# 14 - PF1B Assault by neglect or QE82.3 Personal hi

# PF1B Assault by neglect or QE82.3 Personal history of neglect as a child

729
Relationship problems and maltreatment
Boundaries with other disorders and conditions (differential diagnosis)
Boundary with caregiver–child relationship problem
Psychological maltreatment should be distinguished from caregiver–child relationship problem, 
which – unlike psychological maltreatment – is characterized by parenting behaviours that are 
within the normal range for the sociocultural context but may still have a negative impact on 
the child.
Assault by neglect or personal history of neglect as a child
Essential (required) features
• At least one confirmed or suspected egregious act or omission by a child or adolescent’s 
caregiver that deprives the child of needed age-appropriate care is required for diagnosis 
(e.g. abandonment, lack of appropriate supervision; exposure to physical hazard; failure to 
provide necessary education, health care, nourishment, shelter, clothing).
• The act or omission causes or exacerbates at least one of the following impacts:
• significant physical injury or reasonable potential for significant injury;
• other significant negative consequences to health (e.g. development of an illness directly 
linked to the neglect, malnutrition) or reasonable potential for significant negative 
consequences to health;
• significant fear or psychological distress;
• reasonable potential for significant psychological harm (e.g. development of a mental 
disorder) or for significant disruption of the child’s physical, psychological, cognitive or 
social development);
• somatic symptoms that interfere with normal functioning.
Note: this category is assigned to the victim, not the perpetrator.
If PF1B Assault by neglect is diagnosed, the perpetrator–victim relationship (e.g. parent, other 
relative, stranger) should be specified using the extension codes provided on the ICD-11 platform 
in the context of the assault field. Perpetrator should be specified as a parent, other relative, 
unrelated caregiver, or official or legal authority using the available extension codes. Depending 
on the specific situation, PB5B Unintentional neglect or PH7B Neglect with undetermined intent 
may be diagnosed rather than PF1B Assault by neglect. If QE82.3 Personal history of neglect 
is diagnosed, the time of life for current or past episodes (e.g. child aged under 5 years, early 
adolescence) can be specified using the extension codes provided.
PF1B / 
QE82.3
Problems in relationship between child and current former caregiver and current or past child maltreatment

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
Additional clinical features
• Victims of child neglect can present with severe (chronically untreated) dental caries, ear 
infections or other typical childhood illnesses.
• Child neglect is associated with a variety of mental disorders, including depressive 
disorders, adjustment disorder, anxiety and fear-related disorders, post-traumatic stress 
disorder, oppositional defiant disorder, conduct-dissocial disorder, attentional problems, 
academic problems and suicidality.
Boundary with normality (threshold)
• Parents or other caregivers may provide less than optimal care for their children for brief 
periods due to caregiver illness or stress. However, normal caregiving requires that they 
make other arrangements if their own caregiving will be compromised for more than a 
brief period. If a child is in danger, or is suffering significant harm as a result of inadequate 
caregiving, the omissions in caregiving should be diagnosed as neglect.
Developmental presentations
• Children of any age can experience neglect. Neglected children may appear mature for 
their age, but may also exhibit stunted growth due to lack of adequate nutrition or other 
developmental deficits.
• Failure to meet developmental milestones can be a marker of neglect, as can attachment 
problems (insecure or disorganized patterns), difficulty separating from parents or 
caregivers, social skills deficits, behaviour problems and scholastic problems.
Course features
• Although one incident is sufficient to meet the diagnostic requirements, incidents of child 
neglect often occur as part of a persistent pattern, which substantially increases the risk of 
mental disorders, medical conditions and disrupted development.
Problems in relationship between child and current former caregiver and current or past child maltreatment

731
Relationship problems and maltreatment
Sex- and/or gender-related features
• Although its impact can vary by gender, boys and girls are equally likely to be victims 
of neglect.
Boundaries with other disorders and conditions (differential diagnosis)
Boundary with caregiver–child relationship problem
Neglect is characterized by egregious acts or omissions that result in – or have significant potential 
to result in – negative impacts. A diagnosis of caregiver–child relationship problem is generally 
more appropriate for children of caregivers who are emotionally neglectful (e.g. not engaging 
in positive interactions with the child) but have not committed egregious acts or omissions that 
deprive the child or adolescent of age-appropriate care.
Boundary with reactive attachment disorder and disinhibited social engagement 
disorder
Both reactive attachment disorder and disinhibited social engagement disorder are considered to 
result from a history of grossly insufficient care in early childhood, including persistent disregard 
for the child’s basic emotional or physical needs. They can occur in the context of repeated 
changes of foster care or rearing in institutional settings that prevent the formation of stable 
selective attachments, as well as in dyadic caregiver relationships. The insufficient care would 
meet the diagnostic requirements for neglect and possibly also for other forms of maltreatment. 
Both reactive attachment disorder and disinhibited social engagement disorder are characterized 
by markedly abnormal attachment behaviours towards adult caregivers that are evident by the age 
of 5 years. In reactive attachment disorder, there is a persistent and pervasive pattern of inhibited, 
emotionally withdrawn behaviour, including minimal seeking of comfort when distressed and 
rare or minimal response to comfort when it is offered. In disinhibited social engagement disorder, 
there is a persistent and pervasive pattern of markedly abnormal social behaviours, in which 
the child displays reduced or absent reticence in approaching and interacting with unfamiliar 
adults. If the diagnostic requirements are met for reactive attachment disorder or disinhibited 
social engagement disorder, that diagnosis should be assigned. An additional diagnosis of 
assault by neglect or personal history of neglect may be assigned if it is relevant to the particular 
clinical situation.
Problems in relationship between child and current former caregiver and current or past child maltreatment

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders