CCMD-3: Chinese Classification of Mental Disorders, Third Edition
The CCMD-3 (Chinese Classification of Mental Disorders, Third Edition) is a diagnostic manual developed by the Chinese Society of Psychiatry in 2001. It serves as China's official classification system for mental disorders, harmonizing elements from ICD-10 and DSM-IV while incorporating culturally relevant adaptations.
Overview
CCMD-3 organizes disorders into 10 main categories (0-9) and emphasizes diagnostic criteria based on symptoms, severity, course, exclusions, and clinical evidence (e.g., history, exams, labs). Diagnosis typically requires meeting a threshold of symptoms for a specified duration, causing functional impairment.
"Assessment criteria" in CCMD-3 refer to symptom checklists or standards used to evaluate disorders. These are not always phrased as explicit "questions" but as observable or self-reported symptoms that clinicians assess through interviews, observation, or scales.
Structure of CCMD-3
| Category | Description | Examples of Disorders |
|---|---|---|
| 0 | Organic mental disorders | Dementia, delirium |
| 1 | Substance-related disorders | Alcohol dependence, drug-induced psychosis |
| 2 | Schizophrenia and psychotic disorders | Schizophrenia, schizoaffective disorder |
| 3 | Mood (affective) disorders | Depressive episode, bipolar disorder |
| 4 | Anxiety, stress, and somatoform disorders | Panic disorder, generalized anxiety, neurasthenia |
| 5 | Physiological disorders due to psychological factors | Sleep disorders, eating disorders |
| 6 | Personality and impulse control disorders | Borderline personality, paraphilias |
| 7 | Developmental disorders | Intellectual disability, autism spectrum |
| 8 | Behavioral and emotional disorders in childhood | ADHD, conduct disorder |
| 9 | Other disorders | Adjustment disorders, factitious disorders |
General guidelines: Symptoms must be primary (not secondary to other conditions), cause distress or impairment, and persist for the specified duration. Multi-axial assessment (e.g., clinical, environmental factors) is recommended.
Examples of Assessment Criteria
For each disorder, key symptom criteria are listed (assessable via patient interview or observation), along with severity/course requirements, and exclusions. Clinicians "question" these by asking about presence, duration, and impact (e.g., "Have you experienced low mood most days for 2 weeks?").
1. Schizophrenia (Category 2, Code F20)
Symptom Criteria
At least 2 of the following must be present; assess via detailed history and observation:
- Recurrent verbal auditory hallucinations.
- Obvious thought loosening, breaking, incoherent speech, or poverty of thought/content.
- Delusions of insertion, withdrawal, broadcasting, interruption, or compulsory thinking.
- Experiences of passivity, being controlled, or being appraised.
- Primary delusions (e.g., delusional perception or mood) or absurd delusions.
- Inversion of thought logic, pathological symbolic thinking, or neologisms.
- Emotional inversion or obvious blunting.
- Catatonic syndrome, bizarre/silly behavior.
- Obvious diminution or absence of volition.
Severity: Disturbance in self-awareness with severe social dysfunction or inability to communicate effectively.
Course: Symptoms meet criteria for at least 1 month (simple subtype: at least 2 years).
Exclusions: Not due to organic brain disease, substances, mood disorders, or impaired consciousness/intellect.
2. Depressive Episode (Major Depressive Disorder; Category 3, Code F32)
Symptom Criteria
Low mood as primary symptom, plus at least 4 of the following; assess via self-report scales like SDS if needed:
- Loss of interest or pleasure in activities.
- Diminution of energy or fatigue.
- Psychomotor retardation or agitation.
- Low self-evaluation or excessive guilt.
- Difficulty in concentration or subjective decline in thinking.
- Recurrent suicidal ideas, self-harm, or behavior.
- Sleep disturbance (insomnia, early awakening, or hypersomnia).
- Decreased appetite or weight loss.
- Diminution of sexual desire.
Severity: Causes social dysfunction, distress, or adverse consequences.
Course: Symptoms meet criteria for at least 2 weeks.
Exclusions: Not due to organic disorders, substances, or normal bereavement.
3. Anxiety Disorders (e.g., Panic Disorder Subtype; Category 4, Code F41)
Symptom Criteria
Primary anxiety; for panic: at least 4 sudden attacks with the following, plus fear of recurrence:
- Sudden onset without warning or predictable situation.
- Intense fear/anxiety with autonomic arousal (e.g., palpitations, sweating, trembling).
- Depersonalization, derealization, or fear of losing control/dying.
- Rapid peak in symptoms with clear consciousness and recall.
(For generalized anxiety subtype: Persistent vague fear/tension plus at least 2 autonomic/psychomotor symptoms like restlessness or muscle tension.)
Severity: Distress is intolerable; patient unable to escape or control it.
Course: At least 3 attacks in 1 month, or persistent fear after first attack for 1 month (generalized: at least 6 months).
Exclusions: Not secondary to thyroid issues, substance withdrawal, OCD, phobias, mood disorders, or schizophrenia.
4. Organic Mental Disorders (Category 0, Codes F00-F09)
Symptom Criteria
Evidence of brain disease/injury via exams/labs, plus at least 1 of the following:
- Intellectual impairment syndrome (e.g., memory loss, disorientation).
- Amnesic syndrome.
- Personality change.
- Consciousness disturbance.
- Psychotic symptoms (hallucinations, delusions, catatonia).
- Affective syndrome (mania or depression).
- Dissociative or conversion symptoms.
- Neurosis-like syndrome (anxiety, lability).
Severity: Impairment in daily or social functioning.
Course: Onset and progression tied to the underlying organic condition.
Exclusions: Insufficient evidence for substance use or other non-organic causes.
ADHD in CCMD-3
ADHD is classified under Category 8: Behavioral and emotional disorders in childhood. The CCMD-3 criteria for ADHD align with international standards (ICD-10 and DSM-IV) while incorporating culturally relevant considerations.
Assessment for ADHD in CCMD-3 follows the same general principles: symptoms must be primary, cause functional impairment, persist for the specified duration, and be assessed through clinical interviews, observation, and standardized scales where appropriate.
Comparison with Other Classification Systems
CCMD-3 harmonizes elements from both ICD-10 and DSM-IV while maintaining cultural specificity for the Chinese population. Key differences include:
- Cultural adaptations: Some disorders unique to Chinese culture (e.g., neurasthenia) are included
- Clinical practice: Widely used in China, with 63.8% of surveyed psychiatrists reporting it as their primary diagnostic tool
- Structure: Similar categorical organization to ICD-10, with 10 main categories
- Assessment approach: Emphasizes clinical interviews and observation, similar to ICD-10, rather than standardized questionnaires
Important Notes
For Clinical Use
- CCMD-3 is primarily used in China and Chinese-speaking regions
- For comprehensive and accurate assessment methods, consult the official CCMD-3 manual or related authoritative publications
- The full manual is extensive (300+ pages) and contains detailed diagnostic criteria for all disorders
- Assessment typically requires trained clinicians familiar with CCMD-3 criteria
References & Further Reading
- Primary Source: Chinese Society of Psychiatry. (2001).Chinese Classification of Mental Disorders, Third Edition (CCMD-3). Jinan: Shandong Science and Technology Press.
- Field Trials: The CCMD-3 Task Force conducted field trials involving 114 psychiatrists from 41 mental health centers and psychiatric hospitals, focusing on 17 adult mental disorders and 7 disorders typically onset in childhood and adolescence.
- Usage Statistics: A survey indicated that 63.8% of Chinese psychiatrists primarily utilize CCMD-3, followed by ICD-10 at 28.5% and DSM-IV at 7.7%.