Culture, Medicine, and Psychiatry

, Volume 34, Issue 2, pp 244–278

Khyâl Attacks: A Key Idiom of Distress Among Traumatized Cambodia Refugees


    • Department of Psychiatry, Harvard Medical SchoolMassachusetts General Hospital
  • Vuth Pich
    • Arbour Counseling Services
  • Luana Marques
    • Department of Psychiatry, Harvard Medical SchoolMassachusetts General Hospital
  • Angela Nickerson
    • University of South Wales
  • Mark H. Pollack
    • Department of Psychiatry, Harvard Medical SchoolMassachusetts General Hospital
Original Paper

DOI: 10.1007/s11013-010-9174-y

Cite this article as:
Hinton, D.E., Pich, V., Marques, L. et al. Cult Med Psychiatry (2010) 34: 244. doi:10.1007/s11013-010-9174-y


Traumatized Cambodian refugees with PTSD often complain of khyâl attacks. The current study investigates khyâl attacks from multiple perspectives and examines the validity of a model of how khyâl attacks are generated. The study found that khyâl attacks had commonly been experienced in the previous 4 weeks and that their severity was strongly correlated with the severity of PTSD (PTSD Checklist). It was found that khyâl attacks were triggered by various processes—such as worry, trauma recall, standing up, going to a mall—and that khyâl attacks almost always met panic attack criteria. It was also found that during a khyâl attack there was great fear that death might occur from bodily dysfunction. It was likewise found that a complex nosology of khyâl attacks exists that rates the attacks on a scale of severity, that the severity determines how the khyâl attacks should be treated and that those treatments are often complex. As illustrated by the article, khyâl attacks constitute a key aspect of trauma ontology in this group, a culturally specific experiencing of anxiety and trauma-related disorder. The article also contributes to the study of trauma somatics, that is, to the study of how trauma results in specific symptoms in a specific cultural context, showing that a key part of the trauma-somatic reticulum is often a cultural syndrome.


Idioms of distressCultural syndromesPost-traumatic stress disorderPanic disorderCambodian refugees

Copyright information

© Springer Science+Business Media, LLC 2010