIC CONDITIONS (316*—318* )t
316*tt Social maladjustments without manifest psychiatric dis-
order
.0* Marital maladjustment*
.1* Social maladjustment*
.2* Occupational maladjustment*
.3* Dyssocial behavior*
.9* Other social maladjustment*
2
The terms included under DSM-ll Category 308*, "Behavioral disorders of
childhood and adolescence," differ from those in Category 308 of the ICD. DSM-
II Category 308* includes "Behavioral disorders of childhood and adolescence,"
whereas ICD Category 308 includes only "Behavioral disorders of childhood."
DSM-II Category 308* does not include "Adjustment reactions of infancy and
childhood", whereas ICD Category 308 does. In the DSM-II classification,
"Adjustment reactions of infancy and childhood" are allocated to 307* (Transi-
tional situational disturbances). These differences should be taken into account
in preparing statistical tabulations to conform to the ICD categories.THE NOMENCLATURE
13
317* Non-specific conditions*
318*
No mental disorder*
XI. NON-DIAGNOSTIC TERMS FOR ADMINISTRATIVE USE
(319*)t
319*
Non-diagnostic terms for administrative use*
.0* Diagnosis deferred*
.1* Boarder*
.2* Experiment only*
,9* Other*
f The terms included in this category would normally be listed in that section
of ICD-8 that deals with "Special conditions and examinations without sick-
ness." They are included here to permit coding of some additional conditions
that are encountered in psychiatric clinical settings in the U. S. This has been
done by using several unassigned code numbers at the end of Section 5 of
the ICD.
ff This diagnosis corresponds to the category *Y13, Social maladjustment without
manifest psychiatric disorder in ICDA.Section3
THE DEFINITIONS OF TERMS
I: MENTAL RETARDATION 1 (310—315)
Mental retardation refers to subnormal general intellectual functioning
which originates during the developmental period and is associated with
impairment of either learning and social adjustment or maturation, or
both. (These disorders were classified under "Chronic brain syndrome
with mental deficiency" and "Mental deficiency" in DSM-I.) The
diagnostic classification of mental retardation relates to IQ as follows 2 :
310 Borderline mental retardation—IQ 68—85
311 Mild mental retardation—IQ 52—67
312 Moderate mental retardation—IQ 36—51
313 Severe mental retardation—IQ 20—35
314 Profound mental retardation—IQ under 20
Classifications 310-314 are based on the statistical distribution of levels
of intellectual functioning for the population as a whole. The range of
intelligence subsumed under each classification corresponds to one
standard deviation, making the heuristic assumption that intelligence
is normally distributed. It is recognized that the intelligence quotient
should not be the only criterion used in making a diagnosis of mental
retardation or in evaluating its severity. It should serve only to help
in making a clinical judgment of the patient's adaptive behavioral
capacity. This judgment should also be based on an evaluation of the
patient's developmental history and present functioning, including aca-
demic and vocational achievement, motor skills, and social and emo-
tional maturity.
315 Unspecified mental retardation
This classification is reserved for patients whose intellectual functioning
1
For a fuller definition of terms see the "Manual on Terminology and Classifica-
tion in Mental Retardation," (Supplement to American Journal of Mental Defi-
ciency, Second Edition, 1961) from which most of this section has been adapted.
2
The IQs specified are for the Revised Stanford-Binet Tests of Intelligence, Forms
L and M. Equivalent values for other tests are listed in the manual cited in the
footnote above.
14DEFINITIONS OF TERMS
15
has not or cannot be evaluated precisely but which is recognized as
clearly subnormal.
Clinical Subcategories of Mental Retardation
These will be coded as fourth digit subdivisions following each of the
categories 310-315. When the associated condition is known more
specifically, particularly when it affects the entire organism or an organ
system other than the central nervous system, it should be coded addi-
tionally in the specific field affected.
.0 Following infection and intoxication
This group is to classify cases in which mental retardation is the result
of residual cerebral damage from intracranial infections, serums, drugs,
or toxic agents. Examples are:
Cytomegalic inclusion body disease, congenital. A maternal viral
disease, usually mild or subclinical, which may infect the fetus and
is recognized by the presence of inclusion bodies in the cellular
elements in the urine, cerebrospinal fluid, and tissues.
Rubella, congenital. Affecting the fetus in the first trimester and
usually accompanied by a variety of congenital anomalies of the ear,
eye and heart.
Syphilis, congenital. Two types are described, an early meningo-
vascular disease and a diffuse encephalitis leading to juvenile paresis.
Toxoplasmosis, congenital. Due to infection by a protozoan-like
organism, Toxoplasma, contracted in utero. May be detected by
serological tests in both mother and infant.
Encephalopathy associated with other prenatal infections. Occasion-
ally fetal damage from maternal epidemic cerebrospinal meningitis,
equine encephalomyelitis, influenza, etc. has been reported. The
relationships have not as yet been definitely established.
Encephalopathy due to postnatal cerebral infection. Both focal and
generalized types of cerebral infection are included and are to be
given further anatomic and etiologic specification.
Encephalopathy, congenital, associated with maternal toxemia of
pregnancy. Severe and prolonged toxemia of pregnancy, particularly
eclampsia, may be associated with mental retardation.
Encephalopathy, congenital, associated with other maternal intoxi-
cations. Examples are carbon monoxide, lead, arsenic, quinine, ergot,
etc.16
MENTAL DISORDERS
Bilirubin encephalopathy (Kernicterus). Frequently due to Rh, A, B,
O blood group incompatibility between fetus and mother but may
also follow prematurity, severe neonatal sepsis or any condition pro-
ducing high levels of serum bilirubin. Choreoathetosis is frequently
associated with this form of mental retardation.
Post-immunization encephalopathy. This may follow inoculation
with serum, particularly anti-tetanus serum, or vaccines such as small-
pox, rabies, and typhoid.
Encephalopathy, other, due to intoxication. May result from such
toxic agents as lead, carbon monoxide, tetanus and botulism exotoxin.
.1 Following trauma or physical agent
Further specification within this category follows:
Encephalopathy due to prenatal injury. This includes prenatal irradi-
ation and asphyxia, the latter following maternal anoxia, anemia, and
hypotension.
Encephalopathy due to mechanical injury at birth. These are at-
tributed to difficulties of labor due to malposition, malpresentation,
disproportion, or other complications leading to dystocia which may
increase the probability of damage to the infant's brain at birth, re-
sulting in tears of the meninges, blood vessels, and brain substance.
Other reasons include venous-sinus thrombosis, arterial embolism
and thrombosis. These may result in sequelae which are indistin-
guishable from those of other injuries, damage or organic impairment
of the brain.
Encephalopathy due to asphyxia at birth. Attributable to the
anoxemia following interference with placental circulation due to
premature separation, placenta praevia, cord difficulties, and other
interferences with oxygenation of the placental circulation.
Encephalopathy due to postnatal injury. The diagnosis calls for
evidence of severe trauma such as a fractured skull, prolonged un-
consciousness, etc., followed by a marked change in development.
Postnatal asphyxia, infarction, thrombosis, laceration, and contusion
of the brain would be included and the nature of the injury specified.
.2 With disorders of metabolism, growth or nutrition
All conditions associated with mental retardation directly due to meta-
bolic, nutritional, or growth dysfunction should be classified here, includ-+DEFINITIONS OF TERMS
17
ing disorders of lipid, carbohydrate and protein metabolism, and de-
ficiencies of nutrition.
Cerebral lipoidosis, infantile (Tay-Sach's disease). This is caused
by a single recessive autosomal gene and has infantile and juvenile
forms. In the former there is gradual deterioration, blindness after
the pathognomonic "cherry-red spot," with death occurring usually
before age three.
Cerebral lipoidosis, late infantile (Bielschowsky's disease). This
differs from the preceding by presenting retinal optic atrophy instead
of the "cherry-red spot."
Cerebral lipoidosis, juvenile (Spielmeyer-Vogt disease). This usually
appears between the ages of five and ten with involvement of the
motor systems, frequent seizures, and pigmentary degeneration of
the retina. Death follows in five to ten years.
Cerebral lipoidosis, late juvenile (Kufs disease). This is categorized
under mental retardation only when it occurs at an early age.
Lipid histiocytosis of kerasin type (Gaucher's disease). As a rule this
condition causes retardation only when it affects infants. It is charac-
terized by Gaucher's cells in lymph nodes, spleen or marrow.
Lipid histiocystosis of phosphatide type (Niemann-Pick's disease).
Distinguished from Tay-Sach's disease by enlargement of liver and
spleen. Biopsy of spleen, lymph or marrow show characteristic "foam
cells."
Phenylketonuria. A metabolic disorder, genetically transmitted as a
simple autosomal recessive gene, preventing the conversion of phen-
ylalanine into tyrosine with an accumulation of phenylalanine, which
in turn is converted to phenylpyruvic acid detectable in the urine.
Hepatolenticular degeneration (Wilson's disease). Genetically trans-
mitted as a simple autosomal recessive. It is due to inability of
ceruloplasmin to bind copper, which in turn damages the brain. Rare
in children.
Porphyria. Genetically transmitted as a dominant and characterized
by excretion of porphyrins in the urine. It is rare in children, in whom
it may cause irreversible deterioration.
Galactosemia. A condition in which galactose is not metabolized,
causing its accumulation in the blood. If milk is not removed from
the diet, generalized organ deficiencies, mental deterioration and
death may result.18
MENTAL DISORDERS
Glucogenosis (Von Gierke's disease). Due to a deficiency in glycogen-
metabolizing enzymes with deposition of glycogen in various organs,
including the brain.
Hypoglycemosis. Caused by various conditions producing hypogly-
cemia which, in the infant, may result in epilepsy and mental defect.
Diagnosis may be confirmed by glucose tolerance tests.
.3 Associated with gross brain disease (postnatal)
This group includes all diseases and conditions associated with neo-
plasms, but not growths that are secondary to trauma or infection. The
category also includes a number of postnatal diseases and conditions
in which the structural reaction is evident but the etiology is unknown
or uncertain, though frequently presumed to be of hereditary or familial
nature. Structural reactions may be degenerative, infiltrative, inflam-
matory, proliferative, sclerotic, or reparative.
Neurofibromatosis (Neurofibroblastomatosis, von Recklinghausen's
disease). A disease transmitted by a dominant autosomal gene but
with reduced penetrance and variable expressivity. It is characterized
by cutaneous pigmentation ("cafe au lait" patches) and neurofibromas
of nerve, skin and central nervous system with intellectual capacity
varying from normal to severely retarded.
Trigeminal cerebral angiomatosis (Sturge-Weber-Dimitri's disease).
A condition characterized by a "port wine stain" or cutaneous angi-
oma, usually in the distribution of the trigeminal nerve, accompanied
by vascular malformation over the meninges of the parietal and oc-
cipital lobes with underlying cerebral maldevelopment.
Tuberous sclerosis (Epiloia, Bourneville's disease). Transmitted by
a dominant autosomal gene, characterized by multiple gliotic nodules
in the central nervous system, and associated with adenoma sebaceum
of the face and tumors in other organs. Retarded development and
seizures may appear early and increase in severity along with tumor
growth.
Intracranial neoplasm, other. Other relatively rare neoplastic diseases
leading to mental retardation should be included in this category
and specified when possible.
Encephalopathy associated with diffuse sclerosis of the brain. This
category includes a number of similar conditions differing to some
extent in their pathological and clinical features but characterizedDEFINITIONS OF TERMS
19
by diffuse demyelination of the white matter with resulting diffuse
glial sclerosis and accompanied by intellectual deterioration. These
diseases are often familial in character and when possible should be
specified under the following:
Acute infantile diffuse sclerosis (Krabbe's disease).
Diffuse chronic infantile sclerosis (Merzbacher-Pelizaeus disease,
Aplasia axialis extracorticalis congenita).
Infantile metachromatic leukodystrophy (Greenfield's disease).
Juvenile metachromatic leukodystrophy (Scholz' disease).
Progressive subcortical encephalopathy (Encephalitis periaxialis
diffusa, Schilder's disease).
Spinal sclerosis (Friedreich's ataxia). Characterized by cerebellar
degeneration, early onset followed by dementia.
Encephalopathy, other, due to unknown or uncertain cause with the
structural reactions manifest. This category includes cases of mental
retardation associated with progressive neuronal degeneration or other
structural defects which cannot be classified in a more specific,
diagnostic category.
.4 Associated with diseases and conditions due to unknown pre-
natal influence
This category is for classifying conditions known to have existed al
the time of or prior to birth but for which no definite etiology can be
established. These include the primary cranial anomalies and con-
genital defects of undetermined origin as follows:
Anencephaly (including hemianencephaly).
Malformations of the gyri. This includes agyria, macrogyria (pachy-
gyria) and microgyria.
Porencephaly, congenital. Characterized by large funnel-shaped cavi-
ties occurring anywhere in the cerebral hemispheres. Specify, il
possible, whether the porencephaly is a result of asphyxia at birtl
or postnatal trauma.
Multiple-congenital anomalies of the brain.
Other cerebral defects, congenital.
Craniostenosis. The most common conditions included in thi)
category are acrocephaly (oxycephaly) and scaphocephaly. Thes<
may or may not be associated with mental retardation.20
MENTAL DISORDERS
Hydrocephalus, congenital. Under this heading is included only
that type of hydrocephalus present at birth or occurring soon after
delivery. All other types of hydrocephalus, secondary to other
conditions, should be classified under the specific etiology when
known.
Hypertelorism (Greig's disease). Characterized by abnormal devel-
opment of the sphenoid bone increasing the distance between the
eyes.
Macrocephaly (Megalencephaly). Characterized by an increased
size and weight of the brain due partially to proliferation of glia.
Microcephaly, primary. True microcephaly is probably transmitted
as a single autosomal recessive. When it is caused by other con-
ditions it should be classified according to the primary condition,
with secondary microcephaly as a supplementary term.
Laurence-Moon-Biedl syndrome. Characterized by mental retar-
dation associated with retinitis pigmentosa, adiposo-genital dys-
trophy, and polydactyly.
.5 With chromosomal abnormality
This group includes cases of mental retardation associated with chromo-
somal abnormalities. These may be divided into two sub-groups, those
associated with an abnormal number of chromosomes and those with
abnormal chromosomal morphology.
Autosomal trisomy of group G. (Trisomy 21, Langdon-Down disease,
Mongolism). This is the only common form of mental retardation
due to chromosomal abnormality. (The others are relatively rare.)
It ranges in degree from moderate to severe with infrequent cases of
mild retardation. Other congenital defects are frequently present, and
the intellectual development decelerates with time.
Autosomal trisomy of group £.
Autosomal trisomy of group D.
Sex chromosome anomalies. The only condition under the category
which has any significant frequency is Klinefelter's syndrome.
Abnormal number of chromosomes, other. In this category would
be included monosomy G, and possibly others as well as other forms
of mosaicism.
Short arm deletion of chromosome 5—group B (Cri du chat).A
quite rare condition characterized by congenital abnormalities and a
cat-like cry during infancy which disappears with time.DEFINITIONS OF TERMS
21
Short arm deletion of chromosome 18—group £.
Abnormal morphology of chromosomes, other. This category includes
a variety of translocations, ring chromosomes, fragments, and iso-
chromosomes associated with mental retardation.
.6 Associated with prematurity
This category includes retarded patients who had a birth weight of less
than 2500 grams (5.5 pounds) and/or a gestational age of less than
38 weeks at birth, and who do not fall into any of the preceding cate-
gories. This diagnosis should be used only if the patient's mental
retardation cannot be classified more precisely under categories .0 to
.5 above.
.7 Following major psychiatric disorder
This category is for mental retardation following psychosis or other
major psychiatric disorder in early childhood when there is no evidence
of cerebral pathology. To make this diagnosis there must be good
evidence that the psychiatric disturbance was extremely severe. For
example, retarded young adults with residual schizophrenia should not
be classified here.
.8 With psycho-social (environmental) deprivation
This category is for the many cases of mental retardation with no
clinical or historical evidence of organic disease or pathology but for
which there is some history of psycho-social deprivation. Cases in this
group are classified in terms of psycho-social factors which appear to
bear some etiological relationship to the condition as follows:
Cultural-familial mental retardation. Classification here requires that
evidence of retardation be found in at least one of the parents and
in one or more siblings, presumably, because some degree of cul-
tural deprivation results from familial retardation. The degree of
retardation is usually mild.
Associated with environmental deprivation. An individual deprived
of normal environmental stimulation in infancy and early child-
hood may prove unable to acquire the knowledge and skills required
to function normally. This kind of deprivation tends to be more
severe than that associated with familial mental retardation (q.v.).
This type of deprivation may result from severe sensory impairment,
even in an environment otherwise rich in stimulation. More rarely22
MENTAL DISORDERS
it may result from severe environmental limitations or atypical cul-
tural milieus. The degree of retardation is always marginal or mild.
.9 With other [and unspecified] condition.
II. ORGANIC BRAIN SYNDROMES
(Disorders caused by or associated with impairment of brain
tissue function)
These disorders are manifested by the following symptoms:
(a) Impairment of orientation
(b) Impairment of memory
(c) Impairment of all intellectual functions such as comprehension,
calculation, knowledge, learning, etc.
(d) Impairment of judgment
(e) Lability and shallowness of affect
The organic brain syndrome is a basic mental condition characteristically
resulting from diffuse impairment of brain tissue function from what-
ever cause. Most of the basic symptoms are generally present to some
degree regardless of whether the syndrome is mild, moderate or severe.
The syndrome may be the only disturbance present. It may also be
associated with psychotic symptoms and behavioral disturbances. The
severity of the associated symptoms is affected by and related to not
only the precipitating organic disorder but also the patient's inherent
personality patterns, present emotional conflicts, his environmental situ-
ation, and interpersonal relations.
These brain syndromes are grouped into psychotic and non-psychotic
disorders according to the severity of functional impairment. The psy-
chotic level of impairment is described on page 23 and the non-
psychotic on pages 31-32.
It is important to distinguish "acute" from "chronic" brain disorders
because of marked differences in the course of illness, prognosis and
treatment. The terms indicate primarily whether the brain pathology
and its accompanying organic brain syndrome is reversible. Since the
same etiology may produce either temporary or permanent brain dam-
age, a brain disorder which appears reversible (acute) at the begin-
ning may prove later to have left permanent damage and a persistent
organic brain syndrome which will then be diagnosed "chronic". SomeDEFINITIONS OF TERMS
23
brain syndromes occur in either form. Some occur only in acute forms
(e.g. Delirium tremens). Some occur only in chronic form (e.g. Alco-
holic deterioration). The acute and chronic forms may be indicated for
those disorders coded in four digits by the addition of a fifth qualifying
digit: .xl acute and .x2 chronic.
THE PSYCHOSES
Psychoses are described in two places in this Manual, here with the
organic brain syndromes and later with the functional psychoses. The
general discussion of psychosis appears here because organic brain
syndromes are listed first in DSM-II.
Patients are described as psychotic when their mental functioning is
sufficiently impaired to interfere grossly with their capacity to meet the
ordinary demands of life. The impairment may result from a serious
distortion in their capacity to recognize reality. Hallucinations and de-
lusions, for example, may distort their perceptions. Alterations of mood
may be so profound that the patient's capacity to respond appropri-
ately is grossly impaired. Deficits in perception, language and memory
may be so severe that the patient's capacity for mental grasp of his
situation is effectively lost.
Some confusion results from the different meanings which have become
attached to the word "psychosis." Some non-organic disorders, (295-
298), in the well-developed form in which they were first recognized,
typically rendered patients psychotic. For historical reasons these dis-
orders are still classified as psychoses, even though it now generally is
recognized that many patients for whom these diagnoses are clinically
justified are not in fact psychotic. This is true particularly in the in-
cipient or convalescent stages of the illness. To reduce confusion, when
one of these disorders listed as a "psychosis" is diagnosed in a pa-
tient who is not psychotic, the qualifying phrase not psychotic or not
presently psychotic should be noted and coded .x6 with a fifth digit.
Example: 295.06 Schizophrenia, simple type, not psychotic.
It should be noted that this Manual permits an organic condition to
be classified as a psychosis only if the patient is psychotic during the
episode being diagnosed.
If the specific physical condition underlying one of these disorders is
known, indicate it with a separate, additional diagnosis.+24
MENTAL DISORDERS
II. A. PSYCHOSES ASSOCIATED WITH ORGANIC BRAIN
SYNDROMES (290—294)
290 Senile and Pre-senile dementia
290.0 Senile dementia
This syndrome occurs with senile brain disease, whose causes are
largely unknown. The category does not include the pre-senile
psychoses nor other degenerative diseases of the central nervous
system. While senile brain disease derives its name from the age
group in which it is most commonly seen, its diagnosis should be
based on the brain disorder present and not on the patient's age at
times of onset. Even mild cases will manifest some evidence of or-
ganic brain syndrome: self-centeredness, difficulty in assimilating new
experiences, and childish emotionality. Deterioration may be mini-
mal or progress to vegetative existence. (This condition was called
"Chronic Brain Syndrome associated with senile brain disease" in
DSM-I.)
