The ICD-10 and DSM-IV diagnostic classifications are described and discussed in Chapter 1.11. The extensive comorbidity between these conditions and their diagnostic instability over time are also apparent in elderly people, which supports the idea that they are better considered as aspects of a general neurotic syndrome than as discrete diagnostic categories.(2) This model is particularly applicable to elderly patients, whose illness careers are often the result of a long process of interaction between individual vulnerability, circumstances, and maladaptive and self-defeating responses to distress. Obsessive- compulsive disorder is probably not an integral part of a general neurotic syndrome. Although classified with the anxiety disorders in ICD-10 and DSM-IV, it has a number of features that suggest it is a distinct and stable condition with a different pathological substrate (see Chapt§Ll.,,§).

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