836 Glossary of Cultural Concepts of Distress
Western diagnosis of neurasthenia. In the second, revised edition of the Chinese Classifica-
tion of Mental Disorders  (CCMD-2-R), shenjing shuairuo is defined as a syndrome composed
of three out of five nonhierarchical symptom clusters: weak ness (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 nao  (feeling vexed) is a form  of irritability mixed
with worry and distress over conflicting thoug hts and unfulfilled desires. The third edi-
tion of the CCMD retains shenjing shuairuo  as a somatoform diagno sis of exclusion. Salient
precipitants of shenjing shuairuo  include work- or family-rel ated stressors, loss of face
(mianzi, lianzi ), 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 qi due to excessive worry). In the traditional interpretation, shenjing
shuairuo  results when bodily channels ( jing) conveying vital forces ( shen) become dysreg-
ulated as a result of various social and interpersonal stressors, such as the inability to
change a chronically frustrating and distressi ng situation. Various psychiatric disorders
are associated with shenjing shuairuo,  notably mood, anxiety, and somatic symptom disor-