290.1 Pre-senile dementia
This category includes a group of cortical brain diseases presenting
clinical pictures similar to those of senile dementia but appearing char-
acteristically in younger age groups. Alzheimer's and Pick's diseases
are the two best known forms, each of which has a specific brain
pathology. (In DSM-I Alzheimer's disease was classified as "Chronic
Brain Syndrome with other disturbance of metabolism." Pick's disease
was "Chronic Brain Syndrome associated with disease of unknown
cause.") When the impairment is not of psychotic proportion the
patient should be classified under Non-psychotic OBS with senile or
pre-senile brain disease.
291 Alcoholic psychoses
Alcoholic psychoses are psychoses caused by poisoning with alcohol
(see page 23). When a pre-existing psychotic, psychoneurotic or other
disorder is aggravated by modest alcohol intake, the underlying condi-
tion, not the alcoholic psychosis, is diagnosed.
Simple drunkenness, when not specified as psychotic, is classified under
Non-psychotic OBS with alcohol.
In accordance with ICD-8, this Manual subdivides the alcoholic psy-
choses into Delirium tremens, Korsakov's psychosis, Other alcoholic
hallucinosis and Alcoholic paranoia. DSM-II also adds three furtherDEFINITIONS OF TERMS
25
subdivisions: Acute alcohol intoxication, Alcoholic deterioration and
Pathological intoxication. (In DSM-I "Acute Brain Syndrome, alco-
hol intoxication" included what is now Delirium tremens, Other alco-
holic hallucinosis, Acute alcohol intoxication and Pathological intoxi-
cation.)
291.0 Delirium tremens
This is a variety of acute brain syndrome characterized by delirium,
coarse tremors, and frightening visual hallucinations usually becom-
ing more intense in the dark. Because it was first identified in alco-
holics and until recently was thought always to be due to alcohol
ingestion, the term is restricted to the syndrome associated with
alcohol. It is distinguished from Other alcoholic hallucinosis by the
tremors and the disordered sensorium. When this clinical picture is
due to a nutritional deficiency rather than to alcohol poisoning, it is
classified under Psychosis associated with metabolic or nutritional dis-
order.
291.1 Korsakov's psychosis (alcoholic) Also "Korsakoff"
This is a variety of chronic brain syndrome associated with long-
standing alcohol use and characterized by memory impairment, dis-
orientation, peripheral neuropathy and particularly by confabulation.
Like delirium tremens, Korsakov's psychosis is identified with alco-
hol because of an initial error in identifying its cause, and therefore
the term is confined to the syndrome associated with alcohol. The sim-
ilar syndrome due to nutritional deficiency unassociated with alco-
hol is classified Psychosis associated with metabolic or nutritional
disorder.
291.2 Other alcoholic hallucinosis
Hallucinoses caused by alcohol which cannot be diagnosed as de-
lirium tremens, Korsakov's psychosis, or alcoholic deterioration fall
in this category. A common variety manifests accusatory or threat-
ening auditory hallucinations in a state of relatively clear conscious-
ness. This condition must be distinguished from schizophrenia in
combination with alcohol intoxication, which would require two
diagnoses.
291.3 Alcohol paranoid state ((Alcoholic paranoia))
This term describes a paranoid state which develops in chronic alco-
holics, generally male, and is characterized by excessive jealousy and
delusions of infidelity by the spouse. Patients diagnosed under pri-26
MENTAL DISORDERS
mary paranoid states or schizophrenia should not be included here
even if they drink to excess.
291.4* Acute alcohol intoxication*
All varieties of acute brain syndromes of psychotic proportion caused
by alcohol are included here if they do not manifest features of de-
lirium tremens, alcoholic hallucinosis, or pathological intoxication.
This diagnosis is used alone when there is no other psychiatric dis-
order or as an additional diagnosis with other psychiatric conditions
including alcoholism. The condition should not be confused with
simple drunkenness, which does not involve psychosis. (All patients
with this disorder would have been diagnosed "Acute Brain Syndrome,
alcohol intoxication" in DSM-I.)
291.5* Alcoholic deterioration*
All varieties of chronic brain syndromes of psychotic proportion
caused by alcohol and not having the characteristic features of Kor-
sakov's psychosis are included here. (This condition and Korsakov's
psychosis were both included under "Chronic Brain Syndrome, al-
cohol intoxication with psychotic reaction" in DSM-I.)
291.6* Pathological intoxication*
This is an acute brain syndrome manifested by psychosis after mini-
mal alcohol intake. (In DSM-I this diagnosis fell under "Acute
Brain Syndrome, alcohol intoxication.")
291.9 Other [and unspecified] alcoholic psychosis
This term refers to all varieties of alcoholic psychosis not classified
above.
292 Psychosis associated with intracranial infection
292.0 General paralysis
This condition is characterized by physical signs and symptoms of
parenchymatous syphilis of the nervous system, and usually by posi-
tive serology, including the paretic gold curve in the spinal fluid.
The condition may simulate any of the other psychoses and brain
syndromes. If the impairment is not of psychotic proportion it is
classified Non-psychotic OBS with intracranial infection. If the spe-
cific underlying physical condition is known, indicate it with a sep
arate, additional diagnosis. (This category was included under
"Chronic Brain Syndrome associated with central nervous system
syphilis (meningoencephalitic)" in DSM-I.)DEFINITIONS OF TERMS
27
292.1 Psychosis with other syphilis of central nervous system
This includes all other varieties of psychosis attributed to intracranial
infection by Spirochaeta pallida. The syndrome sometimes has fea-
tures of organic brain syndrome. The acute infection is usually pro-
duced by meningovascular inflammation and responds to systemic
antisyphilitic treatment. The chronic condition is generally due to
gummata. If not of psychotic proportion, the disorder is classified
Non-psychotic OBS with intracranial infection. (In DSM-I "Chronic
Brain Syndrome associated with other central nervous system syphilis"
and "Acute Brain Syndrome associated with intracranial infection"
covered this category.)
292.2 Psychosis with epidemic encephalitis
(von Economo's encephalitis)
This term is confined to the disorder attributed to the viral epi-
demic encephalitis that followed World War I. Virtually no cases
have been reported since 1926. The condition, however, is differ-
entiated from other encephalitis. It may present itself as acute de-
lirium and sometimes its outstanding feature is apparent indifference
to persons and events ordinarily of emotional significance, such as the
death of a family member. It may appear as a chronic brain syndrome
and is sometimes dominated by involuntary, compulsive behavior.
If not of psychotic proportions, the disorder is classified under
Non-psychotic OBS with intracranial infection. (This category was
classified under "Chronic Brain Syndrome associated with intra-
cranial infection other than syphilis" in DSM-I.)
292.3 Psychosis with other and unspecified encephalitis
This category includes disorders attributed to encephalitic infections
other than epidemic encephalitis and also to encephalitis not other-
wise specified. 1 When possible the type of infection should be in-
dicated. If not of psychotic proportion, the disorder is classified under
Non-psychotic OBS with intracranial infection.
292.9 Psychosis with other [and unspecified]
intracranial infection
This category includes all acute and chronic conditions due to non-
syphilitic and non-encephalitic infections, such as meningitis and
1
A list of important encephalitides may be found in "A Guide to the Control
of Mental Disorders," American Public Health Association Inc., New York
1962, pp. 40 ff.28
MENTAL DISORDERS
brain abscess. Many of these disorders will have been diagnosed as
the acute form early in the course of the illness. If not of psychotic
proportion, the disorder should be classified under Non-psychotic OBS
with intracranial injection. (In DSM-I the acute variety was clas-
sified as "Acute Brain Syndrome associated with intracranial in-
fection" and the chronic variety as "Chronic Brain Syndrome asso-
ciated with intracranial infection other than syphilis.")
293 Psychosis associated with other cerebral condition
This major category, as its name indicates, is for all psychoses asso-
ciated with cerebral conditions other than those previously defined. For
example, the degenerative diseases following do not include the previous
senile dementia. If the specific underlying physical condition is known,
indicate it with a separate, additional diagnosis.
293.0 Psychosis with cerebral arteriosclerosis
This is a chronic disorder attributed to cerebral arteriosclerosis. It
may be impossible to differentiate it from senile dementia and prer
senile dementia, which may coexist with it. Careful consideration of
the patient's age, history, and symptoms may help determine th
predominant pathology. Commonly, the organic brain syndrome is
the only mental disturbance present, but other reactions, such as
depression or anxiety, may be superimposed. If not of psychotic pro-
portion, the condition is classified under Non-psychotic OBS with
circulatory disturbance. (In DSM-I this was called "Chronic Brain
Syndrome associated with cerebral arteriosclerosis.")
293.1 Psychosis with other cerebrovascular disturbance
This category includes such circulatory disturbances as cerebral
thrombosis, cerebral embolism, arterial hypertension, cardio-renal
disease and cardiac disease, particularly in decompensation. It ex-
cludes conditions attributed to arteriosclerosis. The diagnosis is de-
termined by the underlying organ pathology, which should be speci-
fied with an additional diagnosis. (In DSM-I this category was di-
vided between "Acute Brain Syndrome associated with circulatory
disturbance" and "Chronic Brain Syndrome associated with circu-
latory disturbance other than cerebral arteriosclerosis.")
293.2 Psychosis with epilepsy
This category is to be used only for the condition associated with
"idiopathic" epilepsy. Most of the etiological agents underlying
chronic brain syndromes can and do cause convulsions, particularlyDEFINITIONS OF TERMS
29
syphilis, intoxication, trauma, cerebral arteriosclerosis, and intra-
cranial neoplasms. When the convulsions are symptomatic of such
diseases, the brain syndrome is classified under those disturbances
rather than here. The disturbance most commonly encountered here
is the clouding of consciousness before or after a convulsive attack.
Instead of a convulsion, the patient may show only a dazed reaction
with deep confusion, bewilderment and anxiety. The epileptic attack
may also take the form of an episode of excitement with hallucina-
tions, fears, and violent outbreaks. (In DSM-I this was included in
"Acute Brain Syndrome associated with convulsive disorder" and
"Chronic Brain Syndrome associated with convulsive disorder.")
293.3 Psychosis with intracranial neoplasm
Both primary and metastatic neoplasms are classified here. Reactions
to neoplasms other than in the cranium should not receive this
diagnosis. (In DSM-I this category included "Acute Brain Syndrome
associated with intracranial neoplasm" and "Chronic Brain Syndrome
associated with intracranial neoplasm.")
293.4 Psychosis with degenerative disease of the central nerv-
ous system
This category includes degenerative brain diseases not listed previous-
ly. (In DSM-I this was part of "Acute Brain Syndrome with disease
of unknown or uncertain cause" and "Chronic Brain Syndrome
associated with diseases of unknown or uncertain cause.")
293.5 Psychosis with brain trauma
This category includes those disorders which develop immediately
after severe head injury or brain surgery and the post-traumatic
chronic brain disorders. It does not include permanent brain dam-
age which produces only focal neurological changes without sig-
nificant changes in sensorium and affect. Generally, trauma pro-
ducing a chronic brain syndrome is diffuse and causes permanent
brain damage. If not of psychotic proportions, a post-traumatic per-
sonality disorder associated with an organic brain syndrome is clas-
sified as a Non-psychotic OBS with brain trauma. If the brain
injury occurs in early life and produces a developmental defect of
intelligence, the condition is also diagnosed Mental retardation. A head
injury may precipitate or accelerate the course of a chronic brain
disease, especially cerebral arteriosclerosis. The differential diagnosis
may be extremely difficult. If, before the injury, the patient had
symptoms of circulatory disturbance, particularly arteriosclerosis,30
MENTAL DISORDERS
and now shows signs of arteriosclerosis, he should be classified
Psychosis with cerebral artiosclerosis. (In DSM-I this category was
divided between "Acute Brain Syndrome associated with trauma"
and "Chronic Brain Syndrome associated with brain trauma.")
293.9 Psychosis with other [and unspecified] cerebral
condition
This category is for cerebral conditions other than those listed above,
and conditions for which it is impossible to make a more precise
diagnosis. [Medical record librarians will include here Psychoses with
cerebral condition, not otherwise specified.]
294 Psychosis associated with other physical condition
The following psychoses are caused by general systemic disorders
and are distinguished from the cerebral conditions previously described.
If the specific underlying physical condition is known, indicate it with a
separate, additional diagnosis.
294.0 Psychosis with endocrine disorder
This category includes disorders caused by the complications of dia-
betes other than cerebral arteriosclerosis and disorders of the thyroid,
pituitary, adrenals, and other endocrine glands. (In DSM-I "Chronic
Brain Syndrome associated with other disturbances of metabolism,
growth or nutrition" included the chronic variety of these disorders.
DSM-I defined these conditions as "disorders of metabolism" but they
here are considered endocrine disorders.)
294.1 Psychosis with metabolic or nutritional disorder
This category includes disorders caused by pellagra, avitaminosis and
metabolic disorders. (In DSM-I this was part of "Acute Brain Syn-
drome associated with metabolic disturbance" and "Chronic Brain
Syndrome associated with other disturbance of metabolism, growth
or nutrition.")
294.2 Psychosis with systemic infection
This category includes disorders caused by severe general systemic
infections, such as pneumonia, typhoid fever, malaria and acute
rheumatic fever. Care must be taken to distinguish these reactions
from other disorders, particularly manic depressive illness and schizo-
phrenia, which may be precipitated by even a mild attack of infectious
disease. (In DSM-I this was confined to "Acute Brain Syndrome as-
sociated with systemic infection.")DEFINITIONS OF TERMS
31
294.3 Psychosis with drug or poison intoxication (other than
alcohol)
This category includes disorders caused by some drugs (including
psychedelic drugs), hormones, heavy metals, gasses, and other in-
toxicants except alcohol. (In DSM-I these conditions were divided
between "Acute Brain Syndrome, drug or poison intoxication" and
"Chronic Brain Syndrome, associated with intoxication." The former
excluded alcoholic acute brain syndromes, while the latter included
alcoholic chronic brain syndromes.)
294.4 Psychosis with childbirth
Almost any type of psychosis may occur during pregnancy and the
post-partum period and should be specifically diagnosed. This cate-
gory is not a substitute for a differential diagnosis and excludes other
psychoses arising during the puerperium. Therefore, this diagnosis
should not be used unless all other possible diagnoses have been
excluded.
294.8 Psychosis with other and undiagnosed physical condition
This is a residual category for psychoses caused by physical condi-
tions other than those listed earlier. It also includes brain syndromes
caused by physical conditions which have not been diagnosed. (In
DSM-I this condition was divided between "Acute Brain Syndrome
of unknown cause" and "Chronic Brain Syndrome of unknown
cause." However, these categories also included the category now
called Psychosis with other [and unspecified] cerebral condition.)
[294.9 Psychosis with unspecified physical condition]
This is not a diagnosis but is included for use by medical record
librarians only.
II. B. NON-PSYCHOTIC ORGANIC BRAIN SYNDROMES (309)
309
Non-psychotic organic brain syndromes ((Mental disorders
not specified as psychotic associated with physical conditions))
This category is for patients who have an organic brain syndrome but
are not psychotic. If psychoses are present they should be diagnosed as
previously indicated. Refer to pages 22-23 for description of organic
brain syndromes in adults.
In children mild brain damage often manifests itself by hyperactivity,
short attention span, easy distractability, and impulsiveness. Some-32
MENTAL DISORDERS
times the child is withdrawn, listless, perseverative, and unresponsive.
In exceptional cases there may be great difficulty in initiating action.
These characteristics often contribute to a negative interaction be-
tween parent and child. If the organic handicap is the major etiological
factor and the child is not psychotic, the case should be classified here.
If the interactional factors are of major secondary importance, supply
a second diagnosis under Behavior disorders of childhood and ado-
lescence; if these interactional factors predominate give only a diagnosis
from this latter category.
309.0 Non-psychotic OBS with intracranial infection
309.1 Non-psychotic OBS with drug, poison, or systemic in-
toxication
390.13* Non-psychotic OBS with alcohol* (simple
drunkenness )
309.14* Non-psychotic OBS with other drug, poison,
or systemic intoxication*
309.2
309.3
309.4
309.5
Non-psychotic OBS with brain trauma
Non-psychotic OBS with circulatory disturbance
Non-psychotic OBS with epilepsy
Non-psychotic OBS with disturbance of metabolism,
growth or nutrition
309.6 Non-psychotic OBS with senile or pre-senile brain disease
309.7 Non-psychotic OBS with intracranial neoplasm
309.8 Non-psychotic OBS with degenerative disease of central
nervous system
309.9 Non-psychotic OBS with other [and unspecified] physi-
cal condition
[.91* Acute brain syndrome, not otherwise speci-
fied*]
[.92* Chronic brain syndrome, not otherwise speci-
fied*]
III. PSYCHOSES NOT ATTRIBUTED TO PHYSICAL CONDI-
TIONS LISTED PREVIOUSLY (295—298)
This major category is for patients whose psychosis is not caused by
physical conditions listed previously. Nevertheless, some of these pa-
tients may show additional signs of an organic condition. If these or-DEFINITIONS OF TERMS
33
ganic signs are prominent the patient should receive the appropriate ad-
ditional diagnosis.
295 Schizophrenia
This large category includes a group of disorders manifested by char-
acteristic disturbances of thinking, mood and behavior. Disturbances in
thinking are marked by alterations of concept formation which may
lead to misinterpretation of reality and sometimes to delusions and hal
lucinations, which frequently appear psychologically self-protective.
Corollary mood changes include ambivalent, constricted and inappro-
priate emotional responsiveness and loss of empathy with others. Be-
havior may be withdrawn, regressive and bizarre. The schizophrenias, in
which the mental status is attributable primarily to a thought disorder,
are to be distinguished from the Major affective illnesses (q.v.) which
are dominated by a mood disorder. The Paranoid states (q.v.) are dis-
tinguished from schizophrenia by the narrowness of their distortions of
reality and by the absence of other psychotic symptoms.
295.0 Schizophrenia, simple type
This psychosis is characterized chiefly by a slow and insidious re-
duction of external attachments and interests and by apathy and in-
difference leading to impoverishment of interpersonal relations, mental
deterioration, and adjustment on a lower level of functioning. In gen-
eral, the condition is less dramatically psychotic than are the hebe-
phrenic, catatonic, and paranoid types of schizophrenia. Also, it
contrasts with schizoid personality, in which there is little or no
progression of the disorder.
295.1 Schizophrenia, hebephrenic type
This psychosis is characterized by disorganized thinking, shallow and
inappropriate affect, unpredictable giggling, silly and regressive be-
havior and mannerisms, and frequent hypochondriacal complaints.
Delusions and hallucinations, if present, are transient and not well
organized.
295.2 Schizophrenia, catatonic type
295.23* Schizophrenia, catatonic type, excited*
295.24* Schizophrenia, catatonic type, withdrawn*
It is frequently possible and useful to distinguish two subtypes of
catatonic schizophrenia. One is marked by excessive and sometimes
violent motor activity and excitement and the other by generalized34
MENTAL DISORDERS
inhibition manifested by stupor, mutism, negativism, or waxy flex-
ibility. In time, some cases deteriorate to a vegetative state.
295.3 Schizophrenia, paranoid type
This type of schizophrenia is characterized primarily by the pres-
ence of persecutory or grandiose delusions, often associated with hal-
lucinations. Excessive religiosity is sometimes seen. The patient's at-
titude is frequently hostile and aggressive, and his behavior tends
to be consistent with his delusions. In general the disorder does
not manifest the gross personality disorganization of the hebephrenic
and catatonic types, perhaps because the patient uses the mech-
anism of projection, which ascribes to others characteristics he can-
not accept in himself. Three subtypes of the disorder may sometimes
be differentiated, depending on the predominant symptoms: hostile,
grandiose, and hallucinatory.
295.4 Acute schizophrenic episode
This diagnosis does not apply to acute episodes of schizophrenic
disorders described elsewhere. This condition is distinguished by
the acute onset of schizophrenic symptoms, often associated with
confusion, perplexity, ideas of reference, emotional turmoil, dream-
like dissociation, and excitement, depression, or fear. The acute
onset distinguishes this condition from simple schizophrenia. In time
these patients may take on the characteristics of catatonic, hebe-
phrenic or paranoid schizophrenia, in which case their diagnosis
should be changed accordingly. In many cases the patient recovers
within weeks, but sometimes his disorganization becomes progres-
sive. More frequently remission is followed by recurrence. (In DSM-I
this condition was listed as "Schizophrenia, acute undifferentiated
type.")
295.5 Schizophrenia, latent type
This category is for patients having clear symptoms of schizophrenia
but no history of a psychotic schizophrenic episode. Disorders some-
times designated as incipient, pre-psychotic, pseudoneurotic, pseudo-
psychopathic, or borderline schizophrenia are categorized here. (This
category includes some patients who were diagnosed in DSM-I under
"Schizophrenic reaction, chronic undifferentiated type." Others for-
merly included in that DSM-I category are now classified under
Schizophrenia, other [and unspecified] types (q.v.).)
