Personality Disorders, ADHD and Autism at the Military Board

The short answer: article 18 of the Schedule of Diseases is stricter than almost any other — it has only two clauses, and both lead to exemption from conscription. Clause «a» gives category D, clause «b» gives category V. There is simply no clause here that leaves you fit. But to fall under the article the disorder must be expressed and documented.

Which fitness category article 18 yields

Note that in column III both rows give V. For contract service and officers this article closes the path too.

What the article actually covers

The list in the regulation is broader than the title suggests:

The article covers: personality disorders; disorders of habits and impulses; gender identity and sexual preference disorders; behavioural disorders associated with sexual orientation; behavioural and emotional disorders beginning in childhood and adolescence; disorders of psychological development.

It follows that attention deficit hyperactivity disorder belongs here — as a behavioural and emotional disorder of childhood and adolescence — and so do autism spectrum disorders, including Asperger syndrome, as disorders of psychological development.

The regulation states separately that sexual orientation in itself is not regarded as a disorder.

What belongs to each clause

Clause «a» covers markedly expressed disorders that do not respond to compensation.

Clause «b» covers: moderately expressed forms of personality disorders manifested by affective breakdowns, reactive states, pronounced autonomic reactions; transient (partial) personality disorders; gender identity and sexual preference disorders.

The operative words of clause «b» are "affective breakdowns", "reactive states", "unstable compensation". A diagnosis in the chart is not enough: recorded episodes where compensation broke down are needed.

ADHD in adults: what remains of a childhood diagnosis

ADHD is usually diagnosed in childhood, and by conscription age the picture changes. What matters to the board is not the diagnosis in a paediatric chart but whether the manifestations persist and how pronounced they are. If the disorder is compensated and free of breakdowns, it fits the wording of neither clause.

The practical question is therefore: is there current psychiatric follow-up, are difficulties of adaptation in study or work recorded, and what do the documents of recent years say. What exactly to gather, and why the history decides rather than the label, is in a separate piece: ADHD and military service.

Autism and Asperger syndrome

Autism spectrum disorders fall under the article as disorders of psychological development. The same logic applies: the clause follows severity and compensation rather than the name of the diagnosis. With pronounced impairment of adaptation clause «a» applies with category D; with moderate impairment and unstable compensation, clause «b» and category V.

For adults whose diagnosis is first discussed before the board, a full work-up will be required: the regulation asks for study not only of medical records but of character references — and for servicemen it prescribes inpatient examination with review of the personal file and service reference. What is regarded as signs of an autism spectrum disorder is covered in the piece on signs of autism.

Similar diagnoses under other articles

This matters because the cost of an error is a different article and a different category:

• Schizotypal disorder belongs not to article 18 but to article 15, "Endogenous psychoses", where column I gives category D.
• Organic personality disorder follows brain injury or disease and is assessed under article 14, "Organic mental disorders".
• Anxious personality disorder is easily confused with anxiety disorder as such: the first is article 18, the second article 17. The difference is covered on the page about anxiety disorder.
• Sleepwalking is not in itself a personality disorder and is assessed on the overall picture.

The regulation also mentions psychopath-like states causally linked to specific external factors — infections, intoxications: those too are assessed differently.

What your records must contain

• A psychiatrist's conclusion with the exact diagnosis — the article follows from it.
• A follow-up history: when the diagnosis was made, how the state changed, whether decompensation occurred.
• Records of affective breakdowns and reactive states — these constitute clause «b».
• Character references from school or work: the regulation names them as a source of assessment.
• Discharge summaries from inpatient examination, where it took place.
• Information on social adaptation: study, work, relationships, independence in daily life.

What is usually missing

• There is a childhood diagnosis but no entries at all in recent years — nothing to assess.
• The diagnosis is worded generally, leaving articles 18, 15 and 14 indistinguishable.
• Breakdowns and decompensations are not recorded, although they are the substance of clause «b».
• There are no character references, while the regulation refers to them directly.
• Personality disorder and neurotic disorder are not separated — different articles with different outcomes; on the latter see depression and article 17.

Questions for your doctor

• What is my diagnosis in its exact wording, and under which article is it assessed?
• Is the disorder considered compensated, or is compensation unstable?
• Are episodes of decompensation recorded, and when did they occur?
• Is there current follow-up rather than only childhood entries?
• Was an inpatient examination carried out?

Mental health at departmental boards

The above concerns assessment under Government Decree No. 565. The Interior Ministry, National Guard, Federal Security Service and Emergencies Ministry use their own schedules of diseases, with stricter mental-health requirements. A review under article 18 shows how complete your records are but is not their regulation.

The short version

Article 18 has no "fit" clause: with a confirmed and expressed disorder the category will be V or D. Precisely for that reason everything rests on documents — current follow-up, recorded decompensations and character references, not only an entry from a childhood chart. And it is worth making sure the diagnosis is worded so that it falls under article 18 rather than neighbouring 14, 15 or 17. Only the military medical board determines the fitness category.