Classification systems identify patterns of behavioural or

mental symptoms that consistently occur together to form a

disorder. In the USA, psychiatrists and other healthcare
professionals use the Diagnostic and Statistical Manual of
Mental Disorders, published by the American Psychiatric
Association (DSM-5). This is a standardized system for
diagnosis based on factors such as the person’s clinical and
medical conditions, psychosocial stressors and the extent to
which a person’s mental state interferes with his or her daily
life. The DSM is developed for American psychiatrists and is
used mainly in the USA. It contains descriptions, symptoms,
and other criteria for diagnosing mental disorders.

In addition to the DSM, the World Health Organization has

published the International Classification of Diseases [ICD]. 
This system is developed by a global health agency and it is
distributed as broadly as possible at a very low cost.

The two major classification systems used by western psychiatrists today are based largely on abnormal experiences
and beliefs reported by patients, as well as agreement among a number of professionals as to what criteria should be
used.  A Chinese Classification of Mental Disorders [CCMD] has also been developed but Chinese psychiatrists also
use the ICD-10 manual. A key difference between the CCMD and the Western classification systems is that it contains
diagnostic criteria for disorders that are specific to Chinese culture.

ATL: Research and critical thinking

One of the disorders specified by the CCMD-2 is qigong deviation syndrome – also called zou huo ru mo.

Do some research on this disorder.  To what extent is this disorder rooted in Chinese culture?  What are the
similarities between this disorder and Western disorders?

 Teacher only box

Questions: To what extent is this disorder rooted in Chinese culture?  What are the similarities between this
disorder and Western disorders?

The symptoms

Qigong is a system of coordinated body posture and movement, breathing, and meditation used for the
purposes of health, spirituality, and martial arts training

In the second edition of the Chinese Classification of Mental Disorders (CCMD-2) the diagnosis of “Qigong
Deviation Syndrome” is based upon the following criteria:

The subject being demonstrably normal before doing qigong exercises

Psychological and physiological reactions appearing during or after qigong exercises (suggestion and
autosuggestion may play an important role in these reactions)
Complaints of abnormal sensations during or after qigong exercises
Diagnostic criteria do not meet other mental disorders such as schizophrenia, affective disorder, and
neurosis.

Unlike most Western diagnoses, this disorder is linked to spiritual practice.  The roots of the disorder are about
"incorrect" qigong practices. The disorder has some similarities to anxiety disorders, which often have some
trigger for feelings of panic or anxiety.

Overall, diagnostic systems provide a set of templates that the clinician can use to compare information about
disorders to the condition of a particular client. In this way, clinicians can use the same standards for diagnosis. The
purpose of such manuals is first and foremost to provide a common language for psychiatrists to communicate about
patients and to establish consistent and reliable diagnoses. This is important in terms of finding a correct treatment for
specific disorders as well as for research purposes.
 Key differences between the ICD-11 and the DSM 5
The ICD is produced by the World Health Organization, while the DSM is produced by the American
Psychiatric Association.
The ICD's approach is multidisciplinary and multilingual with the intent that it will be used globally to
increase mental health; the primary users of the DSM are American psychiatrists.
The ICD is more likely to indicate causes rather than purely symptoms.
The ICD is approved by the health ministers of all 193 WHO member countries; the DSM is approved by
the assembly of the American Psychiatric Association.
The ICD is distributed at a very low cost, with substantial discounts to low-income countries, and available
free on the Internet; the DSM generates a very substantial portion of the American Psychiatric
Association's revenue.

Diagnosing psychological disorders

When an individual seeks help for a potential psychological disorder, how do psychiatrists go about making a
diagnosis? A doctor looks for biological markers of disease -  for example, using brain imaging technology or blood
tests - as well as observable symptoms.  A psychiatrist will often rely on the patient’s subjective description of the
problem as well as assessment tools to evaluate a person for a disorder. Diagnosis is accomplished through a formal
standardized clinical interview—a checklist of questions to ask each patient. This interview can be supplemented by
interviews with the patient’s relatives. After the interview, a mental health status examination is completed, based on
the clinician’s evaluation of the patient’s responses.

There are several limitations of relying on a clinical interview for diagnosis:

The individual is automatically labeled as a “patient.”This means that the psychiatrist is “looking for evidence of
abnormal behaviour.” This assumption that if a person is seeking assistance, s/he must have a mental disorder
is known as sick role bias.
The fact that the person is being observed or asked personal questions may increase anxiety and therefore
change or intensify behaviour. This is called reactivity. This may then be seen by the psychiatrist as further
evidence of dysfunctional symptoms.
A clinician’s unique style, degree of experience, and the theoretical orientation will definitely affect the interview.

Reactivity occurs when individuals change behaviour due to the awareness that they are being observed. The
change may be positive or negative.

When carrying out a clinical interview or observation, psychiatrists refer to the ABCS when describing symptoms of a
disorder.

Affective symptoms: emotional elements, including fear, sadness, anger

Behavioural symptoms: observational behaviours, such as crying, physical withdrawal from others, and
pacing

Cognitive symptoms: ways of thinking, including pessimism, personalization, and self-image

Somatic symptoms: physical symptoms, including facial twitching, stomach cramping and changes in
weight.

Checking for understanding

1
How is the CCMD different from the DSM or ICD?

A. The CCMD does not include somatic symptoms.

B. The CCMD is not available in English.

C. The CCMD includes disorders found in Chinese culture.

D. The CCMD does not include depression, anxiety or schizophrenia.

What is an advantage of using a classificatory system for diagnosis?

A. It helps to recognize cross-cultural differences in disorders.

B. It helps to increase the ecological validity of diagnosis.

C. It helps to increase the objectivity of diagnosis.

D. It helps to increase the reliability of diagnosis.

Which of the following is not a key difference between the ICD and the DSM?

A. The ICD is approved by health ministers from over 190 countries.

B. The ICD is used internationally; the DSM is used primarily in the USA.

C. The ICD includes potential causes, as well as symptoms.

D. The DSM is given free to practicing psychiatrists; the ICD is an expensive system because it is available in so
many languages.

What is meant by the term “sick role bias?”

A. The assunption that if a person is seeking assistasnce, she must have a mental disorder.

B. People who have disorders often experience discrimination.

C. Doctors often treat patients as less intelligent and do not share all information about their disorder with them.

D. A doctor often diagnoses a patient based on his or her own experineces with mental illness.

5
What is one disadvantage of using interviews in the diagnostic process?

A. The data collected is all self-reported.

B. Knowing that they are being observed, the patient may act differently.

C. They are expensive.

D. They take a long time.

Which of the following is not an example of a somatic symptom?

A. Insomnia - not being able to sleep

B. Change in weight

C. Constantly breaking into tears; crying

D. Headaches

Validity and reliability