295.6 Schizophrenia, residual type
This category is for patients showing signs of schizophrenia butDEFINITIONS OF TERMS
35
who, following a psychotic schizophrenic episode, are no longer psy-
chotic.
295.7 Schizophrenia, schizo-affective type
This category is for patients showing a mixture of schizophrenic
symptoms and pronounced elation or depression. Within this category
it may be useful to distinguish excited from depressed types as
follows:
295.73* Schizophrenia, schizo-affective type, excited*
295.74* Schizophrenia, schizo-affective type, depressed*
295.8* Schizophrenia, childhood type*
This category is for cases in which schizophrenic symptoms appear
before puberty. The condition may be manifested by autistic, atypical,
and withdrawn behavior; failure to develop identity separate from
the mother's; and general unevenness, gross immaturity and inade-
quacy in development. These developmental defects may result in
mental retardation, which should also be diagnosed. (This category
is for use in the United States and does not appear in ICD-8. It is
equivalent to "Schizophrenic reaction, childhood type" in DSM-I.)
295.90* Schizophrenia, chronic undifferentiated type*
This category is for patients who show mixed schizophrenic symp-
toms and who present definite schizophrenic thought, affect and be-
havior not classifiable under the other types of schizophrenia. It is
distinguished from Schizoid personality (q.v.). (This category is
equivalent to "Schizophrenic reaction, chronic undifferentiated type"
in DSM-I except that it does not include cases now diagnosed as
Schizophrenia, latent type and Schizophrenia, other [and unspecified]
types.)
295.99* Schizophrenia, other [and unspecified] types*
This category is for any type of schizophrenia not previously de-
scribed. (In DSM-I "Schizophrenic reaction, chronic undifferentiated
type" included this category and also what is now called Schizo-
phrenia, latent type and Schizophrenia, chronic undifferentiated type.)
296 Major affective disorders ((Affective psychoses))
This group of psychoses is characterized by a single disorder of mood,
either extreme depression or elation, that dominates the mental life
of the patient and is responsible for whatever loss of contact he has
with his environment. The onset of the mood does not seem to be36
MENTAL DISORDERS
related directly to a precipitating life experience and therefore is dis-
tinguishable from Psychotic depressive reaction and Depressive neurosis.
(This category is not equivalent to the DSM-I heading "Affective reac-
tions," which included "Psychotic depressive reaction.")
296.0 Involutional melancholia
This is a disorder occurring in the involutional period and character-
ized by worry, anxiety, agitation, and severe insomnia. Feelings of
guilt and somatic preoccupations are frequently present and may be
of delusional proportions. This disorder is distinguishable from Manic-
depressive illness (q.v.) by the absence of previous episodes; it is
distinguished from Schizophrenia (q.v.) in that impaired reality
testing is due to a disorder of mood; and it is distinguished from
Psychotic depressive reaction (q.v.) in that the depression is not
due to some life experience. Opinion is divided as to whether this
psychosis can be distinguished from the other affective disorders. It
is, therefore, recommended that involutional patients not be given this
diagnosis unless all other affective disorders have been ruled out. (In
DSM-I this disorder was included under "Disorders due to dis-
turbances of metabolism, growth, nutrition or endocrine function.")
Manic-depressive illnesses (Manic-depressive psychoses)
These disorders are marked by severe mood swings and a tendency
to remission and recurrence. Patients may be given this diagnosis in
the absence of a previous history of affective psychosis if there is no
obvious precipitating event. This disorder is divided into three
major subtypes: manic type, depressed type, and circular type.
296.1
Manic-depressive illness, manic type ((Manic-depres-
sive psychosis, manic type))
This disorder consists exclusively of manic episodes. These episodes
are characterized by excessive elation, irritability, talkativeness, flight
of ideas, and accelerated speech and motor activity. Brief periods of
depression sometimes occur, but they are never true depressive epi-
sodes.
296.2 Manic-depressive illness, depressed type ((Manic-depres-
sive psychosis, depressed type))
This disorder consists exclusively of depressive episodes. These
episodes are characterized by severely depressed mood and by mental
and motor retardation progressing occasionally to stupor. Uneasi-
ness, apprehension, perplexity and agitation may also be present.DEFINITIONS OF TERMS
37
When illusions, hallucinations, and delusions (usually of guilt or of
hypochondriacal or paranoid ideas) occur, they are attributable to
the dominant mood disorder. Because it is a primary mood dis-
order, this psychosis differs from the Psychotic depressive reaction,
which is more easily attributable to precipitating stress. Cases in-
completely labelled as "psychotic depression" should be classified
here rather than under Psychotic depressive reaction.
296.3 Manic-depressive illness, circular type ((Manic-depressive
psychosis, circular type))
This disorder is distinguished by at least one attack of both a de-
pressive episode and a manic episode. This phenomenon makes
clear why manic and depressed types are combined into a single cate-
gory. (In DSM-I these cases were diagnosed under "Manic depres-
sive reaction, other.") The current episode should be specified and
coded as one of the following:
296.33* Manic-depressive illness, circular type, manic*
296.34* Manic-depressive illness, circular type, depressed*
296.8 Other major affective disorder ((Affective psychosis,
other))
Major affective disorders for which a more specific diagnosis has not
been made are included here. It is also for "mixed" manic-depres-
sive illness, in which manic and depressive symptoms appear almost
simultaneously. It does not include Psychotic depressive reaction
(q.v.) or Depressive neurosis (q.v.). (In DSM-I this category was
included under "Manic depressive reaction, other.")
[296.9 Unspecified major affective disorder]
[Affective disorder not otherwise specified]
[Manic-depressive illness not otherwise specified]
297 Paranoid states
These are psychotic disorders in which a delusion, generally persecu-
tory or grandiose, is the essential abnormality. Disturbances in mood,
behavior and thinking (including hallucinations) are derived from this
delusion. This distinguishes paranoid states from the affective psy-
choses and schizophrenias, in which mood and thought disorders, re-
spectively, are the central abnormalities. Most authorities, however,
question whether disorders in this group are distinct clinical entities
and not merely variants of schizophrenia or paranoid personality.38
MENTAL DISORDERS
297.0 Paranoia
This extremely rare condition is characterized by gradual de-
velopment of an intricate, complex, and elaborate paranoid system
based on and often proceeding logically from misinterpretation of an
actual event. Frequently the patient considers himself endowed with
unique and superior ability. In spite of a chronic course the condi-
tion does not seem to interfere with the rest of the patient's thinking
and personality.
297.1 Involutional paranoid state ((Involutional paraphrenia))
This paranoid psychosis is characterized by delusion formation with
onset in the involutional period. Formerly it was classified as a para-
noid variety of involutional psychotic reaction. The absence of con-
spicuous thought disorders typical of schizophrenia distinguishes it
from that group.
297.9 Other paranoid state
This is a residual category for paranoid psychotic reactions not
classified earlier.
298 Other psychoses
298.0 Psychotic depressive reaction ((Reactive depressive psy-
chosis))
This psychosis is distinguished by a depressive mood attributable to
some experience. Ordinarily the individual has no history of re-
peated depressions or cyclothymic mood swings. The differentiation
between this condition and Depressive neurosis (q.v.) depends on
whether the reaction impairs reality testing or functional adequacy
enough to be considered a psychosis. (In DSM-I this condition was
included with the affective psychoses.)
[298.1 Reactive excitation]
[298.2 Reactive confusion]
[Acute or subacute confusional state]
[298.3 Acute paranoid reaction]
[298.9 Reactive psychosis, unspecified]
[299 Unspecified psychosis]
[Dementia, insanity or psychosis not otherwise specified]
This is not a diagnosis but is listed here for librarians and statis-
ticians to use in coding incomplete diagnoses. Clinicians areDEFINITIONS OF TERMS
39
expected to complete a differential diagnosis for patients who
manifest features of several psychoses.
IV. NEUROSES (300)
300 Neuroses
Anxiety is the chief characteristic of the neuroses. It may be felt and
expressed directly, or it may be controlled unconsciously and auto-
matically by conversion, displacement and various other psychological
mechanisms. Generally, these mechanisms produce symptoms experi-
enced as subjective distress from which the patient desires relief.
The neuroses, as contrasted to the psychoses, manifest neither gross
distortion or misinterpretation of external reality, nor gross personality
disorganization. A possible exception to this is hysterical neurosis,
which some believe may occasionally be accompanied by hallucinations
and other symptoms encountered in psychoses.
Traditionally, neurotic patients, however severely handicapped by their
symptoms, are not classified as psychotic because they are aware that
their mental functioning is disturbed.
300.0 Anxiety neurosis
This neurosis is characterized by anxious over-concern extending to
panic and frequently associated with somatic symptoms. Unlike
Phobic neurosis (q.v.), anxiety may occur under any circumstances
and is not restricted to specific situations or objects. This disorder
must be distinguished from normal apprehension or fear, which occurs
in realistically dangerous situations.
300.1 Hysterical neurosis
This neurosis is characterized by an involuntary psychogenic loss
or disorder of function. Symptoms characteristically begin and end
suddenly in emotionally charged situations and are symbolic of the
underlying conflicts. Often they can be modified by suggestion alone.
This is a new diagnosis that encompasses the former diagnoses "Con-
version reaction" and "Dissociative reaction" in DSM-I. This dis-
tinction between conversion and dissociative reactions should be
preserved by using one of the following diagnoses whenever pos-
sible.
300.13* Hysterical neurosis, conversion type*
In the conversion type, the special senses or voluntary nervous
system are affected, causing such symptoms as blindness, deafness,40
MENTAL DISORDERS
anosmia, anaesthesias, paraesthesias, paralyses, ataxias, akinesias,
and dyskinesias. Often the patient shows an inappropriate lack of
concern or belle indifference about these symptoms, which may
actually provide secondary gains by winning him sympathy or
relieving him of unpleasant responsibilities. This type of hysterical
neurosis must be distinguished from psychophysiologic disorders,
which are mediated by the autonomic nervous system; from malin-
gering, which is done consciously; and from neurological lesions,
which cause anatomically circumscribed symptoms.
300.14* Hysterical neurosis, dissociative type*
In the dissociative type, alterations may occur in the patient's state
of consciousness or in his identity, to produce such symptoms as
amnesia, somnambulism, fugue, and multiple personality.
300.2 Phobic neurosis
This condition is characterized by intense fear of an object or situ-
ation which the patient consciously recognizes as no real danger to
him. His apprehension may be experienced as faintness, fatigue, palpi-
tations, perspiration, nausea, tremor, and even panic. Phobias are
generally attributed to fears displaced to the phobic object or situa-
tion from some other object of which the patient is unaware. A wide
range of phobias has been described.
300.3 Obsessive compulsive neurosis
This disorder is characterized by the persistent intrusion of unwanted
thoughts, urges, or actions that the patient is unable to stop. The
thoughts may consist of single words or ideas, ruminations, or trains
of thought often perceived by the patient as nonsensical. The actions
vary from simple movements to complex rituals such as repeated
handwashing. Anxiety and distress are often present either if the
patient is prevented from completing his compulsive ritual or if he is
concerned about being unable to control it himself.
300.4 Depressive neurosis
This disorder is manifested by an excessive reaction of depression
due to an internal conflict or to an identifiable event such as the loss
of a love object or cherished possession. It is to be distinguished from
Involutional melancholia (q.v.) and Manic-depressive illness (q.v.).
Reactive depressions or Depressive reactions are to be classified here.
300.5 Neurasthenic neurosis ((Neurasthenia))
This condition is characterized by complaints of chronic weakness,DEFINITIONS OF TERMS
41
easy fatigability, and sometimes exhaustion. Unlike hysterical neurosis
the patient's complaints are genuinely distressing to him and there
is no evidence of secondary gain. It differs from Anxiety neurosis
(q.v.) and from the Psychophysiologic disorders (q.v.) in the
nature of the predominant complaint. It differs from Depressive neu-
rosis (q.v.) in the moderateness of the depression and in the chron-
icity of its course. (In DSM-I this condition was called "Psycho-
physiologic nervous system reaction.")
300.6 Depersonalization neurosis ((Depersonalization syn-
drome))
This syndrome is dominated by a feeling of unreality and of es-
trangement from the self, body, or surroundings. This diagnosis should
not be used if the condition is part of some other mental disorder,
such as an acute situational reaction. A brief experience of deper-
sonalization is not necessarily a symptom of illness.
300.7 Hypochonclriacal neurosis
This condition is dominated by preoccupation with the body and
with fear of presumed diseases of various organs. Though the fears
are not of delusional quality as in psychotic depressions, they per-
sist despite reassurance. The condition differs from hysterical neurosis
in that there are no actual losses or distortions of function.
300.8 Other neurosis
This classification includes specific psychoneurotic disorders not
classified elsewhere such as "writer's cramp" and other occupational
neuroses. Clinicians should not use this category for patients with
"mixed" neuroses, which should be diagnosed according to the pre-
dominant symptom.
[300.9 Unspecified neurosis]
This category is not a diagnosis. It is for the use of record librarians
and statisticians to code incomplete diagnoses.
V. PERSONALITY DISORDERS AND CERTAIN OTHER NON-
PSYCHOTIC MENTAL DISORDERS (301—304)
301 Personality disorders
This group of disorders is characterized by deeply ingrained maladaptive
patterns of behavior that are perceptibly different in quality from psy-
chotic and neurotic symptoms. Generally, these are life-long patterns,
often recognizable by the time of adolescence or earlier. Sometimes the42
MENTAL DISORDERS
pattern is determined primarily by malfunctioning of the brain, but
such cases should be classified under one of the non-psychotic organic
brain syndromes rather than here. (In DSM-I "Personality Disorders"
also included disorders now classified under Sexual deviation, Alco-
holism, and Drug dependence.)
301.0 Paranoid personality
This behavioral pattern is characterized by hypersensitivity, rigidity,
unwarranted suspicion, jealousy, envy, excessive self-importance,
and a tendency to blame others and ascribe evil motives to them.
These characteristics often interfere with the patient's ability to main-
tain satisfactory interpersonal relations. Of course, the presence of
suspicion of itself does not justify this diagnosis, since the suspicion
may be warranted in some instances.
301.1 Cyclothymic personality ((Affective personality))
This behavior pattern is manifested by recurring and alternating
periods of depression and elation. Periods of elation may be marked
by ambition, warmth, enthusiasm, optimism, and high energy. Periods
of depression may be marked by worry, pessimism, low energy, and
a sense of futility. These mood variations are not readily attributable
to external circumstances. If possible, the diagnosis should specify
whether the mood is characteristically depressed, hypomanic, or
alternating.
301.2 Schizoid personality
This behavior pattern manifests shyness, over-sensitivity, seclusive-
ness, avoidance of close or competitive relationships, and often
eccentricity. Autistic thinking without loss of capacity to recognize
reality is common, as is daydreaming and the inability to express
hostility and ordinary aggressive feelings. These patients react to
disturbing experiences and conflicts with apparent detachment.
301.3 Explosive personality (Epileptoid personality disorder)
This behavior pattern is characterized by gross outbursts of rage or
of verbal or physical aggressiveness. These outbursts are strikingly
different from the patient's usual behavior, and he may be regretful
and repentant for them. These patients are generally considered
excitable, aggressive and over-responsive to environmental pressures.
It is the intensity of the outbursts and the individual's inability to
control them which distinguishes this group. Cases diagnosed as
"aggressive personality" are classified here. If the patient is amnesicDEFINITIONS OF TERMS
43
for the outbursts, the diagnosis of Hysterical neurosis, Non-psychotic
OBS with epilepsy or Psychosis with epilepsy should be considered.
301.4 Obsessive compulsive personality ((Anankastic person-
ality))
This behavior pattern is characterized by excessive concern with
conformity and adherence to standards of conscience. Consequently,
individuals in this group may be rigid, over-inhibited, over-con-
scientious, over-dutiful, and unable to relax easily. This disorder may
lead to an Obsessive compulsive neurosis (q.v.), from which it must
be distinguished.
301.5 Hysterical personality (Histrionic personality disorder)
These behavior patterns are characterized by excitability, emotional
instability, over-reactivity, and self-dramatization. This self-drama-
tization is always attention-seeking and often seductive, whether or
not the patient is aware of its purpose. These personalities are also
immature, self-centered, often vain, and usually dependent on others.
This disorder must be differentiated from Hysterical neurosis (q.v.).
301.6 Asthenic personality
This behavior pattern is characterized by easy fatigability, low energy
level, lack of enthusiasm, marked incapacity for enjoyment, and
oversensitivity to physical and emotional stress. This disorder must
be differentiated from Neurasthenic neurosis (q.v.).
301.7 Antisocial personality
This term is reserved for individuals who are basically unsocialized
and whose behavior pattern brings them repeatedly into conflict with
society. They are incapable of significant loyalty to individuals, groups,
or social values. They are grossly selfish, callous, irresponsible,
impulsive, and unable to feel guilt or to learn from experience and
punishment. Frustration tolerance is low. They tend to blame others
or offer plausible rationalizations for their behavior. A mere history
of repeated legal or social offenses is not sufficient to justify this
diagnosis. Group delinquent reaction of childhood (or adolescence)
(q.v.), and Social maladjustment without manifest psychiatric dis-
order (q.v.) should be ruled out before making this diagnosis.
301.81* Passive-aggressive personality*
This behavior pattern is characterized by both passivity and ag-
gressiveness. The aggressiveness may be expressed passively, for
example by obstructionism, pouting, procrastination, intentional in-44
MENTAL DISORDERS
efficiency, or stubborness. This behavior commonly reflects hostility
which the individual feels he dare not express openly. Often the
behavior is one expression of the patient's resentment at failing to
find gratification in a relationship with an individual or institution
upon which he is over-dependent.
301.82* Inadequate personality*
This behavior pattern is characterized by ineffectual responses to
emotional, social, intellectual and physical demands. While the
patient seems neither physically nor mentally deficient, he does
manifest inadaptability, ineptness, poor judgment, social instability,
and lack of physical and emotional stamina.
301.89* Other personality disorders of specified types (Im-
mature personality ) *
301.9 [Unspecified personality disorder]
302 Sexual deviations
This category is for individuals whose sexual interests are directed
primarily toward objects other than people of the opposite sex, to-
ward sexual acts not usually associated with coitus, or toward coitus
performed under bizarre circumstances as in necrophilia, pedophilia,
sexual sadism, and fetishism. Even though many find their practices
distasteful, they remain unable to substitute normal sexual behavior
for them. This diagnosis is not appropriate for individuals who per-
form deviant sexual acts because normal sexual objects are not
available to them.
302.0 Homosexuality
302.1 Fetishism
302.2 Pedophilia
302.3 Transvestitism
302.4 Exhibitionism
302.5* Voyeurism*
302.6* Sadism*
302.7* Masochism*
302.8 Other sexual deviation
[302.9 Unspecified sexual deviation]DEFINITIONS OF TERMS
45
303 Alcoholism
This category is for patients whose alcohol intake is great enough to
damage their physical health, or their personal or social functioning, or
when it has become a prerequisite to normal functioning. If the alcohol-
ism is due to another mental disorder, both diagnoses should be made.
The following types of alcoholism are recognized:
303.0 Episodic excessive drinking
If alcoholism is present and the individual becomes intoxicated as
frequently as four times a year, the condition should be classified
here. Intoxication is defined as a state in which the individual's co-
ordination or speech is definitely impaired or his behavior is clearly
altered.
303.1 Habitual excessive drinking
This diagnosis is given to persons who are alcoholic and who either
become intoxicated more than 12 times a year or are recognizably
under the influence of alcohol more than once a week, even though
not intoxicated.
303.2 Alcohol addiction
This condition should be diagnosed when there is direct or strong
presumptive evidence that the patient is dependent on alcohol. If
available, the best direct evidence of such dependence is the appear-
ance of withdrawal symptoms. The inability of the patient to go one
day without drinking is presumptive evidence. When heavy drinking
continues for three months or more it is reasonable to presume addic-
tion to alcohol has been established.
303.9 Other [and unspecified] alcoholism
304 Drug dependence
This category is for patients who are addicted to or dependent on
drugs other than alcohol, tobacco, and ordinary caffeine-containing
beverages. Dependence on medically prescribed drugs is also excluded
so long as the drug is medically indicated and the intake is proportionate
to the medical need. The diagnosis requires evidence of habitual use
or a clear sense of need for the drug. Withdrawal symptoms are not
the only evidence of dependence; while always present when opium
derivatives are withdrawn, they may be entirely absent when cocaine
or marihuana are withdrawn. The diagnosis may stand alone or be
coupled with any other diagnosis.46
MENTAL DISORDERS
304.0 Drug dependence, opium, opium alkaloids and their de-
rivatives
304.1 Drug dependence, synthetic analgesics with morphine-
like effects
304.2 Drug dependence, barbiturates
304.3 Drug dependence, other hypnotics and sedatives or
"tranquilizers"
304.4 Drug dependence, cocaine
304.5 Drug dependence, Cannabis saliva (hashish, marihuana)
304.6 Drug dependence, other psycho-stimulants (ampheta-
mines, etc.)
