È di uso comune la terminologia Disturbi del comportamento anche se nei manuali ICD e DSM più o meno recenti se ne usano altre, non del tutto concordi.
Nel sito vengono trattati analiticamente

Chi desidera sintetiche informazioni su quanto previsto dai manuali ICD-10, ICD-11 e DSM-5 può considerare anche quanto scritto sotto.

ICD-10

Capitolo 5 Disturbi psichici e comportamentali (F00-F99),

Disturbi comportamentali e della sfera emozionale con esordio abituale nell’infanzia e nell’adolescenza (F90-F98)

  • F90 Disturbo da deficit di attenzione/iperattività
    • F90.0 Disturbo da deficit di attenzione/iperattività. Tipo con predominante la disattenzione
    • F90.1 Disturbo da deficit di attenzione/iperattività. Tipo con predominante l’iperattività
    • F90.2 Disturbo da deficit di attenzione/iperattività. Tipo combinato
    • F90.8 Disturbo da deficit di attenzione/iperattività. Altro tipo
    • F90.9 Disturbo da deficit di attenzione/iperattività. Tipo non specificato
  • F91 Disturbi della condotta
    • F91.0 Disturbo della condotta limitato al contesto familiare
    • F91.1 Disturbo della condotta con ridotta socializzazione
    • F91.2 Disturbo della condotta con socializzazione normale
    • F91.3 Disturbo del comportamento sociale oppositivo e provocatorio
    • F91.8 Altri disturbi della condotta
    • F91.9 Disturbo della condotta non specificato
  • F92 Disturbi misti della condotta e della sfera emozionale
    • F92.0 Disturbo della condotta depressivo
    • F92.8 Altro disturbo misto della condotta e della sfera emozionale
    • F92.9 Disturbo misto della condotta e della sfera emozionale, non specificato
  • F93 Disturbi della sfera emozionale con esordio caratteristico nell’infanzia
  • F93.0 Disturbo ansioso da separazione dell’infanzia
  • F93.1 Disturbo fobico dell’infanzia
  • F93.2 Disturbo di ansia sociale dell’infanzia
  • F93.3 Disturbo di rivalità tra fratelli
  • F93.8 Altri disturbi emozionali dell’infanzia
  • F93.9 Disturbo emozionale dell’infanzia non specificato
  • F94 Disturbo del funzionamento sociale con esordio specifico nell’infanzia e nell’adolescenza
    • F94.0 Mutismo elettivo
    • F94.1 Disturbo reattivo dell’attaccamento dell’infanzia
    • F94.2 Disturbo dell’attaccamento disinibito dell’infanzia
    • F94.8 Disturbi del funzionamento sociale dell’infanzia di altro tipo
    • F94.9 Disturbo del funzionamento sociale dell’infanzia non specificato
  • F95 Disturbi a tipo tic
    • F95.0 Disturbo di tipo tic transitorio
    • F95.1 Disturbo di tipo tic cronico motorio o vocale
    • F95.2 Disturbi a tipo tic combinati motori multipli e vocali [Sindrome di Tourette]
    • F95.8 Altri disturbi di tipo tic
    • F95.9 Disturbo di tipo tic non specificato
    • F98 Altri disturbi comportamentali e della sfera emozionale con esordio abituale nell’infanzia e nell’adolescenza

Nell’ICD-11 (vedi allegato in inglese alla fine di questo file) vengono considerati i “Disturbi da comportamento dirompente o dissociale” (“Disruptive behaviour or dissocial disorders”).

Il primo nell’elenco è l’Oppositional defiant disorder (Disturbo oppositivo provocatorio).

Il secondo è il Conduct-dissocial disorder (Disturbo da comportamento dissociale). Più o meno quelli che consideriamo noi e cioè il Disturbo oppositivo provocatorio e il Disturbo della condotta.

