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ICD-10 Learning Lab Exit Presentation Mode

Category: F60 F61 F62 F63 F64 F65 F66 F68 F69

F63 — Habit and impulse disorders: facilitator sheet

Teaching objective

The decisive feature across every F63 subtype is the same recurring cycle — rising tension, the act, then relief — rather than the behaviour's outward content. This is what distinguishes F63 from an occasional, gain-motivated instance of the same surface behaviour (a single bet placed for the money, a single theft for material benefit), which does not show this cycle and is not, by itself, a disorder.

Choose material

Worked example · Case: The pull to bet again · Case: One bet, for the money · Case: The hair loss she won't explain

Worked example

Show scenario

A 38-year-old, financially comfortable and with no history of other rule-breaking, describes a two-year pattern of occasionally taking small, inexpensive items from shops that she does not need and often discards afterward. She describes a rising tension beforehand that only eases once she has taken the item, followed by guilt, and says she has tried and failed to stop several times.

(or reveal one step at a time below)
  1. Reveal step 1

    Step 1 — Check for material motivation: the items are inexpensive, not needed, and often discarded — not taken for financial gain.

  2. Reveal step 2

    Step 2 — Check for the tension-relief cycle: rising tension beforehand, relief upon taking the item, then guilt afterward.

  3. Reveal step 3

    Step 3 — Check for recurrence and failed attempts to stop: a two-year pattern, with repeated unsuccessful attempts to stop.

  4. Reveal step 4

    Conclusion — F63.2, Pathological stealing (kleptomania) — the tension-relief cycle and absence of material motivation together distinguish this from an ordinary theft for gain.

Comparison points

F63 requires a recurrent, rising-tension-then-relief cycle that the person struggles to resist, harmful to their own interests and not primarily gain-motivated — a single, rationally-motivated instance of the same surface behaviour does not meet this threshold.

Discussion prompts

(or reveal one at a time below)
  1. Prompt 1

    Describe the three-part cycle that defines every F63 subtype.

  2. Prompt 2

    Explain why a single theft motivated by financial need is not, by itself, evidence of kleptomania.

  3. Prompt 3

    Explain how F63 is distinguished from a personality disorder when the same surface behaviour is present.

Summary

F63 requires a recurrent tension-then-relief cycle around an impulse the person struggles to resist, harmful to their own interests and not primarily gain-motivated.