Western diagnosis of neurasthenia. In the second, revised edition of the Chinese Classifica- tion of Mental Disorders (CCMD-Z-R), shenjing shuairuo is defined as a syndrome composed of three out of five nonhierarchical symptom clusters: weakness (e.g., mental fatigue), emotions (e.g., feeling vexed), excitement (e.g., increased recollections), nervous pain (e.g., headache), and sleep (e.g., insomnia). Fan nuo (feeling vexed) is a form of irritability mixed with worry and distress over conﬂicting thoughts and unfulfilled desires. The third edi- tion of the CCMD retains shenjing shuairuo as a somatoform diagnosis of exclusion. Salient precipitants of shenjing shuairuo include work- or family-related stressors, loss of face (mianzi, liunzz'), and an acute sense of failure (e.g., in academic performance). Shenjing sh— uairuo is related to traditional concepts of weakness (xu) and health imbalances related to deficiencies of a vital essence (e.g., the depletion of qi [vital energy] following overstrain- ing or stagnation of 111' due to excessive worry). In the traditional interpretation, shenjing ulated as a result of various social and interpersonal stressors, such as the inability to change a chronically frustrating and distressing situation. Various psychiatric disorders are associated with shenjing shuairuo, notably mood, anxiety, and somatic symptom disor- ders. In medical clinics in China, however, up to 45% of patients with shenjing shuairuo do not meet criteria for any DSM-IV disorder.
Related conditions in other cultural contexts: Neurasthenia-spectrum idioms and syndromes are present in India (ashaktapanna) and Japan (shinkei-suijaku), among other set- tings. Other conditions, such as brain fag syndrome, burnout syndrome, and chronic fa- tigue syndrome, are also closely related.
Related conditions in DSM-S: Major depressive disorder, persistent depressive disor- der (dysthymia), generalized anxiety disorder, somatic symptom disorder, social anxiety disorder, specific phobia, posttraumatic stress disorder.
Susto (”fright”) is a cultural explanation for distress and misfortune prevalent among some Latinos in the United States and among people in Mexico, Central America, and
South America. It is not recognized as an illness category among Latinos from the Carib- bean. Susto is an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness, as well as difficulties functioning in key social roles. Symptoms may appear any time from days to years after the fright is experi- enced. In extreme cases, susto may result in death. There are no specific defining symp- toms for susto; however, symptoms that are often reported by people with susto include appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, feelings of sadness, low self—worth or dirtiness, interpersonal sensitivity, and lack of motivation to do anything. Somatic symptoms accompanying susto may include muscle aches and pains, cold in the extremities, pallor, headache, stomachache, and diarrhea. Precipitating events are diverse, and include natural phenomena, animals, interpersonal situations, and super- natural agents, among others.