304.7 Drug dependence, hallucinogens
304.8 Other drug dependence
[304.9 Unspecified drug dependence]
VI. PSYCHOPHYSIOLOGIC DISORDERS (305)
305 Psychophysiologic disorders ((Physical disorders of presum-
ably psychogenic origin))
This group of disorders is characterized by physical symptoms that
are caused by emotional factors and involve a single organ system,
usually under autonomic nervous system innervation. The physiological
changes involved are those that normally accompany certain emotional
states, but in these disorders the changes are more intense and sus-
tained. The individual may not be consciously aware of his emotional
state. If there is an additional psychiatric disorder, it should be
diagnosed separately, whether or not it is presumed to contribute to the
physical disorder. The specific physical disorder should be named and
classified in one of the following categories.
305.0 Psychophysiologic skin disorder
This diagnosis applies to skin reactions such as neurodermatosis,
pruritis, atopic dematitis, and hyperhydrosis in which emotional
factors play a causative role.
305.1 Psychophysiologic musculoskeletal disorder
This diagnosis applies to musculoskeletal disorders such as backache,DEFINITIONS OF TERMS
47
muscle cramps, and myalgias, and tension headaches in which emo-
tional factors play a causative role. Differentiation from hysterical
neurosis is of prime importance and at times extremely difficult.
305.2 Psychophysiologic respiratory disorder
This diagnosis applies to respiratory disorders such as bronchial
asthma, hyperventilation syndromes, sighing, and hiccoughs in which
emotional factors play a causative role.
305.3 Psychophysiologic cardiovascular disorder
This diagnosis applies to cardiovascular disorders such as paroxysmal
tachycardia, hypertension, vascular spasms, and migraine in which
emotional factors play a causative role.
305.4 Psychophysiologic hemic and lymphatic disorder
Here may be included any disturbances in the hemic and lymphatic
system in which emotional factors are found to play a causative
role. ICD-8 has included this category so that all organ systems will
be covered.
305.5 Psychophysiologic gastro-intestinal disorder
This diagnosis applies to specific types of gastrointestinal disorders
such as peptic ulcer, chronic gastritis, ulcerative or mucous colitis,
constipation, hyperacidity, pylorospasm, "heartburn," and "irritable
colon " in which emotional factors play a causative role.
305.6 Psychophysiologic genito-urinary disorder
This diagnosis applies to genito-urinary disorders such as disturbances
in menstruation and micturition, dyspareunia, and impotence in
which emotional factors play a causative role.
305.7 Psychophysiologic endocrine disorder
This diagnosis applies to endocrine disorders in which emotional
factors play a causative role. The disturbance should be specified.
305.8 Psychophysiologic disorder of organ of special sense
This diagnosis applies to any disturbance in the organs of special
sense in which emotional factors play a causative role. Conversion
reactions are excluded.
305.9 Psychophysiologic disorder of other type
VH. SPECIAL SYMPTOMS (306)
306 Special symptoms not elsewhere classified
This category is for the occasional patient whose psychopathology is48
MENTAL DISORDERS
manifested by a single specific symptom. An example might be anorexia
nervosa under Feeding disturbance as listed below. It does not apply,
however, if the symptom is the result of an organic illness or defect
or other mental disorder. For example, anorexia nervosa due to schizo-
phrenia would not be included here.
306.0 Speech disturbance
306.1 Specific learning disturbance
306.2 Tic
306.3 Other psychomotor disorder
306.4 Disorder of sleep
306.5 Feeding disturbance
306.6 Enuresis
306.7 Encopresis
306.8 Cephalalgia
306.9 Other special symptom
VIII. TRANSIENT SITUATIONAL DISTURBANCES (307)
307* Transient situational disturbances 1
This major category is reserved for more or less transient disorders
of any severity (including those of psychotic proportions) that occur
in individuals without any apparent underlying mental disorders and
that represent an acute reaction to overwhelming environmental stress.
A diagnosis in this category should specify the cause and manifestations
of the disturbance so far as possible. If the patient has good adaptive
capacity his symptoms usually recede as the stress diminishes. If, how-
ever, the symptoms persist after the stress is removed, the diagnosis
of another mental disorder is indicated. Disorders in this category are
classified according to the patient's developmental stage as follows:
1
The terms included under DSM-II Category 307*, "Transient situational dis-
turbances," differ from those in Category 307 of the ICD. DSM-II Category
307*, "Transient situational disturbances," contains adjustment reactions of in-
fancy (307.0*), childhood (307.1*), adolescence (307.2*), adult life (307.3*),
and late life (307.4*). ICD Category 307, "Transient situational disturbances,"
includes only the adjustment reactions of adolescence, adult life and late life.
ICD 308, "Behavioral disorders of children," contains the reactions of infancy
and childhood. These differences must be taken into account in preparing statisti-
cal tabulations to conform to ICD categories.DEFINITIONS OF TERMS
49
307.0* Adjustment reaction of infancy*
Example: A grief reaction associated with separation from patient's
mother, manifested by crying spells, loss of appetite and severe
social withdrawal.
307.1* Adjustment reaction of childhood*
Example: Jealousy associated with birth of patient's younger brother
and manifested by nocturnal enuresis, attention-getting behavior,
and fear of being abandoned.
307.2* Adjustment reaction of adolescence*
Example: Irritability and depression associated with school failure
and manifested by temper outbursts, brooding and discouragement.
307.3* Adjustment reaction of adult life*
Example: Resentment with depressive tone associated with an un-
wanted pregnancy and manifested by hostile complaints and suicidal
gestures.
Example: Fear associated with military combat and manifested by
trembling, running and hiding.
Example: A Ganser syndrome associated with death sentence and
manifested by incorrect but approximate answers to questions.
307.4* Adjustment reaction of late life*
Example: Feelings of rejection associated with forced retirement and
manifested by social withdrawal.
IX. BEHAVIOR DISORDERS OF CHILDHOOD AND ADOLES-
CENCE (308)
308* Behavior disorders of childhood and adolescence ((Behavior
disorders of childhood)) 2
This major category is reserved for disorders occurring in childhood
and adolescence that are more stable, internalized, and resistant to
2
The terms included under DSM-II Category 308*, "Behavioral disorders of
childhood and adolescence," differ from those in Category 308 of the ICD.
DSM-II Category 308* includes "Behavioral disorders of childhood and adol-
escence," whereas ICD Category 308 includes only "Behavioral disorders of
childhood." DSM-II Category 308* does not include "Adjustment reactions of
infancy and childhood," whereas ICD Category 308 does. In the DSM-II classifi-
cation, "Adjustment reactions of infancy and childhood" are allocated to 307*
(Transitional situational disturbances). These differences should be taken into
account in preparing statistical tabulations to conform to the ICD categories.50
MENTAL DISORDERS
treatment than Transient situational disturbances (q.v.) but less so than
Psychoses, Neuroses, and Personality disorders (q.v.). This intermediate
stability is attributed to the greater fluidity of all behavior at this age.
Characteristic manifestations include such symptoms as overactivity,
inattentiveness, shyness, feeling of rejection, over-aggressiveness, timid-
ity, and delinquency.
308.0* Hyperkinetic reaction of childhood (or adolescence)*
This disorder is characterized by overactivity, restlessness, distracti-
bility, and short attention span, especially in young children; the
behavior usually diminishes in adolescence.
If this behavior is caused by organic brain damage, it should be
diagnosed under the appropriate non-psychotic organic brain syn-
drome (q.v.).
308.1* Withdrawing reaction of childhood (or adolescence)*
This disorder is characterized by seclusiveness, detachment, sensi-
tivity, shyness, timidity, and general inability to form close inter-
personal relationships. This diagnosis should be reserved for those
who cannot be classified as having Schizophrenia (q.v.) and whose
tendencies toward withdrawal have not yet stabilized enough to
justify the diagnosis of Schizoid personality (q.v.).
308.2* Overanxious reaction of childhood (or adolescence)*
This disorder is characterized by chronic anxiety, excessive and
unrealistic fears, sleeplessness, nightmares, and exaggerated autonomic
responses. The patient tends to be immature, self-conscious, grossly
lacking in self-confidence, conforming, inhibited, dutiful, approval-
seeking, and apprehensive in new situations and unfamiliar surround-
ings. It is to be distinguished from Neuroses (q.v.).
308.3* Runaway reaction of childhood (or adolescence)*
Individuals with this disorder characteristically escape from threaten-
ing situations by running away from home for a day or more without
permission. Typically they are immature and timid, and feel rejected
at home, inadequate, and friendless. They often steal furtively.
308.4* Unsocialized aggressive reaction of childhood (or ado-
lescence ) *
This disorder is characterized by overt or covert hostile disobedience,
quarrelsomeness, physical and verbal aggressiveness, vengefulness,
and destructiveness. Temper tantrums, solitary stealing, lying, andDEFINITIONS OF TERMS
51
hostile teasing of other children are common. These patients usually
have no consistent parental acceptance and discipline. This diagnosis
should be distinguished from Antisocial personality (q.v.), Runaway
reaction of childhood (or adolescence) (q.v.), and Group delinquent
reaction of childhood (or adolscence) (q.v.).
308.5* Group delinquent reaction of childhood (or adoles-
cence ) *
Individuals with this disorder have acquired the values, behavior,
and skills of a delinquent peer group or gang to whom they are loyal
and with whom they characteristically steal, skip school, and stay
out late at night. The condition is more common in boys than girls.
When group delinquency occurs with girls it usually involves sexual
delinquency, although shoplifting is also common.
308.9* Other reaction of childhood (or adolescence)*
Here are to be classified children and adolescents having disorders
not described in this group but which are nevertheless more serious
than transient situational disturbances and less serious than psychoses,
neuroses, and personality disorders. The particular disorder should
be specified.
X. CONDITIONS WITHOUT MANIFEST PSYCHIATRIC DIS-
ORDER AND NON-SPECIFIC CONDITIONS (316*—318* )
316* Social maladjustments without manifest psychiatric dis-
order
This category is for recording the conditions of individuals who are
psychiatrically normal but who nevertheless have severe enough prob-
lems to warrant examination by a psychiatrist. These conditions may
either become or precipitate a diagnosable mental disorder.
316.0* Marital maladjustment*
This category is for individuals who are psychiatrically normal but
who have significant conflicts or maladjustments in marriage.
316.1* Social maladjustment*
This category is for individuals thrown into an unfamiliar culture
(culture shock) or into a conflict arising from divided loyalties to
two cultures.52
MENTAL DISORDERS
316.2* Occupational maladjustment*
This category is for psychiatrically normal individuals who are grossly
maladjusted in their work.
316.3* Dyssocial behavior*
This category is for individuals who are not classifiable as anti-social
personalities, but who are predatory and follow more or less criminal
pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope
peddlers. (DSM-I classified this condition as "Sociopathic personality
disorder, dyssocial type.")
316.9* Other social maladjustment*
317* Non-specific conditions*
This category is for conditions that cannot be classified under any
of the previous categories, even after all facts bearing on the case have
been investigated. This category is not for "Diagnosis deferred" (q.v.).
318* No mental disorder*
This term is used when, following psychiatric examination, none of the
previous disorders is found. It is not to be used for patients whose
disorders are in remission.
XI. NON-DIAGNOSTIC TERMS FOR ADMINISTRATIVE USE
(319*)
319* Non-diagnostic terms for administrative use*
319.0* Diagnosis deferred*
319.1* Boarder*
319.2* Experiment only*
319.9* Other*Section 4
STATISTICAL TABULATIONS
Statistical Reporting of Mental Disorders
Although the first edition of this Manual contained a section on
statistical reporting of mental disorders, this Manual does not. Since
1952 considerable progress has been made on the development of
methods and programs for collection and analysis of statistical data
on the diagnostic characteristics of patients under treatment in various
types of psychiatric services. Guides to the development of such systems
may be found in a variety of publications that describe procedures for
record keeping in mental hospitals and outpatient facilities, the develop-
ment of statistical reporting programs on patient movement in such
facilities, the processing of these data for statistical tabulation and the
uses that can be made of such data. Several of these publications are
issued by the Biometry Branch of the National Institute of Mental
Health, Chevy Chase, Maryland, and are available upon request (7,
9, 10, 11). Other manuals and publications can be obtained from the
mental health and mental hospital authorities of the various states.
The next few years will undoubtedly witness further progress in this
field as a result of the increasing use of automated data processing
methods in mental hospitals, general hospitals and other facilities
where psychiatric services are provided. These methods will make it
possible to introduce further improvements into the management and
use of records for improved patient care and facilitate greatly the
preparation of more extensive statistics on the diagnostic and related
characteristics of the patients under care in psychiatric facilities.
The following references will be found helpful:
1. Computer Techniques in Patient Care, IBM Application Brief, 1966.
2. Crowley, J. F.: Information Processing for Mental Hospitals, 8th IBM
Medical Symposium, Poughkeepsie, N. Y. Apr. 3-7, 1967.
3. Eiduson, B. T., Brooke, S. H., Motto, R. L.: A Generalized Psychiatric
Information Processing System, Behavioral Science, Vol. 11, 1966, 133-145.
4. Eiduson, B. T., Brooke, S. H., Motto, R. L., Platz, A. and Carmichael, R.:
Recent Developments in the Psychiatric Case History Event System, Be-
havioral Science, Vol. 12, 1967, 254-271.
5. Glueck, B. C., Jr.: The Use of Computers in Patient Care, Hospital &
Community Psychiatry, April 1965.
5354
MENTAL DISORDERS
6. Kline, N. S. and Laska, E., Editor: Computer and Other Electronic Devices
in Psychiatry, Grune and Stratton, New York, 1968.
7. Kramer, M. and Nemec, F. C.: A Guide to Recordkeeping in Mental
Hospitals. U. S. Gov. Printing Office, 1965.
8. Laska, E. M., Weinstein, A. S., Logemann, G., Bank, R., and Brewer, F.:
The Use of Computers at a State Psychiatric Hospital, Comprehensive
Psychiatry, Vol. 8, 1967, pp. 476-490.
9. Outpatient Studies Section, Biometry Branch, NIMH: Instructions for
Reporting Services to Patients by Outpatient Psychiatric Clinics, Rev.
March 1964.
10. Person, P. H., Jr.: Processing Guide for Mental Hospital Data, DHEW,
PHS Publication No. 1117, reprinted 1966.
11. Phillips, Wm. Jr. and Bahn, A. K.: Computer Processing in the Maryland
Psychiatric Case Register. (Presented at the Public Health Records and
Statistics Conference, Washington, D. C., June 1966). (Mimeographed).
12. Steck, C. G. and Yoder, R. D.: The Tulane Psychiatric Information System,
Annual Meeting of the American Psychiatric Association 1966.
Tabulation of Multiple Diagnoses
Statistical tabulations of diagnostic characteristics of patients admitted
to psychiatric facilities have usually been prepared on the basis of the
concept of the underlying or primary psychiatric disorder. Thus, official
morbidity statistics on the mentally ill under care in psychiatric
facilities are based on a single mental disorder for each patient, that
is, the primary disorder. The tables reporting these statistics provide
distributions of patients by their primary disorder, disregarding other
disorders that may be recorded as associated with the underlying one.
The recording of multiple diagnoses on a single patient makes it
possible to obtain more extensive information on the simultaneous
occurrence of more than one mental disorder. This is particularly
important in providing more information on the occurrence of disorders
such as alcoholism and drug dependence among persons with specific
types of psychoses, neuroses, and personality disorders.
Principles for recording multiple diagnoses are given on pages 2-3.
It is recommended that, in addition to recording multiple disorders
in conformity with these principles, the diagnostician underscore that
disorder on the patient's record which he considers the underlying one.
This will make it possible to develop tabulations of diagnostic charac-
teristics of patients that will maintain some continuity with existing
time series for admissions to mental hospitals based on the underlying
disorder.TABULATIONS
55
The recording of multiple psychiatric diagnoses poses a series of new
problems for the mental health statistician to solve in relation to the
preparation of statistical tabulations on the diagnostic characteristics
of patients. The development of tabulations that reveal facts about
patterns of occurrence of various combinations of mental disorders
among patients admitted to specific types of psychiatric facilities re-
quires that ICD codes be assigned to each such diagnosis recorded on a
patient's chart, and that each of these codes, as well as the total number
of diagnoses, be transferred to a punch card, computer tape or disc.
A tabulating procedure must then be developed which makes it possible
to detect all patients with a given diagnosis, regardless of whether it is
recorded as a first, second, third, or subsequent diagnosis. As yet, no
experience is available to indicate the maximum number of diagnoses
of mental disorders that are likely to appear on a record.
Tabulation of combinations of disorders appearing on patients'
records can be prepared in a number of different ways, depending on the
question the tabulation is designed to answer. The following illustrate
some possible tabulations for annual admissions to a mental hospital:
Table 1 provides an overall statement of the number of times a given
diagnosis appears and whether it was recorded as a first diagnosis only,
a first diagnosis in combination with one or more other psychiatric
diagnoses, or as a second or subsequent diagnosis.
Table 2 presents a distribution of each mental disorder by age and
sex according to:
1. The total number of times the mental disorder is listed on the
patients' records as a first diagnosis, subdivided by:
1.1 The number of times the condition appears as the only
mental disorder on the patient's record.
1.2 The number of times the condition appears as the first
diagnosis with one or more additional mental disorders.
2. The total number of times the mental disorder appears on a
record either as a first or additional diagnosis. This is equal to
the total number of admission records in which the diagnosis is
listed.
Table 3 presents a distribution of the frequency with which a given
diagnosis was recorded as a second or subsequent diagnosis, in relation
to the first diagnosis listed on patient's record. These counts are based
on the number of diagnoses recorded on the records of all patients
with two or more diagnoses.56
MENTAL DISORDERS
Another series of tabulations can be carried out to determine the
combinations of disorders that can occur among a selected number of
disorders. Thus, a set of three disorders—A, B, C,—can be specified.
A tabulation may be carried out to determine the frequency with which
disorders B and C occur in those instances where disorder A is listed
first. Another tabulation may be carried out to determine the frequency
with which disorder A occurs as an associated condition when disorder
B occurs first and when disorder C occurs first. Each of the preceding
tabulations may be further specified by age, sex, and other relevant
variables.
Similar sets of tabulations can be developed for annual admissions
to other types of facilities as well as of patients resident on a given day
in a specific type of facility, etc. These ideas may also be used in tabu-
lations of diagnostic data on cases detected in population surveys of
mental disorders.
The above deals with combinations of mental disorders with each
other. It is also possible to develop tabulations of mental disorders
occurring in combination with specific types of non-mental disorders.
The increasing use of general hospitals for the care of the mentally ill
and the integration of mental health services with other medical care
services in the community will provide additional opportunities to
explore the occurrence of various combinations of illnesses.THREE
SAMPLE TABLES
57Table 1. Number of times specified diagnosis appeared on record as the only mental disorder or in combination with other
mental disorders. Annual admissions, all State mental hospitals, in the State of
, 1968.
Diagnosis (ICD Code and Title)
(1)
290
291
292.0-.1
292.2-.9 1
293.0
293.1-.9
294.3
004.0 2
294.4-.9)
295'
296 '
297'
298
300'
301'
302
303
304
TOTAL
Senile and Presenile Dementia
Alcoholic Psychosis
Psychosis Associated with Syphilitic Infection
Psychosis with other Intracranial Infection
Psychosis with Cerebral Arteriosclerosis
Psychosis with other Cerebral Condition
Psychosis with Drug or Poison Intoxication
Psychosis with other Physical Condition (Excluding Alcohol)
Schizophrenia
Major Affective Disorders
Paranoid States
Other Psychoses
Neuroses
Personality Disorders
Sexual Deviations
Alcoholism
Drug Dependence
Number of Times Specified Mental Disorder Listed As
First Diagnosis
Total Number of
Second or
No Other With Other
Times Diagnosis
Total
Mental
Subsequent
Mental
Diagnosis
Listed
Disorder
Disorder
(3)=(4+5)
(4)
(5)
(6)
(2)=(3+6)305
Psychophysiologic Disorders
306
Special Symptoms
307
Transient Situational Disturbances
308
Behavior Disorders of Childhood and Adolescence
309' Non-psychotic Organic Brain Syndromes
31x.5 2
Mental Retardation, All Grades, with Chromosomal Abnormality
31x.72
following Major Psychiatric
D
31x.8 2
Mental Retardation, All Grades, with Psychosocial Deprivation
31x.6,61x.4
with Other Conditions
31x6, 31x.9
1
2
Specific disorders occurring within these groups may be tabulated separately.
