Psychiatric Diagnosis and Classification - ResearchGate

36 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
balance between retaining the categories of international systems while
making particular additions e.g. traveling psychosis, qigong induced
mental disorders) and deletions e.g. somatoform disorders, pathological
gambling, and a number of personalityand sexual disorders). Such systems
reveal the changing notions of illness in contemporaryChina [31]. The main
discrepancies between Chinese and American diagnostic systems are in
neurasthenia and hysterical neuroses. Such discrepancies may have resulted
from differential labeling, e.g. depression being labeled as neurasthenia, or
from creating a new disorder entity, such as ``Eastern gymnastic exercisesinduced
mental disorder''. Shenjing shuairuo neurasthenia), a ubiquitous
psychiatric disease in China prior to 1980, is now reconstituted as the
popular Western disease of depression among academic psychiatrists in
urban China. It is argued that this new-found disease of depression is
based not onlyon empirical evidence but also on a confluence of historical,
social, political, and economic forces.
Taijin kyofusho TKS), a common Japanese psychiatric disorder characterized
bya fear of offending or hurting others through one's awkward social
behavior or an imagined physical defect, is similar to dysmorphophobia or
social phobia in ICD-10. Nevertheless, TKS can be understood as an amplification
of culture-specific concerns about the social presentation of self
within the Japanese context. Cultural studies focusing on these disorders
are urgentlyneeded to understand the nature of the phenomenon, the
cultural influences on diagnosis, the relationship of culture-bound syndromes
to psychiatric disorders, and the social and psychiatric history of
the syndrome in the life course of the sufferer. Such research will enhance
the international classifications of mental disorders.
The cultural applicabilityof international classification warrants careful
consideration in future comparative research. For example, WHO's research
on drinking norms definitelyshows differences in terms of thresholds of
problem drinking and dependence in ``wet'' and ``dry'' cultures [32]. Cultural
differences in the meaning of mental distress mayvaryin different
ways: a) in terms of threshold, the point at which respondents from different
societies recognize a disorder as something serious; b) in whether the
entities described in international classifications count as problems in all
cultures; c) in causal assumptions about how mental problems arise; and
d) in the extent to which there exist culture-specific manifestations of
symptoms not adequately captured by official disease nomenclature.
Categorical and Dimensional Models
There are two quite different ways of conceptualizing mental disorders: as
dimensions of symptoms or as categories, often by identifying a threshold