Nell’ICD-11 sono considerati anche i Disturbi da difficoltà di controllo degli impulsi, tra i quali la Piromania, la Cleptomania, il Disturbo da comportamento sessuale compulsivo, il Disturbo da comportamento esplosivo intermittente

Nel DSM-5 (nella traduzione italiana da pag. 539) sono considerati i Disturbi da comportamento dirompente, del controllo degli impulsi e della condotta. Specificamente:

  • Disturbo oppositivo provocatorio
  • Disturbo esplosivo intermittente
  • Disturbo della condotta
  • Piromania
  • Cleptomania

ICD-11

Disruptive behaviour or dissocial disorders (BlockL1‑6C9)

Disruptive behaviour and dissocial disorders are characterised by persistent behaviour problems that range from markedly and persistently defiant, disobedient, provocative or spiteful (i.e., disruptive) behaviours to those that persistently violate the basic rights of others or major age-appropriate societal norms, rules, or laws (i.e., dissocial). Onset of Disruptive and dissocial disorders is commonly, though not always, during childhood.

6C90  Oppositional defiant disorder

Oppositional defiant disorder is a persistent pattern (e.g., 6 months or more) of markedly defiant, disobedient, provocative or spiteful behaviour that occurs more frequently than is typically observed in individuals of comparable age and developmental level and that is not restricted to interaction with siblings. Oppositional defiant disorder may be manifest in prevailing, persistent angry or irritable mood, often accompanied by severe temper outbursts or in headstrong, argumentative and defiant behaviour. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning

6C90.0 Oppositional defiant disorder with chronic irritability-anger

All definitional requirements for oppositional defiant disorder are met. This form of oppositional defiant disorder is characterised by prevailing, persistent angry or irritable mood that may be present independent of any apparent provocation. The negative mood is often accompanied by regularly occurring severe temper outbursts that are grossly out of proportion in intensity or duration to the provocation. Chronic irritability and anger are characteristic of the individual’s functioning nearly every day, are observable across multiple settings or domains of functioning (e.g., home, school, social relationships), and are not restricted to the individual’s relationship with his/her parents or guardians. The pattern of chronic irritability and anger is not limited to occasional episodes (e.g., developmentally typical irritability) or discrete periods (e.g., irritable mood in the context of manic or depressive episodes).

6C90.00 Oppositional defiant disorder with chronic irritability-anger with limited prosocial emotions

All definitional requirements for oppositional defiant disorder with chronic irritability-anger are met. In addition, the individual exhibits characteristics that are sometimes referred to as ‘callous and unemotional’. These characteristics include a lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress; a lack of remorse, shame or guilt over their own behaviour (unless prompted by being apprehended), a relative indifference to the probability of punishment; a lack of concern over poor performance in school or work; and limited expression of emotions, particularly positive or loving feelings toward others, or only doing so in ways that seem shallow, insincere, or instrumental.

6C90.01 Oppositional defiant disorder with chronic irritability-anger with typical prosocial emotions

All definitional requirements for oppositional defiant disorder with chronic irritability-anger are met. The individual does not exhibit characteristics referred to as ‘callous and unemotional’, such as lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress.

6C90.0Z Oppositional defiant disorder with chronic irritability-anger, unspecified

6C90.1 Oppositional defiant disorder without chronic irritability-anger

Meets all definitional requirements for oppositional defiant disorder. This form of oppositional defiant disorder is not characterised by prevailing, persistent, angry or irritable mood, but does feature headstrong, argumentative, and defiant behaviour.

6C90.10 Oppositional defiant disorder without chronic irritability-anger with limited prosocial emotions

All definitional requirements for oppositional defiant disorder without chronic irritability-anger are met. In addition, the individual exhibits characteristics that are sometimes referred to as ‘callous and unemotional’. These characteristics include a lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress; a lack of remorse, shame or guilt over their own behaviour (unless prompted by being apprehended), a relative indifference to the probability of punishment; a lack of concern over poor performance in school or work; and limited expression of emotions, particularly positive or loving feelings toward others, or only doing so in ways that seem shallow, insincere, or instrumental. This pattern is pervasive across situations and relationships (i.e., the qualifier should not be applied based on a single characteristic, a single relationship, or a single instance of behaviour) and is pattern is persistent over time (e.g., at least 1 year).

