Culture, Medicine, and Psychiatry

, Volume 34, Issue 2, pp 244–278 | Cite as

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

  • Devon E. HintonEmail author
  • Vuth Pich
  • Luana Marques
  • Angela Nickerson
  • Mark H. Pollack
Original Paper


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 distress Cultural syndromes Post-traumatic stress disorder Panic disorder Cambodian refugees 


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Devon E. Hinton
    • 1
    Email author
  • Vuth Pich
    • 2
  • Luana Marques
    • 1
  • Angela Nickerson
    • 3
  • Mark H. Pollack
    • 1
  1. 1.Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  2. 2.Arbour Counseling ServicesLowellUSA
  3. 3.University of South WalesSydneyAustralia

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