Cultural Differences in Manual Diagnostics: CCMD-3 and DSM-5

The Chinese Classification of Mental Disorders (CCMD-3) is a diagnostic manual of mental disorders used in China and developed by the Chinese Psychiatric Association. Its third edition was published in 2001 and has been used since. 

On the other hand, in Europe and North America the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is the manual used the most by psychologists and psychiatrists. It’s been developed by the American Psychiatric Association and is targeted at English speaking cultures. 

The existence of both of these manuals points to the importance of cultural differences in psychological and psychiatric diagnosis. 

This could be seen in the example of description of depression in both manuals. In collectivist culture, such as culture in China, denying depression can be typically observed. There is a huge stigma connected to this diagnosis. The social influence is so big that Chinese people tend to describe depression in somatic symptoms or simply deny it. This disorder, in the CCMD-3, is referred to as neurasthenia and is a very common diagnosis not only in China, but also in other collectivist cultures in Asia. As neurasthenia is a medical diagnosis, not a psychiatric one, it does not meet so much stigma in the society. 

Therefore the person that in the West would typically be diagnosed with depression, in Asia would most probably be diagnosed with neurasthenia and vice versa. This could be problematic especially when it comes to the treatment administered to the patient.

This and many other cultural differences can be seen in DSM-5 and CCDM-3 and it is very important to think about them especially while working with mixed cultural patienteints.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.978089042559

Chen Y. F. (2002). Chinese classification of mental disorders (CCMD-3): towards integration in international classification. Psychopathology, 35(2-3), 171–175. https://doi.org/10.1159/000065140.

Parker, G., Gladstone, G., & Chee, K. T. (2001). Depression in the Planet’s Largest Ethnic Group: The Chinese. American Journal of Psychiatry, 158(6), 857–864. https://doi.org/10.1176/appi.ajp.158.6.857

Schwartz P. Y. (2002). Why is neurasthenia important in Asian cultures?. The Western journal of medicine, 176(4), 257–258.