6C90.11 Oppositional defiant disorder without chronic irritability-anger with typical prosocial emotions

All definitional requirements for oppositional defiant disorder without chronic irritability-anger are met. The individual does not exhibit characteristics referred to as ‘callous and unemotional’, such as lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress.

6C90.1Z Oppositional defiant disorder without chronic irritability-anger, unspecified

6C90.Z Oppositional defiant disorder, unspecified

6C91  Conduct-dissocial disorder

Conduct-dissocial disorder is characterised by a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms, rules, or laws are violated such as aggression towards people or animals; destruction of property; deceitfulness or theft; and serious violations of rules. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. To be diagnosed, the behaviour pattern must be enduring over a significant period of time (e.g., 12 months or more). Isolated dissocial or criminal acts are thus not in themselves grounds for the diagnosis.

6C91.0 Conduct-dissocial disorder, childhood onset

Conduct-dissocial disorder, childhood onset is characterised by a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms, rules, or laws are violated such as aggression towards people or animals; destruction of property; deceitfulness or theft; and serious violations of rules. To be diagnosed, features of the disorder must be present during childhood prior to adolescence (e.g., before 10 years of age) and the behaviour pattern must be enduring over a significant period of time (e.g., 12 months or more). Isolated dissocial or criminal acts are thus not in themselves grounds for the diagnosis.

6C91.00 Conduct-dissocial disorder, childhood onset with limited prosocial emotions

Meets all definitional requirements for Conduct-dissocial disorder, childhood onset. In addition, the individual exhibits characteristics that are sometimes referred to as ‘callous and unemotional’. These characteristics include a lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress; a lack of remorse, shame or guilt over their own behaviour (unless prompted by being apprehended), a relative indifference to the probability of punishment; a lack of concern over poor performance in school or work; and limited expression of emotions, particularly positive or loving feelings toward others, or only doing so in ways that seem shallow, insincere, or instrumental.

6C91.01 Conduct-dissocial disorder, childhood onset with typical prosocial emotions

All definitional requirements for conduct-dissocial disorder, childhood onset are met. The individual does not exhibit characteristics referred to as ‘callous and unemotional’, such as lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress.

6C91.0Z Conduct-dissocial disorder, childhood onset, unspecified

6C91.1 Conduct-dissocial disorder, adolescent onset

Conduct-dissocial disorder, adolescent onset is characterised by a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms, rules, or laws are violated such as aggression towards people or animals; destruction of property; deceitfulness or theft; and serious violations of rules. No features of the disorder are present during childhood prior to adolescence (e.g., before 10 years of age). To be diagnosed, the behaviour pattern must be enduring over a significant period of time (e.g., 12 months or more). Isolated dissocial or criminal acts are thus not in themselves grounds for the diagnosis.

6C91.10 Conduct-dissocial disorder, adolescent onset with limited prosocial emotions

All definitional requirements for conduct-dissocial disorder, adolescent onset are met. In addition, the individual exhibits characteristics that are sometimes referred to as ‘callous and unemotional’. These characteristics include a lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress; a lack of remorse, shame or guilt over their own behaviour (unless prompted by being apprehended), a relative indifference to the probability of punishment; a lack of concern over poor performance in school or work; and limited expression of emotions, particularly positive or loving feelings toward others, or only doing so in ways that seem shallow, insincere, or instrumental.

6C91.11 Conduct-dissocial disorder, adolescent onset with typical prosocial emotions

All definitional requirements for conduct-dissocial disorder, adolescent onset are met. The individual does not exhibit characteristics referred to as ‘callous and unemotional’, such as lack of empathy or sensitivity to the feelings of others and a lack of concern for others’ distress.

