Can't sleep after your espresso? Missing out on sexual fantasies? Don't feel like talking? Then you may be exhibiting a clinical disorder, as William Hartston discovers in a new psychiatry manual
Madness ain't what it was. Until the mid-19th century, everything was simple: you were either sane or insane. A hundred years later, at the close of World War II, the US Veterans Administration recognised 26 varieties of mental illness, comprising 10 psychoses, nine psychoneuroses and seven disorders of character, behaviour and intelligence. The first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, published in 1952, closely reflected that taxonomy. But now we are up to the fifth printing of the fourth edition of the manual, known to all good psychiatrists as DSM-IV, and it offers more mental illnesses than there are days of the year.

With each new edition, changing attitudes towards mental illness become apparent. The biggest change between the third and fourth editions was to shun terms such as "a psychotic" or "an alcoholic", preferring instead to use the psycho-politically correct terminology of "an individual with psychotic disorder" or "an individual with alcohol dependence". The other principal symptom is that behaviour previously considered perfectly normal, such as drinking coffee, snoring or losing your temper, is now in danger of being classified as mental illness.

The manner of presentation, with each illness given a four or five-digit decimal classification, gives the manual the flavour of a rather esoteric home-shopping catalogue from Psychotherapists-R-Us. With exactly 400 different possible diagnoses mentioned in the index, and over 900 pages in the book, we can give only a flavour of its contents. So here, with our explanations, is an A to Z of American mental disorders.

Antisocial Personality Disorder

"A pervasive pattern of disregard for, and violation of, the rights of others,"says the Manual, including deceitfulness, impulsiviness, irritability, reckless disregard for safety, lack of remorse and "failure to conform to social norms with respect to lawful behaviours". Awkward sods, in other words.

Breathing Related Sleep Disorder

Sleep disturbances that are not better accounted for by another mental disorder or general medical condition. Snoring and obesity may be danger signs. Caffeine-induced Sleep Disorder

The social instruction, "no thanks, coffee keeps me awake at night", now takes its place alongside "caffeine intoxication", "caffeine withdrawal" and "caffeine-related disorders".

Disorder of Infancy, Childhood or Adolescence Not Otherwise Specified

Growing up can damage your mental health. This catch-all category permits the classification as a mental illness of any symptom of childhood that is not already in a category of its own.

Elective Mutism

"Consistent failure to speak in specific social situations." As in when a child sometimes won't talk at school. "The duration of the disturbance is at least one month (not limited to the first month of school)."

Factitious Disorders

"Intentional production or feigning of physical or psychological symptoms." Not to be confused with Malingering or with Factitious Disorders by Proxy, where the sufferer pretends that someone else is ill.

Generalised Anxiety Disorder

Excessive worry on more days than not, plus any three symptoms of these six: 1) restlessness, 2) being easily fatigued, 3) difficulty concentrating, 4) irritability, 5) muscle tension, 6) sleep disturbance. Worrying, isn't it?

Hypoactive Sexual Desire Disorder

Feeling distress for not having enough sexual fantasies or desire for sexual activity. Hyperactive sexual desire, where you're caused distress by having too many sexual fantasies and desires, seems not to be classified as a disorder at all.

Intermittent Explosive Disorder

"Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property." It sounds not unlike the the condition of being a Millwall fan.


An Indian complaint, similar to dhat and not unlike the shen-k'uei of China, whose main symptoms are feelings of weakness and anxiety connected with the discharge of semen.


Another "culture-bound" disorder, Malaysian in origin, which exhibits itself as "a sudden and intense anxiety that the penis (or the vulva and nipples) will recede into the body and possibly cause death".

Learning Disorders

Includes Reading Disorder, Mathematics Disorder and Learning Disorder not Otherwise Specified - basically, anything at which a child may be under-performing for reasons other than general lack of intelligence. Formerly known as "he's better at sums than reading" (or vice versa).


A Factitious Disorder (see above) with intent or external incentives - in Factitious Disorder, you just pretend to be ill without profiting from it. "Under some circumstances, Malingering may represent adaptive behaviour - for example, feigning illness while a captive of the enemy during wartime".

Non-compliance With Treatment

Non-compliance with treatment for a mental disorder because of discomfort, side-effects, personal value judgements or expense. So if you disagree with the psychiatrist's diagnosis on another count or query his bill, he can always get you on this one.

Oppositional Defiant Disorder

A disorder of children featuring "negativistic, hostile and defiant behaviour" with at least four of the following symptoms: 1) often loses temper, 2) argues with adults, 3) defies adults' requests, 4) deliberately annoys people, 5) blames others for his or her mistakes, 6) often touchy or easily annoyed, 7) angry or resentful, 8) spiteful or vindictive. This is what used to be called "spoilt brat".


"During the attack, the individual may tear off his or her clothing, break furniture, shout obscenities, eat faeces, flee from protective shelters, or perform other irrational or dangerous acts." It's found among Eskimos, mostly - unless it's just a symptom of Partner Relational Problem, which is characterised by negative or distorted communication such as criticism, withdrawal or unrealistic expectations.

Qi-gong psychotic reaction

Acute paranoid symptoms after over-indulging in the "Chinese folk health- enhancing practice of qi-gong (exercise of vital energy)".

Relational Problems

You can suffer from Parent-Child Relational Problem, Sibling Relational Problem or Relational Problem Not Otherwise Specified, which presumably includes cousins and aunts.

Social Phobia

A persistent fear of certain social situations, which may result in a panic attack when such situations are threatened. Also known as "I don't want to go to church, Mummy, and I'll scream and scream if you make me go".


Recurrent pulling out of one's hair resulting in noticeable hair loss. Most interestingly, however, the diagnostic criteria include: "The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning". In other words, if it doesn't worry you or hamper your life in any way, it's perfectly all right to tear your hair out.

Unspecified Mental Disorder (non-psychotic)

You can use this one "when none of the available Not Otherwise Specified categories is appropriate".


You only have to fulfil two criteria: 1) watching, over a period of at least six months, "an unsuspecting person who is naked in the process of disrobing or engaging in sexual activity"; and 2) "fantasies, sexual urges or behaviours causing clinically significant distress or impairment in important areas of functioning". So peep on, Tom, as long as you don't let it interfere with your normal functioning.

Written Expression Disorder

When you can't do grammatically correct sentences.With verbs and all.

And organise your paragraphs proper.

eXpressive Language Disorder

"Symptoms include having a markedly limited vocabulary, making errors in tense, or having difficulty recalling words or producing sentences with developmentally appropriate length or complexity". Know what I mean, Harry?


Although "not mentioned specifically as a mental illness, it is difficult to avoid the conclusion, after seeing the above definitions of "Disorder of Infancy, Childhood, Adolescence Not Otherwise Specified", "Elective Mutism" and "Oppositional Defiant Disorder", that youth itself is the major ailment underlying many of these complaints.


Shouting, laughing, hitting your head against a wall, singing or weeping, together with symptoms of apathy and withdrawal, because the individual believes he or she is possessed by spirits. Seen mostly in North Africa and the Middle East, but "such behaviour is not considered pathological locally"

"DSM-IV" is published by the American Psychiatric Association, Washington DC