This indicates the total for all grades of mental retardation within a given etiologic category. That is, the total of 310.5, 311.5,
312.5, 313.5, 314.5, 315.5 is represented as 31x.5. Similarly, 31x.7 is used to represent the total of 310.7, 311.7, 312.7, 313.7,
314.7, 315.7; etc. If desired, each grade of mental retardation for each etiologic category can be listed.Table 2. Distribution of each mental disorder as to whether it was first diagnosis or subsequent diagnosis. Numbers of persons
with diagnosis, selected diagnoses, by age, sex, and race. Annual admissions, State Mental Hospitals, State of
, 1968.
Diagnosis
(ICD Code and Title)
All Races — Both Sexes
290 Senile and Presenile Dementia
First Diagnosis
Alone
In Combination
Total Times Mentioned 1
291 Alcoholic Psychosis
First Diagnosis
Alone
In Combination
Total Times Mentioned 1
293 Psychosis with Cerebral Arteriosclerosis
First Diagnosis
Alone
In Combination
Total Times Mentioned 1
295 Schizophrenia
First Diagnosis
Alone
In Combination
Total Times Mentioned'
296 Major Affective Disorders
First Diagnosis
Age in Years
All
Ages
<5 br="">5-14
15-24
25-34
35-54
55-74
75 and
overAlone
In Combination
Total Times Mentioned'
300.0 Anxiety Neurosis
First Diagnosis
Alone
In Combination
Total Times Mentioned'
300.4 Depressive Neurosis
First Diagnosis
Alone
In Combination
Total Times Mentioned 1
300.1-.3
300.5-.9
303
All Other Neuroses
First Diagnosis
Alone
In Combination
Total Times Mentioned'
Alcoholism
First Diagnosis
Alone
In Combination
Total Times Mentioned 1
Other diagnoses may be added to above list.
Repeat for White Males, White Females, Nonwhite Males, Nonwhite Females.
1
The total times a single diagnosis is mentioned is equal to the total number of admission records with the diagnosis.
The total number of times a three-digit diagnostic category is mentioned is also equal to the total number of admission
records on which the diagnosis is recorded, except in those instances where the inclusions within the category are not
mutually independent.Table 3. Number of times a mental disorder mentioned as an additional diagnosis in relation to specified first diagnosis; all annual admis-
sions with two or more diagnoses on records, State Mental Hospitals, State of
, 1968.
Number of Times Specified ICD Code Appeared as an Additional
Diagnosis
First Diagnosis
(ICD Code & Title)
290
291
292.0-.1
292.2-.9 1
293.0
293.1-.9
294.3
2940-2'
TOTAL
Senile and Presenile Dementia
Alcoholic Psychosis
Psychosis Associated with Syphilitic
Infection
Psychosis with other Intracranial
Infection
Psychosis with Cerebral
Arteriosclerosis
Psychosis with other Cerebral Condition
Psychosis with Drug or Poison Intoxication
(Excluding Alcohol)
294.4-.9) Psychosis with other Physical Condition
295'
296'
297'
298
300 1 Schizophrenia
Major Affective Disorders
Paranoid States
Other Psychoses
Neuroses
Number of Number of
Admissions Diagnoses
290
292.2
293.1
292.0, to
to
291 292.1 292.9 293.0 293.9 294.3 294.0-.2
294.4-.9 295 296 297 298 300
incl.
incl.
etc.301'
302
303
304
305
306
307
308
309'
31x.5 2
31x.7 2
31x.8 2
Personality Disorders
Sexual Deviations
Alcoholism
Drug Dependence
Psychophysiologic Disorders
Special Symptoms
Transient Situational Disturbances
Behavior Disorders of Childhood
Non-Psychotic Organic Brain Syndromes
Mental Retardation, All Grades, with
Chromosomal Abnormality
Mental Retardation, All Grades, Following
Major Psychiatric Disorder
Mental Retardation, All Grades, with
Psychosocial Deprivation
Q1 v fi Q1 v /I ) ^
Mental Retardation, All Grades, with
31x.6,31x.9
Other Conditions
1 Specific disorders occurring within these groups may be tabulated separately.
2 This indicates the total for all grades of mental retardation within a given etiologic category. That is, the total of 310.5, 311.5, 312.5,
313.5, 314.5, 315.5 is represented at 31x.5. Similarly, 31x.7 is used to represent the total of 310.7, 311.7, 312.7, 313.7, 314.7, 315.7;
etc. If desired, each grade of mental retardation for each etiologic category can be listed.Section 5
COMPARATIVE LISTING OF TITLES AND CODES 1
Introduction to the Use of the Table
This section provides a cross reference between the titles and codes
used in this Manual (DSM-II) and those used in the previous Manual
(DSM-I).
The International Classification of Diseases consists of a basic code
of three digits (see Section 6 of this Manual) and a fourth digit for
achieving greater detail within each of the three-digit categories. The
APA Committee on Nomenclature and Statistics found it necessary to
add a fifth digit to the ICD code to obtain still further detail within
each four-digit ICD category for the mental disorders and to maintain
continuity with DSM-I. These fifth-digit codes are discussed on page 3
of Section 1. When statistics are produced for categories designated by
these five-digit codes, the codes for these categories should be clearly
earmarked as not part of the official ICD. In the following table all
such code numbers are identified with a single asterisk.
To facilitate the coding of all disorders, a zero (0) is used as the
fifth digit for those codes in which no special fifth digit is required.
Whenever a category in one manual corresponds to several categories
in the other, the latter categories are enclosed in one brace. If more
than one DSM-II diagnosis corresponds to a single DSM-I diagnosis,
the appropriate DSM-II diagnosis must be chosen.
Finally, selected additional ICD codes are indicated in parentheses
for use when detail is desired regarding the specific condition with which
a mental disorder is associated. For listing of non-psychiatric disorders
whose codes are referred to here, see Section 6 of this Manual.
1
Prepared by Morton Kramer, Sc.D., Chief, and Frances C. Nemec, Medical
Record Librarian, Biometry Branch, National Institute of Mental Health.
64TABLE: COMPARATIVE LISTING OF TITLES AND CODES, DSM-I and DSM-II
(Refer to preceding page concerning use of symbols)
DSM-I Code Numbers and Titles 1
DSM-II Code Numbers and Titles
01-09 ACUTE BRAIN DISORDERS
01 Acute Brain Syndrome associated with infection
01.0 Intracranial infection (except epidemic encephalitis) ..... 292.91* Psychosis with other [and unspecified] intracranial infec-
fection. Specify infection with additional code.
01.1 Epidemic encephalitis
292.21* Psychosis with epidemic encephalitis
01.2 With systemic infection, NEC
294.21* Psychosis with systemic infection. Specify infection with
additional code.
Acute Brain Syndrome associated with intoxication
291.01* Delirium tremens
02.1 Alcohol intoxication
91.21* Other alcoholic hallucinosis
291.41* Acute alcohol intoxication. Excludes simple drunkenness.
291.61* Pathological intoxication
02.2 Drug or poison intoxication (except alcohol)
294.31* Psychosis with drug or poison intoxication. Specify drug
or poison. Excludes alcoholic psychosis (291).
Acute Brain Syndrome associated with trauma
293.51* Psychosis with brain trauma. Specify type of trauma with
additional code (800-804; 850-854; 998).
293.11* Psychosis with other cerebrovascular disturbance. Specify
disturbance with additional code (430-436; 438).
Acute Brain Syndrome associated with circulatory disturbance 294.81* Psychosis with other and undiagnosed physical condition.
Specify circulatory disturbance with additional code (393-
429; 440-458).
Acute Brain Syndrome associated with convulsive disorder
293.21* Psychosis with epilepsy
02
03
04
05
1
The code numbers and titles referred to here are those found on pages 78-86 of DSM-I.DSM-I Code Numbers and Titles
DSM-II Code Numbers and Titles
Acute Brain Syndrome associated with metabolic disturbance .. 294.11* Psychosis with metabolic or nutritional disorder. Specify
disorder with additional code (240-279).
07
Acute Brain Syndrome associated with intracranial neoplasm _„ 293.31* Psychosis with intracranial neoplasm. Specify type of
neoplasm with additional code.
08
Acute Brain Syndrome with disease of unknown or uncertain
cause
293.41* Psychosis with degenerative disease of the central nervous
system. Specify disease with additional code.
294.81* Psychosis with other and undiagnosed physical condition.
brNSYENT
09kjdfjdsjifadskffadskfljadsklfaljakd
Specify condition with additional code.
[294.91* Psychosis with unspecified physical condition]
10-19 CHRONIC BRAIN DISORDERS
10
Chronic Brain Syndrome associated with diseases and condi-
tions due to prenatal (constitutional) influence
10.0 With congenital cranial anomaly
10.00 Without qualifying phrase
309.92* Non-psychotic OBS with other [and unspecified] physical
condition. Specify type of congenital cranial anomaly
with additional code (740-743).
10.01 With psychotic reaction
294.82* Psychosis with other and undiagnosed physical condition.
Specify type of congenital cranial anomaly with addition-
al code (740-743).
10.02 With neurotic reaction )
309.92* See above.
10.03 With behavioral reaction]
10.1 With congenital spastic paraplegia
10.10 Without qualifying phrase
309.22* Non-psychotic OBS with brain trauma. Specify congenital
spastic paraplegia with additional code (343).
06DSM-II Code Numbers and Titles
DSM-I Code Numbers and Titles
10.11
With psychotic reaction
10.12 With neurotic reaction )
10.13 With behavioral reaction j
10.2 With mongolism
10.20 Without qualifying phrase
10.21 With psychotic reaction
293.52* Psychosis with brain trauma. Specify congenital spastic
paraplegia with additional code (343).
309.22* See above.
309.92*
Non-psychotic DBS with other [and unspecified] physical
condition. Specify mongolism and degree of retardation
with an additional code (310.52, 311.52, 312.52, 313.52,
314.52, 315.52).
294.82* Psychosis with other and undiagnosed physical condition.
Specify mongolism and degree of retardation with an
3additional code (310.52, 311.52, 312.52, 313.52, 314.52,
10.22
10.23
10.3 Due to
10.30
With neurotic reaction )
With behavioral reaction j
prenatal maternal infectious diseases
Without qualifying phrase
10.31 With psychotic reaction
10.32 With neurotic reaction )
10.33 With behavioral reaction j
11
Chronic Brain Syndrome associated with central nervous
system syphilis
315.52).
309.92* See above.
Non-psychotic OBS with intracranial infection. Specify ma-
ternal infection with additional code (761).
lcode(761.
292.92* Psychosis with other [and unspecified] intracranial infec-
tion. Specify maternal infection with additional code
309.02* See above.
309.02*DSM-I Code Numbers and Titles
11.0
Meningoencephalitic
11.00 Without qualifying phrase
11.01 With psychotic reaction
11.02 With neurotic reaction j
11.03 With behavioral reaction
11.1 Meningovascular
11.10 Without qualifying phrase
11.12 With neurotic reaction )
11.13 With behavioral reaction j
Other central nervous system syphilis
11.20 Without qualifying phrase
11.21 With psychotic reaction .
11.22 With neurotic reaction
12
11.23 With behavioral reaction
309.02* Non-psychotic OBS with intracranial infection. Specify
syphilis of CNS with additional code (094.1).
292.02* Psychosis with general paralysis
309.02* See above.
309.02* Non-psychotic OBS with intracranial infection. Specify
other syphilis of CNS with additional code (094.9).
292.12* Psychosis with other syphilis of central nervous system.
11.11 With psychotic reaction
11.2
DSM-II Code Numbers and Titles
Specify other syphilis of CNS with additional code (094.9).
30902* See above
309.02* Non-psychotic OBS with intracranial infection. Specify
other syphilis of CNS with additional code (094.9).
292.12* Psychosis with other syphilis of central nervous system.
)
Specify other syphilis of CNS with additional code
(094.9).
309.02* See above.
Chronic Brain Syndrome associated with intracranial infection
other than syphilis
12.0 Epidemic encephalitis
12.00 Without qualifying phrase
309.02*
Non-psychotic OBS with intracranial infection. Specify en-
cephalitis with additional code (062-065)DSM-II Code Numbers and Titles
DSM-I Code Numbers and Titles
12.1
13
12.01 With psychotic reaction 292.22* Psychosis with epidemic encephalitis.
12.02
12.03 With neurotic reaction j
With behavioral reaction j 309.02* See above.
Other intracranial infections
12.10 Without qualifying phrase 309.02* Non-psychotic OBS with intracranial infection. Specify in-
12.11 With psychotic reaction 292.92* Psychosis with other [and unspecified] intracranial infec-
12.12
12.13 With neurotic reaction
j
With behavioral reaction j 309.02* See above.
Chronic Brain Syndrome associated with intoxication
13.0 Alcohol intoxication
13.00 Without qualifying phrase
13.01
With psychotic reaction
13.02 With neurotic reaction
id.Ud With behavioral reaction
13.1
fection with additional code.
tion. Specify infection with additional code.
No exact counterpart in DSM-II. Closest approximation is
291.52* (Alcohol deterioration).
291.12* Korsakov's psychosis (alcoholic)
291.32*
Alcohol
paramoid
state
291-52* Alcoholic deterioration*
No exact counterpart in DSM-II. Closest approximation is
291.52*
(Alcohol
detertoration)
Drug or poison intoxication, except alcohol
13.10
Without qualifying phrase
309.14* Non-psychotic OBS with other drug, poison, or systemic in-
toxication.* Excludes drug dependence (304). This code (304). This code
and title are used for both the acute and chronic forms
of the disorder. Specify drug or poison with additional
code (960-979; 981-989).DSM-I Code Numbers and Titles
13.11
14
With psychotic reaction
13.12 With neurotic reaction ]
13.13 With behavioral reaction j
Chronic Brain Syndrome associated with trauma
14.0 Birth trauma
14.00 Without qualifying phrase
14.01 With psychotic reaction
14.1
14.2
DSM-II Code Numbers and Titles
294.32* Psychosis with drug or poison intoxication. Excludes alcp-
coholic psychosis (291). Specify drug or poison with addi-
tional code (960-979; 981-989).
_ 309.14* See above.
Non-psychotic OBS with brain trauma. Specify type of birth
trauma with additional code (764.0, 765.0, 766.0, 767.0,
768.0, 772.0).
293.52* Psychosis with brain trauma. Specify type of birth trauma
with additional code (764.0, 765.0, 766.0, 767.0, 768.0,
772.0).
309.22* See above.
309.22*
14.02
14.03
Brain
14.10 With neurotic reaction )
With behavioral reaction j
Trauma, gross force
Without qualifying phrase 14.11 With psychotic reaction „ 293.52*
14.12 With neurotic action
)
14.13 With behavioral reaction |
Following brain operation
14.20 Without qualifying phrase 309.22*
309.22*
309.22*
Non-psychotic OBS with brain trauma. Specify type of
trauma with additional code (800-804; 850-854).
Psychosis with brain trauma. Specify type of trauma with
additional code (800-804; 850-854).
See above.
Non-psychotic OBS with brain trauma. Specify brain opera-
tion with additional code (998).DSM-I Code Numbers and Titles
14.21 With psychotic reaction
14.22 With neurotic reaction j
14.23 With behavioral reaction j
14.3 Following electrical brain trauma
14.30 Without qualifying phrase
14.31 With psychotic reaction
14.32 With neurotic reaction )
14.33 With behavioral reaction j
14.4 Following irradiational brain trauma
14.40 Without qualifying phrase
DSM-II Code Numbers and Titles
Psychosis with brain trauma. Specify brain operation with
additional code (998).
309.22* See above.
293.52*
309.22* See above. Specify type of trauma with additional code
(994.8).
293.52* Psychosis with brain trauma. Specify type of trauma with
additional code (994.8).
309.22* See above.
309.22*
14.41 With psychotic reaction 293.52*
14.42 With neurotic reaction j
14.43 With behavioral reaction j 309.22*
14.5 Following other trauma
14.50 Without qualifying phrase
14.51 With psychotic reaction
309.22*
293.52*
Non-psychotic OBS with brain trauma. Specify type of
trauma with additional code (990).
Psychosis with brain trauma. Specify type of trauma with
additional code (990).
See above.
Non-psychotic OBS with brain trauma. Specify type of
trauma with additional code.
Psychosis with brain trauma. Specify type of trauma with
additional code.DSM-I Code Numbers and Titles
14.52 With neurotic reaction
14.53 With behavioral reaction
DSM-II Code Numbers and Titles
309.22* See above.
15 Chronic Brain Syndrome associated with circulatory disturbance
15.0 With cerebral arteriosclerosis
15.00 Without qualifying phrase
309.32* Non-psychotic OBS with circulatory disturbance. Specify
cerebral arteriosclerosis with additional code (437).
15.01 With psychotic reaction
293.02* Psychosis with cerebral arteriosclerosis.
15.02 With neurotic reaction j
309.32* See above.
15.03 With behavioral reaction j
15.1 With circulatory disturbance other than cerebral arteri-
sclerosis
15.10 Without qualifying phrase
_ 309.32* See above. Specify other circulatory disturbance with addi-
tional code (393-436; 438-458).
15.11 With psychotic reaction
293.12* Psychosis with other cerebrovascular disturbance. Specify
disturbance with additional code (393-436; 438-458).
15.12 With neurotic reaction )
15.13 With behavioral reaction j
309.32* See above.
16 Chronic Brain Syndrome associated with convulsive disorder
16.00 Without qualifying phrase
16.01 With psychotic reaction
16.02 With neurotic reaction \
16.03 With behavioral reaction
309.42* Non-psychotic OBS with epilepsy
293.22* Psychosis with epilepsy
309.42* See above.DSM-I Code Numbers and Titles
17
DSM-II Code Numbers and Titles
Chronic Brain Syndrome associated with disturbance of
metabolism, growth or nutrition
17.1
17.2
With senile brain disease
17.10 Without qualifying phrase 309.62* 17.11 With psychotic reaction 290.02* Senile dementia
17.12
17.13 With neurotic reaction j
With behavioral reaction j 309.62* See above.
17.20 Without qualifying phrase 309.62* Non-psychotic OBS with senile or presenile brain disease
17.21 290.12* Presenile dementia
Presenile brain disease
With psychotic reaction
17.22 With neurotic reaction )
17.23 With behavioral reaction j
17.3
Non-psychotic OBS with senile or presenile brain disease
With other disturbance of metabolism, etc., except
presenile brain disease
17.30 Without qualifying phrase _
-.
17.31 with neurotic reaction
309.62* See above.
309.52* Non-psychotic OBS with disturbance of metabolism, growth
294.02* Psychosis with endocrine disorder. Specify disorder with ad-
ditional
code
(240-258).
or nutrition. Specify disturbance with additional code
(240-279).
2 94.12*
Psychosis with metabolic or nutritional disorder. Specify
disorder with additional code (260-279).
17.32 With neurotic reaction j
17.33 With behavioral reaction j
309.52*
See above.DSM-I Code Numbers and Titles
18
Chronic Brain Syndrome associated with new growth
18.0 With intracranial neoplasm
18.00 Without qualifying phrase ___
18.01 With psychotic reaction
18.02 With neurotic reaction ]
18.03 With behavioral reaction j
19
309.72* Non-psychotic OBS with intracranial neoplasm
293.32* Psychosis with intracranial neoplasm
...309.72* See above.
Chronic Brain Syndrome associated with diseases of unknown
or uncertain cause; chronic brain syndrome of unknown or
unspecified cause
19.0
19
DSM-II Code Numbers and Titles
Multiple sclerosis
19.00 Without qualifying phrase
309.82* Non-psychotic OBS with degenerative disease of CNS.
Specify multiple sclerosis with additional code (340).
19.01 With psychotic reaction 293.42* Psychosis with degenerative disease of CNS. Specify mul-
tiple sclerosis with additional code (340).
19.02 With neurotic reaction )
19.03 With behavioral reaction \ 309.82* See above.
Chronic Brain Syndrome associated with diseases of unknown
or uncertain cause; chronic brain syndrome of unknown or
unspecified cause (cont.)
19.1
Huntington's chorea
19.10 Without qualifying phrase
309.82* Non-psychotic OBS with degenerative disease of CNS.
Specify Huntington's chorea as additional code (331.0).DSM-II Code Numbers and Titles
DSM-I Code Numbers and Titles
19.11 With psychotic reaction
19.12 With neurotic reaction )
19.13 With behavioral reaction j
19.2 Pick's
19.20
19.21
19.22
19.23
disease
Without qualifying phrase _.
With psychotic reaction
With neurotic reaction
)
Without qualifying reaction j
19.3 Other diseases of unknown or uncertain cause
19.30 Without qualifying phrase
19.31 With psychotic reaction
19.32 With neurotic reaction j
19.33 With behavioral reaction j
293.42* Psychosis with degenerative disease of the CNS. Specify
Huntington's chorea as additional code (331.0).
309.82* See above.
