Category: F90 F91 F92 F93 F94 F95 F98
F93 — Emotional disorders with onset specific to childhood: facilitator sheet
Teaching objective
F93 requires the specific fear, worry, or emotional reaction to be developmentally atypical in degree for the child's age, persistent (not a brief or passing phase), and associated with significant functional impairment — reusing this product's established 'ordinary experience versus disorder' reasoning pattern, first taught for F40-F48's adult neurotic disorders and now applied to childhood-specific presentations.
Choose material
Worked example · Case: Refusing school, months on · Case: Crying for a few minutes with a new babysitter
Worked example
Show scenario
An 18-month-old cries and reaches for her father when a new babysitter arrives, calms within a few minutes once her father stays nearby briefly, and plays normally with the babysitter for the rest of the evening.
Reveal step 1
Step 1 — Check degree and developmental stage: stranger and separation wariness around this age is a normal, expected developmental phase, not itself abnormal.
Reveal step 2
Step 2 — Check persistence and impairment: the distress resolves within minutes and does not disrupt the rest of the evening.
Reveal step 3
Step 3 — Weigh what this means: F93 requires the reaction to be developmentally atypical in degree, persistent, and functionally impairing — none of which is shown here.
Reveal step 4
Conclusion — This is ordinary developmental separation wariness, not F93.
Comparison points
F93 is distinguished from ordinary developmental fears and separation wariness by degree, persistence, and functional impairment together — all three must be present, not merely the fear itself. It is distinguished from F91 by which feature is primary — internalizing distress in F93 versus externalizing rule-violating conduct in F91 — and from F94 by whether the presentation is a fear/worry-based emotional reaction (F93) or is instead rooted in the caregiving environment and social-functioning pattern itself (F94).
Misconception prompt
Mistaking a developmentally normal childhood fear for F93: "The child is scared and upset, so that's an emotional disorder."
Ask the class why this reasoning fails before revealing the explanation below.
Reveal why it fails
F93 covers emotional disorders that are, for the most part, exaggerations of normal developmental trends — the same fears and worries appear, to some degree, in typical development. The diagnostic question is one of degree, persistence, and functional impairment together, not the mere presence of fear or worry. Ordinary stranger wariness in a toddler, brief separation distress on starting school, or age-typical caution around a new sibling are all expected developmental phases, not evidence of a disorder by themselves.
Discussion prompts
Prompt 1
Name the three elements required together for F93 (beyond the fear itself).
Prompt 2
Explain why ordinary stranger wariness in a toddler does not meet F93.
Summary
A developmentally atypical, persistent, functionally impairing fear or worry — degree, persistence, and impairment must all be present together, not just the fear itself.