Category: F90 F91 F92 F93 F94 F95 F98
F98 — Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence: facilitator sheet
Teaching objective
Several F98 subcategories (enuresis, encopresis) specifically require the presentation to be 'nonorganic' — that is, not attributable to a physical or neurological cause such as a urinary tract abnormality or bowel disease — which must be actively ruled out, not merely assumed, before the code applies. Others are distinguished from one another and from tic disorders (F95) primarily by the specific character of the repetitive or disrupted behaviour involved.
Choose material
Worked example · Case: Bedwetting, with an organic cause ruled out · Case: Sudden bedwetting, with daytime symptoms
Worked example
Show scenario
A 7-year-old continues to wet the bed most nights. Her paediatrician has examined her, found no structural abnormality, no daytime urinary symptoms, and no history suggestive of a urinary tract infection or neurological condition, and confirms there is no identified physical cause.
Reveal step 1
Step 1 — Check whether an organic cause has actually been assessed: a paediatric examination was carried out, not merely assumed unnecessary.
Reveal step 2
Step 2 — Confirm no physical or neurological cause was found: no structural abnormality, infection, or neurological condition was identified.
Reveal step 3
Step 3 — Check developmental appropriateness: continued bedwetting at this age, without an organic explanation, is inappropriate for her expected developmental stage.
Reveal step 4
Conclusion — With an organic cause actively ruled out, F98.0 (nonorganic enuresis) is supported.
Comparison points
F98.0/F98.1's 'nonorganic' qualifier is decisive: a physical cause must be actively ruled out, not merely unmentioned, before either code applies. F98.4 (stereotyped movement disorder) is distinguished from F95 (tic disorders) by its more rhythmic, sustained, often self-soothing, voluntary-seeming character, versus a tic's sudden, non-rhythmic, suppressible-but-involuntary quality. Stuttering (F98.5) and cluttering (F98.6) are distinguished from one another by the specific character of the fluency disruption, not by overall severity.
Misconception prompt
Treating bedwetting or soiling as a moral failing or deliberate misbehaviour: "He's old enough to know better, so he must just be doing it on purpose."
Ask the class why this reasoning fails before revealing the explanation below.
Reveal why it fails
Nonorganic enuresis (F98.0) and encopresis (F98.1) are common, often treatable childhood conditions, not evidence of laziness, defiance, or intentional misbehaviour. Framing them this way is both clinically inaccurate and a significant, needless source of shame for children and families. The genuine diagnostic question is narrower and more careful: whether the pattern is developmentally inappropriate for the child's age, and whether a physical or neurological cause has been actively assessed and ruled out — not a judgement about the child's character or effort.
Discussion prompts
Prompt 1
Explain why 'nonorganic' must be actively established, not assumed, for F98.0/F98.1.
Prompt 2
Explain the difference between stuttering and cluttering.
Summary
A heterogeneous group of common, treatable childhood conditions, each with its own specific criteria — 'nonorganic' must be actively confirmed for enuresis/encopresis, never assumed.