309.62* Non-psychotic OBS with senile or presenile brain disease
290.12* Presenile dementia
309.62* See above.
309.92* Non-psychotic OBS with other [and unspecified] physical
condition. Specify condition when known.
294.82* Psychosis associated with other and undiagnosed physical
condition. Specify condition when known.
309.92* See above.
19.4 Chronic brain syndrome of unknown or unspecified cause
19.40 Without qualifying phrase
309.92*
19.41 With psychotic reaction
j 293.92*
i 294.82*
19.42 With neurotic reaction j
309.92*
19.43 With behavioral reaction j
See above.
Psychosis with other [and unspecified] cerebral condition
Psychosis with other and undiagnosed physical condition
See above.DSM-II Code Numbers and Titles
DSM-I Code Numbers and Titles
Psychoses not attributed to physical conditions listed
previously
20 Involutional Psychotic Reaction 296.00 Involutional melancholia
297.10 Involutional paranoid state
21
Affective Reactions
21.0 Manic depressive reaction, manic type
.. 296.10
Manic-depressive illness, manic type
21.1 Manic depressive reaction, depressed type
296.20 Manic-depressive illness, depressed type. Includes "Endo-
genous depression".
296.30 Manic-depressive illness, circular type
296.80 Other major affective disorder
212kfdsaihfiusdfhmodsijfioudsahfofi
[296.90 Unspecified major affective disorder]
21.3 Psychotic depressive reaction
298.00 Psychotic depressive reaction
22
Schizophrenic Reactions
295
Schizophrenia
22.0 Schizophrenic reaction, simple type
295.00 Schizophrenia, simple type
22.1 Schizophrenic reaction, hebephrenic type
295.10 Schizophrenia, hebephrenic type
22.2 Schizophrenic reaction, catatonic type
295.20 Schizophrenia, catatonic type
22.3 Schizophrenic reaction, paranoid type
295.30 Schizophrenia, paranoid type
22.4 Schizophrenic reaction, acute undifferentiated type
295.40 Acute schizophrenic episode. Excludes acute schizophrenia
of types listed above.
22.5 Schizophrenic reaction, chronic undifferentiated type ( 295.90* Schizophrenia, chronic undifferentiated type
( 295.50 Schizophrenia, latent type
22.6 Schizophrenic reaction, schizo-affective type
295.70 Schizophrenia, schizo-affective type
22.7 Schizophrenic reaction, childhood type
295.80* Schizophrenia, childhood type 1
22.8 Schizophrenic reaction, residual type
295.60 Schizophrenia, residual type
22.9 Other and unspecified
295.99* Schizophrenia, other [and unspecified] types
20-24 PSYCHOTIC DISORDERS
1
295-298
The code designated as "Schizophrenia, childhood type" is for use in the USA only. ICD code 295.8 is "Schizophrenia, other".DSM-I Code Numbers and Titles
23
24
Paranoid Reactions
DSM-II Code Numbers and Titles
297
23.1 Paranoia 297.00 Paranoia
23.2 Paranoid state 297.90 Other paranoid state
Psychotic Reaction Without Clearly Defined Structural Change
Other than Above
[299
No Matching Codes and Titles
[298.10
[298.20
[298.30
[298.90
30-39 PSYCHOPHYSIOLOGIC AUTONOMIC AND VISCERAL DISORDERS 305
Psychophysiologic Skin Reaction
305.00
30
31
32
33
34
35
36
37
38
39
Paranoid states
Psychophysiologic
Psychophysiologic
Psychophysiologic
Psychophysiologic
Musculo-skeletal Reaction
Respiratory Reaction
Cardiovascular Reaction
Hemic and Lymphatic Reaction
305.10
305.20
305.30
305.40
Unspecified psychosis]
Reactive excitation]
Reactive confusion]
Acute paranoid reaction]
Reactive psychosis, unspecified]
Psychophysiologic
Psychophysiologic
Psychophysiologic
Psychophysiologic
Psychophysiologic
disorders
skin disorder
musculo-skeletal disorder
respiratory disorder
cardiovascular disorder
Psychophysiologic Gastro-intestinal Reaction
Psychophysiologic Genito-urinary Reaction 305.50
305.60 Psychophysiologic hemic and lymphatic disorder
Psychophysiologic gastro-intestinal disorder
Psychophysiologic genito-urinary disorder
Psychophysiologic Endocrine Reaction
Psychophysiologic Nervous System Reaction
Psychophysiologic Reaction of Organs of special sense 305.70
300.50
305.80 Psychophysiologic endocrine disorder
Neurasthenic neurosis
Psychophysiologic disorder of organ of special senseDSM-I Code Numbers and Titles
40
40
PSYCHONEUROTIC DISORDERS
Psychoneurotic Reactions
40.0 Anxiety reaction
40.1 Dissociative reaction
40.2 Conversion reaction
40.3 Phobic reaction
40.4 Obsessive compulsive reaction
40.5 Depressive reaction
40.6 Psychoneurotic reaction, other
50-53 PERSONALITY DISORDERS
50
Personality Pattern Disturbance
50.0 Inadequate personality
50.1 Schizoid personality
50.2 Cyclothymic personality
50.3 Paranoid personality
50.4 Personality pattern disturbance, other
51
Personality Trait Disturbance
51.0 Emotionally unstable personality
51.1 Passive-aggressive personality
51.2 Compulsive personality
51.3 Personality trait disturbance, other
DSM-II Code Numbers and Titles
300
300.00
300.14*
300.13*
300.20
300.30
300.40
300.50
300.60
300.70
300.80
[300.90
Neuroses
Anxiety neurosis
Hysterical neurosis, dissociative type*
Hysterical neurosis, conversion type*
Phobic neurosis
Obsessive compulsive neurosis
Depressive neurosis
Neurasthenic neurosis
Depersonalization neurosis
Hypochrondriacal neurosis
Other neurosis
Unspecified neurosis]
301 Personality disorders
301.82*
301.20
301.10
301.00
301.89* Inadequate personality*
Schizoid personality
Cyclothymic personality
Paranoid personality
Other personality disorders of specified types*
301.50
301.81*
301.40
301.89* Hysterical personality
Passive-aggressive personality*
Obsessive-compulsive personality
Other personality disorders of specified types*DSM-I Code Numbers and Titles
52
DSM-II Code Numbers and Titles
Sociopathic Personality Disturbance
52.0 Antisocial reaction 301.70
52.1 Dyssocial reaction 316.30* Dyssocial behavior*
52.2 Sexual deviation
Detailed subdivisions not contained in DSM-I
52.3 Alcoholism (addiction)
Detailed subdivisions no. contained in DSM-I
52.4 Drug addiction
[302.90
302.00
302.10
302.20
302.30
v. 302.40
302.50*
302.60*
302.70*
302.80
Antisocial personality
Unspecified sexual deviation]
Homosexuality
Fetishism
Pedophilia
Transvestitism
Exhibitionism
Voyeurism*
Sadism*
Masochism*
Other sexual deviation
303.90 Other [and unspecified] Alcoholism. Excludes alcoholic
psychosis (291); acute poisoning by alcohol (980, E860).
303.00 Episodic excessive drinking
303.90 Other [and unspecified] alcoholism
303.10 Habitual excessive drinking
303.20 Alcoholic addiction
[304.90
Unspecified drug dependence]DSM-II Code Numbers and Titles
DSM-I Code Numbers and Titles
' 304.00
304.10
304.20
Detailed subdivisions not contained in DSM-1
53
304.30
Special Symptom Reaction 304.40
304.50
304.60
304.70
. 304.80
306
53.0 Learning disturbance ._. 306.10
Drug dependence, opium, opium alkaloids and their deriva-
tives
Drug dependence, synthetic analgesics with morphine-like
effects
Drug dependence, barbiturates
Drug dependence, other hypontics and sedatives or "tran-
quilizer"
Drug dependence, cocaine
Drug dependence, Cannabis sativa (hashish, marijuana)
Drug dependence, other psycho-stimulants
Drug dependence, hallucinogens
Other drug dependence
Special symptoms not elsewhere classified
Specific learning disturbance
53.1 Speech disturbance 306.00 Speech disturbance
53.2 Enuresis 306.60 Enuresis
53.3 Somnambulism 306.40
306.20
306.30 Disorder of sleep
Tic
Other psychomotor disorder
306.80
306.90 Cephalalgia
Other special symptom
53.4 Other
306.50 Feeding disturbance
306.70
EncopresisDSM-I Code Numbers and Titles
54
TRANSIENT SITUATIONAL PERSONALITY DISORDERS
54.0 Gross stress reaction
54.1 Adult situational reaction
54.2 Adjustment reaction of infancy
54.3 Adjustment reaction of childhood
54.4 Adjustment reaction of adolescence
54.5 Adjustment reaction of late life
54.6 Other transient situational personality disturbance
60-62 MENTAL DEFICIENCY
60
Mental Deficiency (Familial or Hereditary)
60.0 Mild (I.Q. 70-85)
307*
307.30*
307.30*
307.00*
307.10*
307.20*
307.40* Transient situational disturbances
Adjustment reaction of adult life*
Adjustment reaction of adult life*
Adjustment reaction of infancy*
Adjustment reaction of childhood*
Adjustment reaction of adolescence*
Adjustment reaction of late life*
No corresponding diagnosis (Assign another diagnosis in
307 category based upon patient's age).
310-315 Mental Retardation
60.3 Severity not specified 310.80
( 310.80
311.80
( 312.80
( 312.80
...{ 313.80
( 314.80
315.80
Mental Deficiency, Idiopathic
61.0 Mild (I.Q. 70-85) 310.90
60.1
Moderate (I.Q. 50-69)
60.2 Severe (I.Q. Below 50)
61
DSM-II Code Numbers and Titles
Borderline mental retardation (I.Q. 70-85)
Borderline mental retardation (I.Q. 68-69)
Mild mental retardation (I.Q. 52-67)
Moderate mental retardation (I.Q. 50-51)
Moderate mental retardation (I.Q. 36-49)
Severe mental retardation (I.Q. 20-35)
Profound mental retardation (I.Q. Below 20)
Unspecified mental retardation
Borderline mental retardation (I.Q. 70-85)DSM-I Code Numbers and Titles
61.1
Moderate (I.Q. 50-69)
61.2 Severe (I.Q. below 50)
61.3 Severity not specified
DSM-II Code Numbers and Titles
( 310.90
311.90
( 312.90
' 312.90
j 313.90
314.90
315.90
Borderline mental retardation (I.Q. 68-69)
Mild mental retardation (LQ. 52-67)
Moderate mental retardation (I.Q. 50-51)
Moderate mental retardation (I.Q. 36-49)
Severe mental retardation (I.Q. 20-35)
Profound mental retardation (I.Q. Below 20)
Unspecified mental retardationSection 6
DETAILED LIST OF MAJOR DISEASE
CATEGORIES IN ICD-8 1
INTRODUCTORY NOTE
The complete three-digit ICD classification is included to provide a
framework for the statistical classification of various diseases and con-
ditions. Some of these may be associated with mental disorders occur-
ring with various infections, organic diseases and other physical factors.
For further details concerning the fourth digits of the ICD and the
inclusion terms under each category, reference should be made to the
Eighth Revision of the International Classification of Diseases adapted
for use in the United States.
I. INFECTIVE AND PARASITIC DISEASES
(000-136)
Intestinal Infectious Diseases (000-009)
000 Cholera
001 Typhoid fever
002 Paratyphoid fever
003 Other Salmonella infections
004 Bacillary dysentery
005
006
007
008
009 Food poisoning (bacterial)
Amebiasis
Other protozoal intestinal diseases
Enteritis due to other specified organism
Diarrheal disease
Tuberculosis (010-019)
010
011
012
013
014
Silicotuberculosis
Pulmonary tuberculosis
Other respiratory tuberculosis
Tuberculosis of meninges and central nervous system
Tuberculosis of intestines, peritoneum, and mesenteric
glands
1
Reprinted from Eighth Revision International Classification of Diseases,
Adapted For Use in the United States, Public Health Service Publication No.
1693, Superintendent of Documents, U. S. Government Printing Office, Wash-
ington, D. C. 20402.
8384
MENTAL DISORDERS
015
016
017
018
019
Tuberculosis of bones and joints
Tuberculosis of genitourinary system
Tuberculosis of other organs
Disseminated tuberculosis
Late effects of tuberculosis
Zoonotic bacterial diseases (020-027)
020 Plague
021 Tularemia
022 Anthrax
023 Brucellosis
024 Glanders
025 Melioidosis
026 Rat-bite fever
027 Other zoonotic bacterial diseases
Other bacterial diseases (030-039)
030
031
032
033
034
035
036
037
038
039
Leprosy
Other diseases due to mycobacteria
Diphtheria
Whooping cough
Streptococcal sore throat and scarlet fever
Erysipelas
Meningococcal infection
Tetanus
Septicemia
Other bacterial diseases
Poliomyelitis and other enterovirus diseases of central nervous
system (040-046)
040 Acute paralytic poliomyelitis specified as bulbar
041 Acute poliomyelitis with other paralysis
042 Acute nonparaylitic poliomyelitis
043 Acute poliomyelitis, unspecified
044 Late effects of acute poliomyelitis
045 Aseptic meningitis due to enterovirus
046 Other enterovirus diseases of central nervous system
Viral diseases accompanied by exanthem (050-057)
050 Smallpox
051 CowpoxMAJOR DISEASE CATEGORIES
052 Chickenpox
053 Herpes zoster
054 Herpes simplex
055 Measles
056 Rubella
057 Other viral exanthem
Arthopod-borne viral diseases (060-068)
060 Yellow fever
061 Dengue
062 Mosquito-borne viral encephalitis
063 Tick-borne viral encephalitis
064 Viral encephalitis transmitted by other arthropods
065 Viral encephalitis, unspecified
066 Late effects of viral encephalitis
067 Arthropod-borne hemorrhagic fever
068 Other arthropod-borne viral diseases
Other viral diseases (070-079)
070 Infectious hepatitis
071 Rabies
072 Mumps
073 Psittacosis
074 Specific diseases due to Coxsackie virus
075 Infectious mononucleosis
076 Trachoma, active
077 Late effects of trachoma
078 Other viral diseases of the conjunctiva
079 Other viral diseases
Rickettsioses and other arthropod-borne diseases (080-089)
080
081
082
083
084
085
086
087
088
089
Epidemic louse-borne typhus
Other typhus
Tick-borne rickettsioses
Other rickettsioses
Malaria
Leishmaniasis
American trypanosomiasis
Other trypanosomiasis
Relapsing fever
Other arthropod-borne diseases
8586
MENTAL DISORDERS
Syphilis and other venereal diseases ( 090-099 )
090
091
092
093
094
095
096
097
098
099
Congenital syphilis
Early syphilis, symptomatic
Early syphilis, latent
Cardiovascular syphilis
Syphilis of central nervous system
Other forms of late syphilis, with symptoms
Late syphilis, latent
Other syphilis and not specified
Gonoccal infections
Other venereal diseases
Other spirochetal diseases (100-104)
100
101
102
103
104
Leptospirosis
Vincent's angina
Yaws
Pinta
Other spirochetal infection
Mycoses (110-117)
110 Dermatophytosis
111 Dermatomycosis, other and unspecified
112 Moniliasis
113 Actinomycosis
114 Coccidioidomycosis
115 Histoplasmosis
116 Blastomycosis
117 Other systemic mycosis
Helminthiases (120-129)
120Schistosomiasis
121 Other trematode infestation
122 Hydatidosis
123 Other cestode infestation
124 Trichiniasis
125 Filarial infestation
126 Ancylostomiasis
127 Other intestinal helminthiasis
128 Other and unspecified helminthiasis
129 Intestinal parasitism, unspecifiedMAJOR DISEASE CATEGORIES
87
Other infective and parasitic diseases (130-136)
130 Toxoplasmosis
131 Trichomoniasis urogenitalis
132 Pediculosis
133 Acariasis
134 Other infestation
135 Sarcoidosis
136 Other and unspecified infective and parasitic diseases
II. NEOPLASMS (140-239)
Malignant neoplasm of buccal cavity and pharynx (140-149)
140
141
142
143
144
145
146
147
148
149
Malignant neoplasm of lip
Malignant neoplasm of tongue
Malignant neoplasm of salivary gland
Malignant neoplasm of gum
Malignant neoplasm of floor of mouth
Malignant neoplasm of other and unspecified parts
of mouth
Malignant neoplasm of oropharynx
Malignant neoplasm of nasopharynx
Malignant neoplasm of hypopharynx
Malignant neoplasm of pharynx, unspecified
Malignant neoplasm of digestive organs and peritoneum
(150-159)
150 Malignant neoplasm of esophagus
151 Malignant neoplasm of stomach
152 Malignant neoplasm of small intestine, including duo-
denum
153 Malignant neoplasm of large intestine, except rectum
154 Malignant neoplasm of rectum and rectosigmoid junction
155 Malignant neoplasm of liver and intrahepatic bile ducts,
specified as primary
156 Malignant neoplasm of gallbladder and bile ducts
157 Malignant neoplasm of pancreas
158 Malignant neoplasm of peritoneum and retroperitoneal
tissue
159 Malignant neoplasm of unspecified digestive organs88
MENTAL DISORDERS
Malignant neoplasm of respiratory system (160-163)
160 Malignant neoplasm of nose, nasal cavities, middle ear,
and accessory sinuses
161 Malignant neoplasm of larynx
162 Malignant neoplasm of trachea, bronchus, and lung
163 Malignant neoplasm of other and unspecified respiratory
organs
Malignant neoplasm of bone, connective tissue, skin, and breast
(170-174)
170 Malignant neoplasm of bone
171 Malignant neoplasm of connective and other soft tissue
172 Malignant melanoma of skin
173 Other malignant neoplasm of skin
174 Malignant neoplasm of breast
Malignant neoplasm of genitourinary organs (180-189)
180
181
182
183
184
185
186
187
188
189
Malignant neoplasm of cervix uteri
Chorionepithelioma
Other malignant neoplasms of uterus
Malignant neoplasm of ovary, fallopian tube, and broad
ligament
Malignant neoplasm of other and unspecified female
genital organs
Malignant neoplasm of prostate
Malignant neoplasm of testis
Malignant neoplasm of other and unspecified male genital
organs
Malignant neoplasm of bladder
Malignant neoplasm of other and unspecified urinary
organs
Malignant neoplasm of other and unspecified sites (190-199 )
190
191
192
193
194
195
196
Malignant
Malignant
Malignant
Malignant
Malignant
Malignant
Secondary
nodes
neoplasm of eye
neoplasm of brain
neoplasm of other parts of nervous system
neoplasm of thyroid gland
neoplasm of other endocrine glands
neoplasm of ill-defined sites
and unspecified malignant neoplasm of lymphMAJOR DISEASE CATEGORIES
89
197
Secondary malignant neoplasm of respiratory and diges-
tive systems
198 Other secondary malignant neoplasm
199 Malignant neoplasm without specification of site
Neoplasms
200
201
202
203
204
205
206
207
208
209
of lymphatic and hematopoietic tissue (200-209)
Lymphosarcoma and reticulum-cell sarcoma
Hodgkin's disease
Other neoplasms of lymphoid tissue
Multiple myeloma
Lymphatic leukemia
Myeloid leukemia
Monocytic leukemia
Other and unspecified leukemia
Polycythemia vera
Myelofibrosis
Benign neoplasms (210-228)
210 Benign neoplasm of buccal cavity and pharynx
211 Benign neoplasm of other parts of digestive system
212 Benign neoplasm of respiratory system
213 Benign neoplasm of bone and cartilage
214 Lipoma
215 Other benign neoplasm of muscular and connective tissue
216 Benign neoplasm of skin
217 Benign neoplasm of breast
218 Uterine fibroma
219 Other benign neoplasm of uterus
220 Benign neoplasm of ovary
221 Benign neoplasm of other female genital organs
222 Benign neoplasm of male genital organs
223 Benign neoplasm of kidney and other urinary organs
224 Benign neoplasm of eye
225 Benign neoplasm of brain and other parts of nervous
system
226 Benign neoplasm of endocrine glands
227 Hemangioma and lymphangioma
228 Benign neoplasm of other and unspecified organs and
tissues90
MENTAL DISORDERS
Neoplasm of unspecified nature (230-239)
230
231
232
233
234
235
236
237
238
239
Neoplasm of unspecified nature of digestive organs
Neoplasm of unspecified nature of respiratory organs
Neoplasm of unspecified nature of skin and musculo-
skeletal system
Neoplasm of unspecified nature of breast
Neoplasm of unspecified nature of uterus
Neoplasm of unspecified nature of ovary
Neoplasm of unspecified nature of other female genital
organs
Neoplasm of unspecified nature of other genito-urinary
organs
Neoplasm of unspecified nature of eye, brain, and other
parts of nervous system
Neoplasm of unspecified nature of other and unspecified
organs
HI. ENDOCRINE, NUTRITIONAL, AND METABOLIC
DISEASES (240-279)
Diseases of thyroid gland (240-246)
240 Simple goiter
241 Nontoxic nodular goiter
242 Thyrotoxicosis with or without goiter
243 Cretinism of congenital origin
244 Myxedema
245 Thyroiditis
246 Other diseases of thyroid gland
Diseases of other endocrine glands (250-258)
250
251
252
253
254
255
256
257
258
Diabetes mellitus
Disorders of pancreatic internal secretion other than
diabetes mellitus
Diseases of parathyroid gland
Diseases of pituitary gland
Diseases of thymus gland
Diseases of adrenal glands
Ovarian dysfunction
Testicular dysfunction
Polyglandular dysfunction and other diseases of endocrine
glandsMAJOR DISEASE CATEGORIES
91
Avitaminoses and other nutritional deficiency (260-269)
260 Vitamin A deficiency
261 Thiamine deficiency
262 Niacin deficiency
263 Other vitamin B deficiency
264 Ascorbic acid deficiency
265 Vitamin D deficiency
266 Other vitamin deficiency states
267 Protein malnutrition
268 Nutritional marasmus
269 Other nutritional deficiency
Other metabolic diseases (270-279)
270
271
272
273
274
275
276
277
278
279
Congenital disorders of amino-acid metabolism
Congenital disorders of carbohydrate metabolism
Congenital disorders of lipid metabolism
Other and unspecified congenital disorders of metabolism
