Tag: CCMD: Chinese Classification of Mental Disorders

What is the Chinese Classification of Mental Disorders?

Published on by Andrew Marshall1 Comment

Introduction

The Chinese Classification of Mental Disorders (CCMD; Chinese: 中国精神疾病分类方案与诊断标准), published by the Chinese Society of Psychiatry (CSP), is a clinical guide used in China for the diagnosis of mental disorders.

It is currently on a third version, the CCMD-3, written in Chinese and English. It is intentionally similar in structure and categorisation to the International Classification of Diseases (ICD) and DSM, the two most well-known diagnostic manuals, though it includes some variations on their main diagnoses and around 40 culturally related diagnoses.

Brief History

The first published Chinese psychiatric classificatory scheme appeared in 1979. A revised classification system, the CCMD-1, was made available in 1981 and further modified in 1984 (CCMD-2-R). The CCMD-3 was published in 2001.

Many Chinese psychiatrists believed the CCMD had special advantages over other manuals, such as simplicity, stability, the inclusion of culture-distinctive categories, and the exclusion of certain Western diagnostic categories. The Chinese translation of the ICD-10 was seen as linguistically complicated, containing very long sentences and awkward terms and syntax (Lee, 2001).

Diagnostic Categories

The diagnosis of depression is included in the CCMD, with many similar criteria to the ICD or DSM, with the core having been translated as ‘low spirits’. However, Neurasthenia is a more central diagnosis. Although also found in the ICD, its diagnosis takes a particular form in China, called ‘shenjing shuairuo’, which emphasizes somatic (bodily) complaints as well as fatigue or depressed feelings. Neurasthenia is a less stigmatising diagnosis than depression in China, being conceptually distinct from psychiatric labels, and is said to fit well with a tendency to express emotional issues in somatic terms. The concept of neurasthenia as a nervous system disorder is also said to fit well with the traditional Chinese epistemology of disease causation on the basis of disharmony of vital organs and imbalance of qi.

The diagnosis of schizophrenia is included in the CCMD. It is applied quite readily and broadly in Chinese psychiatry.

Some of the wordings of the diagnosis are different, for example rather than borderline personality disorder as in the DSM, or emotionally unstable personality disorder (borderline type) as in the ICD, the CCMD has impulsive personality disorder.

Diagnoses that are more specific to Chinese or Asian culture, though they may also be outlined in the ICD (or DSM glossary section), includes:

  • Koro or Genital retraction syndrome: excessive fear of the genitals (and also breasts in women) shrinking or drawing back into the body.
  • Zou huo ru mo (走火入魔) or qigong deviation (氣功偏差): perception of uncontrolled flow of qi in the body.
  • Mental disorders due to superstition or witchcraft.
  • Travelling psychosis.

The CCMD-3 lists several “disorders of sexual preference” including ego-dystonic homosexuality, but does not recognise paedophilia.

Koro

Koro or Genital retraction syndrome is a culture-specific syndrome from Southeast Asia in which the patient has an overpowering belief that the genitalia (or nipples in females) are shrinking and will shortly disappear. In China, it is known as shuk yang, shook yong, and suo yang (simplified Chinese: 缩阳; traditional Chinese: 縮陽). This has been associated with cultures placing a heavy emphasis on balance, or on fertility and reproduction.

Zou Huo Ru Mo

Zou huo ru mo (走火入魔) or “qigong deviation” (氣功偏差) is a mental condition characterised by the perception that there is uncontrolled flow of qi in the body. Other complaints include localised pains, headache, insomnia, and uncontrolled spontaneous movements.

What is the Chinese Society of Psychiatry?

Published on by Andrew Marshall1 Comment

Introduction

The Chinese Society of Psychiatry (CSP; Chinese: 中华医学会精神病学分会; lit. ‘Chinese Medical Association Psychiatry Branch’) is the largest organisation for psychiatrists in China.

It publishes the Chinese Classification of Mental Disorders (“CCMD”), first published in 1985. The CSP also publishes clinical practice guidelines; promotes psychiatric practice, research and communication; trains new professionals; and holds academic conferences.

Origins and Organisation

The organisation developed out of the Chinese Society of Neuro-Psychiatry, which was founded in 1951. This separated into the Chinese Society of Psychiatry and Chinese Society of Neurology in 1994. Since then, successive committees have run the organisation, currently the 3rd Committee, which started in 2003, whose president is Dongfeng Zhou. The CCMD is now on its third revision.

The official journal of the CSP is the Chinese Journal of Psychiatry (中华精神科杂志).[2] The Society held its seventh annual academic conference in 2006. The Society is a member of the World Psychiatric Association.

As of 2005, the CSP had 800 members.

Brief History

In 2001, the CSP declassified homosexuality and bisexuality as a mental disorder. However, the organization specified that, “although homosexuality was not a disease, a person could be conflicted or suffering from mental illness because of their sexuality, and that condition could be treated”, according to Damien Lu, founder of the Information Clearing House for Chinese Gays and Lesbians. Reportedly, this loophole is used to promote conversion therapy in China.

Beginning in 2014, the CSP began collaborating with the McLean Hospital. The purpose of the programme is to share research cross-culturally between specialists in psychotic and mood disorders.

Controversy

The Chinese Society of Psychiatrists (CSP) has been criticised for alleged complicity in the government’s political abuse of psychiatry towards Falun Gong practitioners – including by detaining individuals via diagnosing adherents as “political maniacs” or with “Qi Gong psychosis”. Antipsychotic drugs were wrongly prescribed to practitioners.

In 2004, the CSP agreed on a joint response with the World Psychiatric Association to the allegations. According to the CSP, certain psychiatrists had “failed to distinguish between spiritual-cultural beliefs and delusions” due to “lack of training and professional skills”, and this led to misdiagnoses. However, they claimed this was not a systematic issue and invited the WPA to correct the problem.

The WPA stated, “What has become clear… has been the need to assist Chinese colleagues in matters concerning forensic psychiatry, medical ethics, patients’ rights, mental health legislation, diagnosis and classification, to help them improve the care of mentally ill in China and prevent future abuses.” Arthur Kleinman, a psychiatrist at Harvard University, said he believed the claims about systematic abuse of psychiatry were exaggerated, while acknowledging that it did occur in some cases. Abraham Halpern, a psychiatrist at New York Medical College and board member of the Friends of Falun Gong, USA, criticised the WPA for not demanding an investigative mission in China.

A follow-up review of the controversy was written by Alan A. Stone, a professor of psychiatry and president of the American Psychiatric Association, and published in the Psychiatric Times. Stone determined that psychiatrists in China were generally poorly trained and did not receive the sort of medical training which was standard in the West. Stone said this was cause for the misdiagnoses.