6C91.1Y Other specified conduct-dissocial disorder, adolescent onset

6C91.Z Conduct-dissocial disorder, unspecified

6C9Y  Other specified disruptive behaviour or dissocial disorders

6C9Z  Disruptive behaviour or dissocial disorders, unspecified

ICD-11

Impulse control disorders (BlockL1‑6C7)

Impulse control disorders are characterised by the repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite consequences such as longer-term harm either to the individual or to others, marked distress about the behaviour pattern, or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Impulse Control Disorders involve a range of specific behaviours, including fire-setting, stealing, sexual behaviour, and explosive outbursts.

Coded Elsewhere: Substance-induced impulse control disorders

Gambling disorder (6C50)

Gaming disorder (6C51)

Secondary impulse control syndrome (6E66)

Body-focused repetitive behaviour disorders (6B25)

6C70  Pyromania

Pyromania is characterised by a recurrent failure to control strong impulses to set fires, resulting in multiple acts of, or attempts at, setting fire to property or other objects, in the absence of an apparent motive (e.g., monetary gain, revenge, sabotage, political statement, attracting attention or recognition). There is an increasing sense of tension or affective arousal prior to instances of fire setting, persistent fascination or preoccupation with fire and related stimuli (e.g., watching fires, building fires, fascination with firefighting equipment), and a sense of pleasure, excitement, relief or gratification during, and immediately after the act of setting the fire, witnessing its effects, or participating in its aftermath. The behaviour is not better explained by intellectual impairment, another mental and behavioural disorder, or substance intoxication.

Inclusions: pathological fire-setting

Exclusions: Conduct-dissocial disorder (6C91)

Bipolar type I disorder (6A60)

Schizophrenia or other primary psychotic disorders (BlockL1‑6A2)

Fire-setting as the reason for observation for suspected mental or behavioural disorders, ruled out (QA02.3)

6C71  Kleptomania

Kleptomania is characterised by a recurrent failure to control strong impulses to steal objects in the absence of an apparent motive (e.g., objects are not acquired for personal use or monetary gain). There is an increasing sense of tension or affective arousal before instances of theft and a sense of pleasure, excitement, relief, or gratification during and immediately after the act of stealing. The behaviour is not better explained by intellectual impairment, another mental and behavioural disorder, or substance intoxication.

Coding Note: If stealing occurs within the context of conduct-dissocial disorder or a manic episode, Kleptomania should not be diagnosed separately.

Inclusions: pathological stealing

Exclusions: shoplifting as the reason for observation for suspected mental disorder, ruled out (QA02.3)

6C72  Compulsive sexual behaviour disorder

Compulsive sexual behaviour disorder is characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.

Exclusions: Paraphilic disorders (BlockL1‑6D3)

6C73  Intermittent explosive disorder

Intermittent explosive disorder is characterised by repeated brief episodes of verbal or physical aggression or destruction of property that represent a failure to control aggressive impulses, with the intensity of the outburst or degree of aggressiveness being grossly out of proportion to the provocation or precipitating psychosocial stressors. The symptoms are not better explained by another mental, behavioural, or neurodevelopmental disorder and are not part of a pattern of chronic anger and irritability (e.g., in oppositional defiant disorder). The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Exclusions: Oppositional defiant disorder (6C90)

6C7Y  Other specified impulse control disorders

6C7Z  Impulse control disorders, unspecified

Renzo Vianello, 01.01.2023

Per i riferimenti bibliografici di queste pagine vedi Riferimenti bibliografici generali

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: Author.

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. (Trad. 2014. Manuale diagnostico e statistico dei disturbi mentali. Quinta edizione. Milano: Raffaello Cortina).

WHO. (1992). The ICD-10 classification of mental and behaviour disorder: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.

https://icd.who.int