Gout
Plasma protein abnormalities
Amyloidosis
Obesity not specified as of endocrine origin
Other hyperalimentation
Other and unspecified metabolic diseases
IV. DISEASES OF THE BLOOD AND BLOOD-FORMING
ORGANS (280-289)
280
281
282
283
284
285
286
287
288
289
Iron deficiency anemias
Other deficiency anemias
Hereditary hemolytic anemias
Acquired hemolytic anemias
Aplastic anemia
Other and unspecified anemias
Coagulation defects
Purpura and other hemorrhagic conditions
Agranulocytosis
Other diseases of blood and blood-forming organs
V. MENTAL DISORDERS (290-315)
Psychoses (290-299)
290
Senile and presenile dementia92
MENTAL DISORDERS
291 Alcoholic psychosis
292 Psychosis associated with intracranial infection
293 Psychosis associated with other cerebral condition
294 Psychosis associated with other physical conditions
295 Schizophrenia
296 Affective psychoses
297 Paranoid states
298 Other psychoses
299 Unspecified psychosis
Neuroses, personality disorders, and other nonpsychotic mental
disorders (300-309)
300
301
302
303
304
305
306
307
308
309
Neuroses
Personality disorders
Sexual deviation
Alcoholism
Drug dependence
Physical disorders of presumably psychogenic origin
Special symptoms not elsewhere classified
Transient situational disturbances
Behavior disorders of childhood
Mental disorders not specified as psychotic associated
with physical conditions
Mental retardation (310-315)
310 Borderline mental retardation
311 Mild mental retardation
312 Moderate mental retardation
313 Severe mental retardation
314 Profound mental retardation
315 Unspecified mental retardation
VI. DISEASES OF THE NERVOUS SYSTEM AND
SENSE ORGANS (320-389)
Inflammatory diseases of central nervous system (320-324)
320
321
322
Meningitis
Phlebitis and thrombophlebitis of intracranial venous
sinuses
Intracranial and intraspinal abscessMAJOR DISEASE CATEGORIES
323
324
Encephalitis, myelitis, and encephalomyelitis
Late effects of intracranial abscess or pyogenic infection
Hereditary and familial diseases of nervous system (330-333)
330 Hereditary neuromuscular disorders
331 Hereditary diseases of the striatopallidal system
332 Hereditary ataxia
333 Other hereditary and familial diseases of nervous
system
Other diseases of central nervous system (340-349)
340
341
Multiple sclerosis
Other demyelinating diseases of central nervous
system
342 Paralysis agitans
343 Cerebral spastic infantile paralysis
344 Other cerebral paralysis
345 Epilepsy
346 Migraine
347 Other diseases of brain
348 Motor neurone disease
349 Other diseases of spinal cord
Diseases of nerves and peripheral ganglia (350-358)
350
351
352
353
354
355
356
357
358
93
Facial paralysis
Trigeminal neuralgia
Brachial neuritis
Sciatica
Polyneuritis and polyradiculitis
Other and unspecified forms of neuralgia and neuritis
Other diseases of cranial nerves
Other diseases of peripheral nerves except autonomic
Diseases of peripheral autonomic nervous system
Inflammatory diseases of the eye ( 360-369 )
360 Conjunctivitis and ophthalmia
361 Blepharitis
362 Hordeolum
363 Keratitis
264 Iritis
365 Choroiditis94
MENTAL DISORDERS
366
367
368
369
Other inflammation of uveal tract
Inflammation of optic nerve and retina
Inflammation of lacrimal glands and ducts
Other inflammatory diseases of eye
Other diseases and conditions of eye (370-379)
370
371
372
373
374
375
376
377
378
379
Refractive errors
Cornea! opacity
Pterygium
Strabismus
Cataract
Glaucoma
Detachment of retina
Other diseases of retina and optic nerve
Other diseases of eye
Blindness
Diseases of the ear and mastoid process (380-389)
380 Otitis externa
381 Otitis media without mention of mastoiditis
382 Otitis media with mastoiditis
383 Mastoiditis without mention of otitis media
384 Other inflammatory diseases of ear
385 Meniere's disease
386 Otosclerosis
387 Other diseases of ear and mastoid process
388 Deaf mutism
389 Other deafness
VII. DISEASES OF THE CIRCULATORY SYSTEM (390-458)
Active rheumatic fever (390-392)
390 Rheumatic fever without mention of heart involvement
391 Rheumatic fever with heart involvement
392 Chorea
Chronic rheumatic heart disease (393-398)
393
394
395
396
Diseases
Diseases
Diseases
Diseases
of
of
of
of
pericardium
mitral valve
aortic valve
mitral and aortic valvesMAJOR DISEASE CATEGORIES
397
398
95
Diseases of other endocardial structures
Other heart disease, specified as rheumatic
Hypertensive disease (400-404)
400
401
402
403
404
Malignant hypertension
Essential benign hypertension
Hypertensive heart disease
Hypertensive renal disease
Hypertensive heart and renal disease
Ischemic heart disease (410-414)
410
411
412
413
414
Acute myocardial infarction
Other acute and subacute forms of ischemic heart disease
Chronic ischemic heart disease
Angina pectoris
Asymptomatic ischemic heart disease
Other forms of heart disease (420-429)
420 Acute pericarditis, nonrheumatic
421 Acute and subacute endocarditis
422 Acute myocarditis
423 Chronic disease of pericardium, nonrheumatic
424 Chronic disease of endocardium
425 Cardiomyopathy
426 Pulmonary heart disease
427 Symptomatic heart disease
428 Other myocardial insufficiency
429 Ill-defined heart disease
Cerebrovascular disease (430-438)
430 Subarachnoid hemorrhage
431 Cerebral hemorrhage
432 Occulsion of precerebral arteries
433 Cerebral thrombosis
434 Cerebral embolism
435 Transient cerebral ischemia
436 Acute but ill-defined cerebrovascular disease
437 Generalized ischemic cerebrovascular disease
438 Other and ill-defined cerebrovascular disease96
MENTAL DISORDERS
Diseases of arteries, arterioles, and capillaries (440-448)
440
441
442
443
444
445
446
447
448
Arteriosclerosis
Aortic aneurysm (nonsyphilitic)
Other aneurysm
Other peripheral vascular disease
Arterial embolism and thrombosis
Gangrene
Polyarteritis nodosa and allied conditions
Other diseases of arteries and arterioles
Diseases of capillaries
Diseases of veins and lymphatics, and other diseases of circula-
tory system (450-458)
450
451
452
453
454
455
456
457
458
Pulmonary embolism and infarction
Phlebitis and thrombophlebitis
Portal vein thrombosis
Other venous embolism and thrombosis
Varicose veins of lower extremities
Hemorrhoids
Varicose veins of other sites
Noninfective disease of lymphatic channels
Other diseases of circulatory system
VIII. DISEASES OF THE RESPIRATORY SYSTEM (460-519)
Acute respiratory infections, except influenza (460-446)
460
461
462
463
464
465
466
Acute
Acute
Acute
Acute
Acute
Acute
fied
Acute
nasopharyngitis (common cold)
sinusitis
pharyngitis
tonsillitis
laryngitis and tracheitis
upper respiratory infection of multiple or unspeci-
sites
bronchitis and bronchiolitis
Influenza (470-474)
470
471
472
473
474
Influenza, unqualified
Influenza with pneumonia
Influenza with other respiratory manifestations
Influenza with digestive manifestations
Influenza with nervous manifestationsMAJOR DISEASE CATEGORIES
Pneumonia (480-486)
480 Viral pneumonia
481 Pneumococcal pneumonia
482 Other bacterial pneumonia
483 Pneumonia due to other specified organism
484 Acute interstitial pneumonia
485 Bronchopneumonia, unspecified
486 Pneumonia, unspecified
Bronchitis,
490
491
492
493
emphysema, and asthma (490-493)
Bronchitis, unqualified
Chronic bronchitis
Emphysema
Asthma
Other diseases of upper respiratory tract (500-508)
500
501
502
503
504
505
506
507
508
Hypertrophy of tonsils and adenoids
Peritonsillar abscess
Chronic pharyngitis and nasopharyngitis
Chronic sinusitis
Deflected nasal septum
Nasal polyp
Chronic laryngitis
Hay fever
Other diseases of upper respiratory tract
Other diseases of respiratory system (510-519)
510 Empyema
511 Pleurisy
512 Spontaneous pneumothorax
513 Abscess of lung
514 Pulmonary congestion and hypostasis
515 Pneumoconiosis due to silica and silicates
516 Other pneumoconioses and related diseases
517 Other chronic interstitial pneumonia
518 Bronchiectasis
519 Other diseases of respiratory system
IX. DISEASES OF THE DIGESTIVE SYSTEM (520-577)
Diseases of oral cavity, salivary glands, and jaws (520-529)
520 Disorders of tooth development and eruption
9798
MENTAL DISORDERS
521
522
523
524
525
Diseases of hard tissues of teeth
Diseases of pulp and periapical tissue
Periodontal diseases
Dento-facial anomalies including malocculusion
Other diseases and conditions of the teeth and supporting
structures
526 Diseases of the jaws
527 Diseases of the salivary glands
528 Diseases of the oral soft tissues, excluding gingiva and
tongue
529 Diseases of the tongue and other oral conditions
Diseases of esophagus, stomach, and duodenum ( 530-537 )
530
531
532
533
534
535
536
537
Diseases of esophagus
Ulcer of stomach
Ulcer of duodenum
Peptic ulcer, site unspecified
Gastrojejunal ulcer
Gastritis and duodenitis
Disorders of function of stomach
Other diseases of stomach and duodenum
Appendicitis (540-543)
540 Acute appendicitis
541 Appendicitis, unqualified
542 Other appendicitis
543 Other diseases of appendix
Hernia of abdominal cavity (550-553)
550 Inguinal hernia without mention of obstruction
551 Other hernia of abdominal cavity without mention of
obstruction
552 Inguinal hernia with obstruction
553 Other hernia of abdominal cavity with obstruction
Other diseases of intestine and peritoneum (560-569 )
560 Intestinal obstruction without mention of hernia
561 Gastroenteritis and colitis, except ulcerative, of non-
infectious origin
562 Diverticula of intestine
563 Chronic enteritis and ulcerative colitisMAJOR DISEASE CATEGORIES
99
564 Functional disorders of intestines
565 Anal fissure and fistula
566 Abscess of anal and rectal regions
567 Peritonitis
568 Peritoneal adhesions
569 Other diseases of intestines and peritoneum
Diseases of liver, gallbladder, and pancreas ( 570-577 )
570
571
572
573
574
575
576
577
Acute and subacute necrosis of liver
Cirrhosis of liver
Suppurative hepatitis and liver abscess
Other diseases of liver
Cholelithiasis
Cholecystitis and cholangitis, without mention of calculus
Other diseases of gallbladder and biliary ducts
Diseases of pancreas
X. DISEASES OF THE GENITOURINARY SYSTEM (580-629)
Nephritis and nephrosis (580-584)
580
581
582
583
584
Acute nephritis
Nephrotic syndrome
Chronic nephritis
Nephritis, unqualified
Renal sclerosis, unqualified
Other diseases of urinary system (590-599)
590
591
592
593
594
595
596
597
598
599
Infections of kidney
Hydronephrosis
Calculus of kidney and ureter
Other diseases of kidney and ureter
Calculus of other parts of urinary system
Cystitis
Other diseases of bladder
Urethritis (nonvenereal)
Stricture of urethra
Other diseases of urinary tract
Diseases of male genital organs (600-607)
600
601
Hyperplasia of prostate
Prostatitis100
MENTAL DISORDERS
602 Other diseases of prostate
603 Hydrocele
604 Orchids and epididymitis
605 Redundant prepuce and phimosis
606 Sterility, male
607 Other diseases of male genital organs
Diseases of breast, ovary, fallopian tube, and parametrium
(610-616)
610 Chronic cystic disease of breast
611 Other diseases of breast
612 Acute salpingitis and oophoritis
613 Chronic salpingitis and oophoritis
614 Salpingitis and oophoritis, unqualified
615 Other diseases of ovary and fallopian tube
616 Diseases of parametrium and pelvic peritoneum (female)
Diseases of
620
621
622
623
624
625
626
627
628
629
uterus and other female genital organs (620-629)
Infective diseases of cervix uteri
Other diseases of cervix
Infective diseases of uterus (except cervix), vagina, and
vulva
Uterovaginal prolapse
Malposition of uterus
Other diseases of uterus
Disorders of menstruation
Menopausal symptoms
Sterility, female
Other diseases of female genital organs
XI. COMPLICATIONS OF PREGNANCY, CHILDBIRTH, AND
THE PUERPERIUM (630-678)
Complications of pregnancy ( 630-634 )
630 Infections of genital tract during pregnancy
631 Ectopic pregnancy
632 Hemorrhage of pregnancy
633 Anemia of pregnancy
634 Other complications of pregnancyMAJOR DISEASE CATEGORIES
101
Urinary infections and toxemias of pregnancy and the puer-
perium (635-639)
635 Urinary infections arising during pregnancy and the
puerperium
636 Renal disease arising during pregnancy and the
puerperium
637 Pre-eclampsia, eclampsia, and toxemia, unspecified
638 Hyperemesis gravidarum
639 Other toxemias of pregnancy and the puerperium
Abortion (640-645)
640
641
642
643
644
645
Abortion induced for medical indications
Abortion induced for other legal indications
Abortion induced for other reasons
Spontaneous abortion
Abortion not specified as induced or spontaneous
Other abortion
Delivery (650-662)
650 Delivery without mention of complication
651 Delivery complicated by placenta previa or antepartum
hemorrhage
652 Delivery complicated by retained placenta
653 Delivery complicated by other postpartum hemorrhage
654 Delivery complicated by abnormality of bony pelvis
655 Delivery complicated by fetopelvic disproportion
656 Delivery complicated by malpresentation of fetus
657 Delivery complicated by prolonged labor of other origin
658 Delivery with laceration of perineum without mention
of other laceration
659 Delivery with rupture of uterus
660 Delivery with other obstetrical trauma
661 Delivery with other complications
662 Anesthetic death in uncomplicated delivery
Complications of the puerperium (670-678)
670 Sepsis of childbirth and the puerperium
671 Puerperal phlebitis and thrombosis
672 Pyrexia of unknown origin during the puerperium
673 Puerperal pulmonary embolism
674 Cerebral hemorrhage in the puerperium102
MENTAL DISORDERS
675
676
677
678
Puerperal blood dyscrasias
Anemia of the puerperium
Other and unspecified complications of the puerperium
Mastitis and other disorders of lactation
XII. DISEASES OF THE SKIN AND SUBCUTANEOUS
TISSUE (680-709)
Infections of skin and subcutaneous tissue (680-686)
680 Boil and carbuncle
681 Cellulitis of finger and toe
682 Other cellulitis and abscess
683 Acute lymphadenitis
684 Impetigo
685 Pilonidal cyst
686 Other local infections of skin and subcutaneous tissue
Other inflammatory conditions of skin and subcutaneous tissue
(690-698)
690 Seborrheic dermatitis
691 Infantile eczema and related conditions
692 Other eczema and dermatitis
693 Dermatitis herpetiformis
694 Pemphigus
695 Erythematous conditions
696 Psoriasis and similar disorders
697 Lichen
698 Pruritus and related conditions
Other diseases of skin and subcutaneous tissue (700-709)
700 Corns and callosities
701 Other hypertrophic and atrophic conditions of skin
702 Other dermatoses
703 Diseases of nail
704 Diseases of hair and hair follicles
705 Diseases of sweat glands
706 Diseases of sebaceous glands
707 Chronic ulcer of skin
708 Urticaria
709 Other diseases of skinMAJOR DISEASE CATEGORIES
103
XIH. DISEASES OF THE MUSCULOSKELETAL SYSTEM AND
CONNECTIVE TISSUE (710-718)
Arthritis and rheumatism, except rheumatic fever (710-718)
710 Acute arthritis due to pyogenic organisms
711 Acute nonpyogenic arthritis
712 Rheumatoid arthritis and allied conditions
713 Osteoarthritis and allied conditions
714 Other specified forms of arthritis
715 Arthritis, unspecified
716 Polymyositis and dermatomyositis
717 Other nonarticular rheumatism
718 Rheumatism, unspecified
Osteomyelitis and other diseases of bone and joint (720-729 )
720
721
722
723
724
725
726
727
728
729
Osteomyelitis and periostitis
Osteitis deformans
Osteochondrosis
Other diseases of bone
Internal derangement of joint
Displacement of intervertebral disc
Affection of sacroiliac joint
Ankylosis of joint
Vertebrogenic pain syndrome
Other diseases of joint
Other diseases of musculoskeletal system (730-738)
730 Bunion
731 Synovitis, bursitis, and tenosynovitis
732 Infective myositis and other inflammatory diseases of
tendon and fascia
733 Other diseases of muscle, tendon, and fascia
734 Diffuse diseases of connective tissue
735 Curvature of spine
736 Flat foot
737 Hallux valgus and varus
738 Other deformities
XIV. CONGENITAL ANOMALIES (740-759)
740 Anencephalus
741 Spina bifida104
MENTAL DISORDERS
742
743
744
745
746
747
748
749
750
751
752
753
754
755
756
757
758
759
Congenital hydrocephalus
Other congenital anomalies of nervous system
Congenital anomalies of eye
Congenital anomalies of ear, face, and neck
Congenital anomalies of heart
Other congenital anomalies of circulatory system
Congenital anomalies of respiratory system
Cleft palate and cleft lip
Other congenital anomalies of upper alimentary tract
Other congenital anomalies of digestive system
Congenital anomalies of genital organs
Congenital anomalies of urinary system
Clubfoot (congenital)
Other congenital anomalies of limbs
Other congenital anomalies of musculoskeletal system
Congenital anomalies of skin, hair, and nails
Other and unspecified congenital anomalies
Congenital syndromes affecting multiple systems
XV. CERTAIN CAUSES OF PERINATAL MORBIDITY AND
MORTALITY (760-779)
760 Chronic circulatory and genitourinary diseases in mother
761 Other maternal conditions unrelated to pregnancy
762 Toxemia of pregnancy
763 Maternal ante- and intrapartum infection
764 Difficult labor with abnormality of bones, organs, or
tissues of pelvis
765 Difficult labor with disproportion, but no mention of ab-
normality of pelvis
766 Difficult labor with malposition of fetus
767 Difficult labor with abnormality of forces of labor
768 Difficult labor with other and unspecified complications
769 Other complications of pregnancy and childbirth
770 Conditions of placenta
771 Conditions of umbilical cord
772 Birth injury without mention of cause
773 Termination of pregnancy
774 Hemolytic disease of newborn with kernicterus
775 Hemolytic disease of newborn without mention of ker-
nicterusMAJOR DISEASE CATEGORIES
776
777
778
779
105
Anoxic and hypoxic conditions not elsewhere classifiable
Immaturity, unqualified
Other conditions of fetus or newborn
Fetal death of unknown cause
XVI. SYMPTOMS AND ILL-DEFINED CONDITIONS (780-796)
Symptoms referable to systems or organs (780-789)
780
781
782
783
784
785
786
787
788
789
Certain symptoms referable to nervous system and special
senses
Other symptoms referable to nervous system and special
senses
Symptoms referable to cardiovascular and lymphatic
system
Symptoms referable to respiratory system
Symptoms referable to upper gastrointestinal tract
Symptoms referable to abdomen and lower gastroin-
testinal tract
Symptoms referable to genitourinary system
Symptoms referable to limbs and joints
Other general symptoms
Abnormal urinary constituents of unspecified cause
Senility and ill-defined diseases ( 790-796 )
790 Nervousness and debility
791 Headache
792 Uremia
793 Observation, without need for further medical care
794 Senility without mention of psychosis
795 Sudden death (cause unknown)
796 Other ill-defined and unknown causes of morbidity and
mortality
XVII. ACCIDENTS, POISONINGS, AND VIOLENCE (NATURE
OF INJURY) (800-999)
Fracture of skull, spine, and trunk (800-809)
800
801
802
803
Fracture of vault of skull
Fracture of base of skull
Fracture of face bones
Other and unqualified skull fractures106
MENTAL DISORDERS
804
Multiple fractures involving skull or face with other
bones
805 Fracture and fracture dislocation of vertebral column
without mention of spinal cord lesion
806 Fracture and fracture dislocation of vertebrae column with
spinal cord lesion
807 Fracture of rib(s), sternum, and larynx
808 Fracture of pelvis
809 Multiple and ill-defined fractures of trunk
Fracture of
810
811
812
813
814
815
816
817
818
819
upper limb (810-819)
Fracture of clavicle
Fracture of scapula
Fracture of humerus
Fracture of radius and ulna
Fracture of carpal bone(s)
Fracture of metacarpal bone(s)
Fracture of one or more phalanges of hand
Multiple fractures of hand bones
Other, multiple, and ill-defined fractures of upper limb
Multiple fractures both upper limbs, and upper limb with
rib(s) and sternum
Fracture of
820
821
822
823
824
825
826
827
828
lower limb (820-829)
Fracture of neck of femur
Fracture of other and unspecified parts of femur
Fracture of patella
Fracture of tibia and fibula
Fracture of ankle
