F91 vs F93
F93 — Emotional disorders with onset specific to childhood
Distinguish externalizing, rule-violating conduct (F91) from internalizing emotional distress (F93), using which feature is primary, since a young person's distress can present outwardly as defiance or acting-out rather than as visible sadness or worry.
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Show overlap — what both share
A young person with an underlying emotional disorder can present with irritability, angry outbursts, or oppositional behaviour that superficially resembles conduct disorder, and a young person with a genuine conduct disorder may also appear anxious or distressed about the consequences of their behaviour, so surface presentation alone can mislead.
Show decisive evidence
- F91 is primarily about a persistent pattern of dissocial, aggressive, or defiant conduct — an externalizing pattern of rule-violating behaviour.
- F93 is primarily about a developmentally atypical, persistent, functionally impairing fear, worry, or emotional reaction — an internalizing pattern of distress focused on separation, a specific feared object, social settings, or a new sibling.
- Irritability or defiance that is best understood as a behavioural expression of an underlying, genuine fear or worry (for example, refusing school due to separation anxiety, framed by others as 'defiance') favours F93.
- A persistent pattern of aggression, rule-breaking, or dissocial acts without an underlying fear or worry driving the behaviour favours F91.
What weakens F91: Behaviour clearly driven by an underlying, specific fear or worry (rather than a general pattern of defiance or aggression for its own sake) weakens F91 as the primary classification.
Show duration / course
Both require persistence over a meaningful period, but F91's persistence concerns a conduct pattern while F93's concerns an emotional reaction disproportionate to the child's developmental stage.
Show exclusions / context
Neither category's exclusions_distinctions entries treat the other as automatically ruled out; the discriminating question is always which feature — externalizing conduct or internalizing distress — is primary and independently established.
Show information still needed
Whether the young person's behaviour is best explained as a general pattern of rule-violating conduct (F91) or as a specific, developmentally atypical fear or worry expressing itself behaviourally (F93).
Show the common trap
Labelling a young person's separation-anxiety-driven school refusal or specific-phobia avoidance as 'defiant' or 'oppositional' without checking for the underlying fear or worry that F93 requires.
Mini challenge — practise this distinction
Apply the discriminating evidence above to a fresh case before checking the full feedback.