, Volume 25, Issue 3, pp 297-316

A Unique Panic-Disorder Presentation Among Khmer Refugees: The Sore-Neck Syndrome

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This article describes a previouslyunreported cultural syndrome among Khmerrefugees. This common presentation of distresscenters on the complaint of a sore neck, thesufferer fearing that wind-and-blood pressuremay burst the vessels in this area. During anacute episode, a Khmer endures many – if notall – of the following neck-and-head complaints:headache, blurry vision, a buzzing in the ear,and dizziness. While in the throes of thesore-neck attack, the patient frequentlyexperiences palpitations as well as othersymptoms of autonomic arousal, such asdiaphoresis, shortness of breath, andtrembling. A sufferer of sore-neck episodesoften meets panic disorder criteria.In a clinic survey, thirty-five out ofeighty-five patients (41%) were found tocurrently suffer the ``sore-neck syndrome''(i.e., to have endured at least one episode inthe last month), with almost all of thesethirty-five patients (80%) fearing deathduring the acute event. The sore-neck syndromerepresents a common and important way in whichdistress becomes embodied. The clinician mustlearn this body language; otherwise, thepatient's communication of psychic,interpersonal, and physical pain goesunheard – and grave somatic suffering anddisability unattended to – discounted aspuzzling somatic complaints and unreasonableobsessionalism about blood pressure.