Fracture of one or more tarsal and metatarsal bones
Fracture of one or more phalanges of foot
Other, multiple, and ill-defined fractures of lower limb
Multiple fractures involving both lower limbs, lower
with upper limb, and lower limb(s) with rib(s) and
sternum
829 Fracture of unspecified bones
Dislocation without fracture (830-839)
830 Dislocation of jaw
831 Dislocation of shoulder
832 Dislocation of elbowMAJOR DISEASE CATEGORIES
833
834
835
836
837
838
839
107
Dislocation of wrist
Dislocation of finger
Dislocation of hip
Dislocation of knee
Dislocation of ankle
Dislocation of foot
Other, multiple, and ill-defined dislocations
Sprains and strains of joints and adjacent muscles (840-848)
840
841
842
843
844
845
846
847
848
Sprains and strains of shoulder and upper arm
Sprains and strains of elbow and forearm
Sprains and strains of wrist and hand
Sprains and strains of hip and thigh
Sprains and strains of knee and leg
Sprains and strains of ankle and foot
Sprains and strains of sacroiliac region
Sprains and strains of other and unspecified parts
of back
Other and ill-defined sprains and strains
Intracranial injury (excluding those with skull fracture)
(850-854)
850 Concussion
851 Cerebral laceration and contusion
852 Subarachnoid, subdural and extradural hemorrhage, fol-
lowing injury (without mention of cerebral laceration
or contusion)
853 Other and unspecified intracranial hemorrhage following
injury (without mention of cerebral laceration or con-
tusion)
854 Intracranial injury of other and unspecified nature
Internal injury of chest, abdomen, and pelvis (860-869)
860
861
862
863
864
865
866
867
Traumatic pneumothorax and hemothorax
Injury to heart and lung
Injury to other and unspecified intrathoracic organs
Injury to gastrointestinal tract
Injury to liver
Injury to spleen
Injury to kidney
Injury to pelvic organs108
MENTAL DISORDERS
868
869
Injury to other and unspecified intra-abdominal organs
Internal injury, unspecified, or involving intrathoracic and
intra-abdominal organs
Laceration and open wound of head, neck, and trunk (870-879)
870
871
872
873
874
875
876
877
878
879
Open wound of eye and orbit
Enucleation of eye
Open wound of ear
Other and unspecified laceration of head
Open wound of neck
Open wound of chest (wall)
Open wound of back
Open wound of buttock
Open wound of genital organs (external) including trau-
matic amputation
Other, multiple, and unspecified open wounds of head,
neck, and trunk
Laceration and open wound of upper limb (880-887 )
880
881
882
883
884
885
886
887
Open wound of shoulder and upper arm
Open wound of elbow, forearm, and wrist
Open wound of hand except finger(s) alone
Open wound of ringer (s)
Multiple and unspecified open wound of upper limb
Traumatic amputation of thumb (complete) (partial)
Traumatic amputation of other finger (s) (complete)
(partial)
Traumatic amputation of arm and hand (complete)
(partial)
Laceration and open wound of lower limb (890-897 )
890 Open wound of hip and thigh
891 Open wound of knee, leg (except thigh), and ankle
892 Open wound of foot, except toe(s) alone
893 Open wound of toe(s)
894 Multiple and unspecified open wound of lower limb
895 Traumatic amputation of toe(s) (complete) (partial)
896 Traumatic amputation of foot (complete) (partial )
897 Traumatic amputation of leg(s) (complete) (partial)MAJOR DISEASE CATEGORIES
109
Laceration
900
901
902
903
904
905
906
907 and open wound of multiple location (900-907)
Multiple open wounds of both upper limbs
Multiple open wounds of both lower limbs
Multiple open wounds of upper with lower limb(s)
Multiple open wounds of both hands
Multiple open wounds of head with limb(s)
Multiple open wounds of trunk with limb(s)
Multiple open wounds of face with limb(s)
Multiple open wounds of other and unspecified location
Superficial
910
911
912
913
914
915
916
917
918 injury (910-918)
Superficial injury of face, neck, and scalp
Superficial injury of trunk
Superficial injury of shoulder and upper arm
Superficial injury of elbow, forearm, and wrist
Superficial injury of hand(s), except finger(s) alone
Superficial injury of finger (s)
Superficial injury of hip, thigh, leg, and ankle
Superficial injury of foot and toe(s)
Superficial injury of other, multiple, and unspecified sites
Contusion and crushing with intact skin surface (920-929)
920
921
922
923
924
925
926
927
928
929
Contusion
Contusion
Contusion
Contusion
Contusion
Contusion
Contusion
Contusion
Contusion
Contusion
of face, scalp, and neck except eye(s)
of eye and orbit
of trunk
of shoulder and upper arm
of elbow, forearm, and wrist
of hand(s), except finger(s) alone
of finger (s)
of hip, thigh, leg, and ankle
of foot and toe(s)
of other, multiple, and unspecified sites
Effects of foreign body, entering through orifice (930-939)
930 Foreign body in eye and adnexa
931 Foreign body in ear
932 Foreign body in nose
933 Foreign body in pharynx and larynx
934 Foreign body in bronchus and lung
935 Foreign body in mouth, esophagus, and stomach110
MENTAL DISORDERS
936
937
938
939
Foreign body in intestine and colon
Foreign body in anus and rectum
Foreign body in digestive system, unspecified
Foreign body in genitourinary tract
Burn (940-949)
940 Burn confined to eye
941 Burn confined to face, head, and neck
942 Burn confined to trunk
943 Burn confined to upper limb, except wrist and hand
944 Burn confined to wrist(s) and hand(s)
945 Bum confined to lower limb(s)
946 Burn involving face, head, and neck, with limb(s)
947 Burn involving trunk with limb(s)
948 Burn involving face, head, and neck, with trunk arid
limb(s)
949 Burn involving other and unspecified parts
Injury to nerves and spinal cord (950-959 )
950
951
952
953
954
955
956
957
958
959
Injury to optic nerve(s)
Injury to other cranial nerve (s)
Injury to nerve(s) in upper arm
Injury to nerve(s) in forearm
Injury to nerve (s) in wrist and hand
Injury to nerve (s) in thigh
Injury to nerve (s) hi lower leg
Injury to nerve(s) in ankle and foot
Spinal cord lesion without evidence of spinal bone injury
Other nerve injury including nerve injury in several parts
Adverse effect of medicinal agents (960-979)
960 Adverse effect of antibiotics
961 Adverse effect of other anti-infectives
962 Adverse effect of hormones and synthetic substitutes
963 Adverse effect of primarily systemic agents
964 Adverse effect of agents primarily affecting blood
constituents
965 Adverse effect of analgesics and antipyretics
966 Adverse effect of anticonvulsants
967 Adverse effect of other sedatives and hypnoticsMAJOR DISEASE CATEGORIES
968
969
970
971
972
973
974
975
976
977
978
979
111
Adverse effect of other central nervous system depres-
sants
Adverse effect of local anesthetics
Adverse effect of psychotherapeutics
Adverse effect of other central nervous system stimulants
Adverse effect of agents primarily affecting the autonomic
nervous system
Adverse effect of agents primarily affecting cardiovascular
system
Adverse effect of drugs primarily affecting gastrointestinal
system
Adverse effect of diuretics
Adverse effect of agents acting directly upon musculo-
skeletal system
Adverse effect of other and unspecified drugs
Adverse effect of two or more medicinal agents in specified
combinations
Alcohol in combination with specified medicinal agents
Toxic effect of substances chiefly nonmedicinal as to source
(980-989)
980
981
982
983
984
985
986
987
988
989
Toxic effect of alcohol
Toxic effect of petroleum products
Toxic effect of industrial solvents
Toxic effect of corrosive aromatics, acids, and caustic
alkalis
Toxic effect of lead and its components (including fumes)
Toxic effect of other metals, chiefly nonmedicinal as to
source
Toxic effect of carbon monoxide
Toxic effect of other gases, fumes, or vapors
Toxic effect of noxious foodstuffs
Toxic effect of other substances chiefly nonmedicinal as
to source
Other adverse effects (990-999)
990
991
992
993
994
Effects
Effects
Effects
Effects
Effects
of radiation
of reduced temperature and excessive dampness
of heat
of air pressures
of other external causes112
MENTAL DISORDERS
995
996
997
998
999
Certain early complications of trauma
Injury, other and unspecified
Complications peculiar to certain surgical procedures
Other complications of surgical procedures
Other complications of medical care
E XVII. ACCIDENTS, POISONINGS, AND VIOLENCE
(EXTERNAL CAUSE) (E800-E999)
Railway accidents (E800-E807)
E800
E801
E802
E803
E804
E805
E806
E807
Railway accident involving collision with rolling stock
Railway accident involving collision with other object
Railway accident involving derailment without ante-
cedent collision
Railway accident involving explosion, fire, burning
Fall in, on, or from train
Hit by rolling stock
Other specified railway accident
Railway accident of unspecified nature
Motor vehicle traffic Accidents (E810-E819)
E810
E811
E812
E813
E814
E815
E816
E817
E818
E819
Motor vehicle traffic accident involving collision with
train
Motor vehicle traffic accident involving collision with
street car
Motor vehicle traffic accident involving collision with
another motor vehicle
Motor vehicle traffic accident involving collision with
other vehicle
Motor vehicle traffic accident involved collision with
pedestrian
Other motor vehicle traffic accident involving collision
Noncollision motor vehicle traffic accident due to loss
of control
Noncollision motor vehicle traffic accident while board-
ing or alighting
Other noncollision motor vehicle traffic accident
Motor vehicle traffic accident of unspecified natureMAJOR DISEASE CATEGORIES
113
Motor Vehicle Nontraffic Accidents (E820-E823)
E820
E821
E822
E823
Motor vehicle nontraffic accident involving collision with
moving object
Motor vehicle nontraffic accident involving collision with
stationary object
Motor vehicle nontraffic accident while boarding or
alighting
Motor vehicle nontraffic accident of other and unspeci-
fied nature
Other road vehicle accidents (E825-E827)
E825
E826
E827
Street car accident
Pedal cycle accident
Other nonmotor road vehicle accident
Water transport accidents (E830-E838)
E830
E831
E832
E833
E834
E835
E836
E837
E838
Accident to watercraft causing submersion
Accident to watercraft causing other injury
Other accidental submersion or drowning in water trans-
port
Fall on stairs or ladders in water transport
Other fall from one level to another in water trans-
port
Other and unspecified fall in water transport
Machinery accident in water transport
Explosion, fire, burning and in water transport
Other and unspecified water transport accident
Air and space transport accidents (E840-E845)
E840
E841
E842
E843
E844
E845
Accident to powered aircraft at take-off or landing
Accident to powered aircraft, other and unspecified
Accident to unpowered aircraft
Fall in, on, or from aircraft
Other specified air transport accidents
Accident involving spacecraft
Accidental poisoning by drugs and medicaments (E850-E859)
E850
Accidental poisoning by antibiotics and other anti-
infectives
E851 Accidental poisoning by hormones and synthetic sub-
stitutes114
MENTAL DISORDERS
E852 Accidental poisoning by primarily systemic and hem-
atologic agents
E853 Accidental poisoning by analgesics and antipyretics
E854 Accidental poisoning by other sedatives and hypnotics
E855 Accidental poisoning by autonomic nervous system
and psychotherapeutic drugs
E856 Accidental poisoning by other central nervous system
depressants and stimulants
E857 Accidental poisoning by cardiovascular drugs
E858 Accidental poisoning by gastrointestinal drugs
E859 Accidental poisoning by other and unspecified drugs
and medicaments
Accidental poisoning by other solid and liquid substances (E860-
E869)
E860
E861
E862
E863
E864
Accidental poisoning by alcohol
Accidental poisoning by cleansing and polishing agents
Accidental poisoning by disinfectants
Accidental poisoning by paints and varnishes
Accidental poisoning by petroleum products and other
solvents
E865 Accidental poisoning by pesticides, fertilizers, or plant
food
E866 Accidental poisoning by heavy metals and their fumes
E867 Accidental poisoning by corrosives and caustics, not
elsewhere classified
E868 Accidental poisoning by noxious foodstuffs and poison-
ous plants
E869 Accidental poisoning by other and unspecified solid and
liquid substances
Accidental poisoning by gases and vapors (E870-E877)
E870 Accidental poisoning by gas distributed by pipeline
E871 Accidental poisoning by liquefied petroleum gas dis-
tributed in mobile containers
E872 Accidental poisoning by other utility gas
E873 Accidental poisoning by motor vehicle exhaust gas
E874 Accidental poisoning by carbon monoxide from incom-
plete combustion of domestic fuels
E875 Accidental poisoning by other carbon monoxideMAJOR DISEASE CATEGORIES
115
E876 Accidental poisoning by other gases and vapors
E877 Accidental poisoning by unspecified gases and vapors
Accidental falls (E880-E887)
E880
E881
E882
E883
E884
E885
E886
E887
Fall on or from stairs or steps
Fall on or from ladders or scaffolding
Fall from or out of building or other structure
Fall into hole or other opening in surface
Other fall from one level to another
Fall on same level from slipping, stumbling, or trip-
ping
Fall on same level from collision, pushing, or shoving
by or with other person
Other and unspecified fall
Accidents caused by fires and flames (E890-E899)
E890 Accident caused by conflagration in private dwelling
E891 Accident caused by conflagration in other building or
structure
E892 Accident caused by conflagration not in building or
structure
E893 Accident caused by ignition of clothing
E894 Accident caused by ignition of highly inflammable ma-
terial
E895 Accident caused by controlled fire in private dwelling
E896
Accident caused by controlled fire in other building or
structure
E897 Accident caused by controlled fire not in building or
structure
E898 Accident caused by other specified fires or flames
E899 Accident caused by unspecified fire
Accidents due to natural and environmental factors ( E900-E909 )
E900
E901
E892
E903
E904
E905
E906
Excessive heat
Excessive cold
High and low air pressure
Effects of travel and motion
Hunger, thirst, exposure, and neglect
Bites and stings of venomous animals and insects
Other accidents caused by animals116
MENTAL DISORDERS
E907 Lightning
E908 Cataclysm
E909 Accident due to other natural environmental factors
Other accidents (E910-E929)
E910
E911
E912
E913
E914
E915
E916
E917
E918
E919
E920
E921
E922
E923
E924
E925
E926
E927
E928
E929
Accidental drowning and submersion
Inhalation and ingestion of food causing obstruction
or suffocation
Inhalation and ingestion of other object causing ob-
struction or suffocation
Accidental mechanical suffocation
Foreign body accidentally entering eye and adnexa
Foreign body accidentally entering other orifice
Struck accidentally by falling object
Striking against or struck accidentally by objects
Caught accidentally in or between objects
Overexertion and strenuous movements
Accidents caused by cutting or piercing instruments
Accidents caused by explosion of pressure vessel
Accident caused by firearm missiles
Accident caused by explosive material
Accident caused by hot substance, corrosive liquid, and
steam
Accident caused by electric current
Accident caused by radiation
Vehicle accidents not elsewhere classifiable
Machinery accidents not elsewhere classifiable
Other and unspecified accidents
Surgical and medical complications and misadventures
(E930-E936)
E930
E931
E932
E933
E934
Complications and misadventures in operative thera-
peutic procedures
Complications and misadventures in other and unspeci-
fied therapeutic procedures
Complications and misadventures in diagnostic pro-
cedures
Complications and misadventures in prophylaxis with
bacterial vaccines
Complications and misadventures in prophylaxis with
other vaccinesMAJOR DISEASE CATEGORIES
E935
E936
117
Complications and misadventures in other prophylactic
procedures
Complications and misadventures in other nonthera-
peutic procedures
Late effects of accidental injury (E940-E949)
E940
E941
E942
E943
E944
E945
E946
E947
E948
E949
Late effect of motor vehicle accident
Late effect of other transport accident
Late effect of accidental poisoning
Late effect of accidental fall
Late effect of accident caused by fire
Late effect of accident due to natural and environmental
factors
Late effect of other accident
Late effect of surgical operation
Late effect of irradiation
Late effect of other surgical and medical procedures
Suicide and self-inflicted injury (E950-E959)
E950
E951
E952
E953
E954
E955
E956
E957
E958
E959
Suicide and self-inflicted poisoning by solid or liquid
substances
Suicide and self-inflicted poisoning by gases in domes-
tic use
Suicide and self-inflicted poisoning by other gases
Suicide and self-inflicted injury by hanging, strangula-
tion, and suffocation
Suicide and self-inflicted injury by submersion (drown-
ing)
Suicide and self-inflicted injury by firearms and ex-
plosives
Suicide and self-inflicted injury by cutting and piercing
instruments
Suicide and self-inflicted injury by jumping from high
place
Suicide and self-inflicted injury by other and unspecified
means
Late effect of self-inflicted injury
Homicide and injury purposely inflicted by other persons
(E960-E969)
E960
Fight, brawl, or rape118
MENTAL DISORDERS
E961
E962
E963
E964
E965
E966
E967
E968
E969
Assault by corrosive or caustic substances, except poi-
oning
Assault by poisoning
Assault by hanging and strangulation
Assault by submersion (drowning)
Assault by firearms and explosives
Assault by cutting and piercing instruments
Assault by pushing from high place
Assault by other and unspecified means
Late effect of injury purposely inflicted by other person
Legal intervention (E970-E978)
E970 Injury due to legal intervention by firearms
E971 Injury due to legal intervention by explosives
E972 Injury due to legal intervention by gas
E973 Injury due to legal intervention by blunt object
E974 Injury due to legal intervention by cutting and piercing
instruments
E975 Injury due to legal intervention by other specified means
E976 Injury due to legal intervention by unspecified means
E977 Late effect of injuries due to legal intervention
E978 Legal execution
Injury undetermined whether accidentally or purposely inflicted
(E980-E989)
E980 Poisoning by solid or liquid substances, undetermined
whether accidentally or purposely inflicted
E981 Poisoning by gases in domestic use, undetermined
whether accidentally or purposely inflicted
E982 Poisoning by other gases, undetermined whether acci-
dentally or purposely inflicted
E983 Hanging and strangulation, undetermined whether ac-
cidentally or purposely inflicted
E984 Submersion (drowning), undetermined whether acci-
dentally or purposely inflicted
E985 Injury by firearms and explosives, undetermined whether
accidentally or purposely inflicted
E986 Injury by cutting and piercing instruments, undetermined
whether accidentally or purposely inflicted
E987 Falling from high place, undetermined whether acci-
dentally or purposely inflictedMAJOR DISEASE CATEGORIES119
E988
E989
Injury by other and unspecified means, undetermined
whether accidentally or purposely inflicted
Late effect of injury, undetermined whether accidental-
ly or purposely inflicted
Injury resulting from operations of war (E990-E999)
E990 Injury due to war operations by fires and conflagrations
E991 Injury due to war operations by bullets and fragments
E992 Injury due to war operations by explosion of marine
weapons
E993 Injury due to war operations by other explosion
E994 Injury due to war operations by destruction of aircraft
E995 Injury due to war operations by other and unspecified
forms of conventional warfare
E996 Injury due to war operations by nuclear weapons
E997 Injury due to war operations by other forms of uncon-
ventional warfare
E998 Injury due to war operations but occurring after ces-
sation of hostilities
E999 Late effect of injury due to war operations