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. Hinton
  • Vuth Pich
  • Luana Marques
  • Angela Nickerson
  • Mark H. Pollack
Original Paper

Abstract

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.

Keywords

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

References

  1. American Psychiatric Association (APA) 1994 Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA.Google Scholar
  2. Brown, T., and J. McNiff, 2009 Specificity of Autonomic Arousal to DSM-IV Panic Disorder and Posttraumatic Stress Disorder. Behaviour Research and Therapy 47:487–493.CrossRefGoogle Scholar
  3. Carr, J.E., and P.P. Vitaliano 1985 The Theoretical Implications of Converging Research on Depression and Culture-Bound Syndrome. In Culture and Depression. A. Kleinman and B. Good, eds., pp. 244–266. Berkeley: University of California Press.Google Scholar
  4. Forbes, D., M. Creamer, and D. Biddle 2001 The Validity of the PTSD Checklist as a Measure of Symptomatic Change in Combat-Related PTSD. Behaviour Research and Therapy 39:977–986.CrossRefGoogle Scholar
  5. Ghafori, B., Y. Neria, M. Olfson, R. Lantigua, S. Shea, and M. Weissman 2009 Screening for Generalized Anxiety Disorder Symptoms in the Wake of Terrorist Attacks: A Study in Primary Care. Journal of Traumatic Stress 22:218–226.CrossRefGoogle Scholar
  6. Good, B. 1994 Medicine, Rationality, and Experience: An Anthropological Perspective. Cambridge: Cambridge University Press.Google Scholar
  7. Gregor, K., M. Zvolensky, and A. Yartz 2005 Perceived Health among Individuals with Panic Disorder. Journal of Nervous and Mental Disease 10:1–3.Google Scholar
  8. Hinton, D., and B. Good, eds. 2009 Culture and Panic Disorder. Stanford, CA: Stanford University Press.Google Scholar
  9. Hinton, D.E., and R. Lewis-Fernández 2010 The Cross-Cultural Validity of Posttraumatic Stress Disorder: Implications for DSM-V. Depression and Anxiety (in press).Google Scholar
  10. Hinton, D.E., K. Um, and P. Ba 2001a Kyol Goeu (‘Wind Overload’) Part I: A Cultural Syndrome of Orthostatic Panic among Khmer Refugees. Transcultural Psychiatry 38: 403–432.Google Scholar
  11. Hinton, D.E., K. Um, and P. Ba 2001b Kyol Goeu (‘Wind Overload’) Part II: Prevalence, Characteristics and Mechanisms of Kyol Goeu and Near-kyol Goeu Episodes of Khmer Patients Attending a Psychiatric Clinic. Transcultural Psychiatry 38: 433–460.Google Scholar
  12. Hinton, D. E., S. Hinton, K. Um, A. Chea, and S. Sak 2002 The Khmer “Weak Heart” Syndrome: Fear of Death from Palpitations. Transcultural Psychiatry 39:323–344.CrossRefGoogle Scholar
  13. Hinton, D.E., T. Pham, H. Chau, M. Tran, and S. Hinton 2003 ‘Hit by the Wind’ and Temperature-Shift Panic among Vietnamese Refugees. Transcultural Psychiatry 40:342–376.CrossRefGoogle Scholar
  14. Hinton, D. E., A. Chea, P. Ba, and M. H. Pollack 2004 Olfactory Panic among Cambodian Refugees: A Contextual Approach. Transcultural Psychiatry 41:155–199.CrossRefGoogle Scholar
  15. Hinton, D., V. Pich, S. Safren, M. H. Pollack, and R. McNally 2005 Anxiety Sensitivity in Traumatized Cambodian Refugees: A Discriminant Function and Factor Analytic Investigation. Behaviour Research and Therapy 43:1631–1643.CrossRefGoogle Scholar
  16. Hinton, D. E., D. Chhean, J. M. Fama, M. H. Pollack, and R. J. McNally 2007 Gastrointestinal-Focused Panic Attacks Among Cambodian Refugees: Associated Psychopathology, Flashbacks, and Catastrophic Cognitions. Journal of Anxiety Disorders 21:42–58.CrossRefGoogle Scholar
  17. Hinton, D.E., R. Chong, M.H. Pollack, D.H. Barlow, and R.J. McNally 2008a Ataque de Nervios: Relationship to Anxiety Sensitivity and Dissociation Predisposition. Depression and Anxiety 25: 489–495.Google Scholar
  18. Hinton, D.E., S.G. Hofmann, R.K. Pitman, M.H. Pollack, and D.H. Barlow 2008b The Panic Attack–PTSD Model: Applicability to Orthostatic Panic among Cambodian Refugees. Cognitive Behaviour Therapy 27: 101–116.Google Scholar
  19. Hinton, D.E., D. Howes, and L.J. Kirmayer 2008c Towards a Medical Anthropology of Sensations: Definitions and Research Agenda. Transcultural Psychiatry 45: 142–162.Google Scholar
  20. Hinton, D.E., S.G. Hofmann, M.H. Pollack, and M.W. Otto 2009a Mechanisms of Efficacy of CBT for Cambodian Refugees with PTSD: Improvement in Emotion Regulation and Orthostatic Blood Pressure Response. CNS Neuroscience and Therapeutics 15: 255–263.Google Scholar
  21. Hinton, D.E., R. Lewis-Fernández, and M.H. Pollack 2009b A Model of the Generation of Ataque de Nervios: The Role of Fear of Negative Affect and Fear of Arousal Symptoms. CNS Neuroscience and Therapeutics 15: 264–275.Google Scholar
  22. Jenkins, J. H., and N. Cofresi 1998 The Sociosomatic Course of Depression and Trauma: A Cultural Analysis of Suffering and Reslience in the Life of a Puerto Rican Woman. Psychosomatic Medicine 60:439–447.Google Scholar
  23. Jones, E., and S. Wessely 2005 Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War. New York: Hove.Google Scholar
  24. Kirmayer, L. J., and N. Sartorius 2007 Cultural Models and Somatic Syndromes. Psychosomatic Medicine 69:832–840.CrossRefGoogle Scholar
  25. Kleinman, A. 1986 Social Origins of Distress and Disease: Depression, Neurasthenia and Pain in Modern China. New Haven, CT: Yale University Press.Google Scholar
  26. Kleinman A, and J. Kleinman J. 1991 Suffering and Its Professional transformation: Toward an Ethnography of Interpersonal Experience. Culture Medicine and Psychiatry 15:275–301.CrossRefGoogle Scholar
  27. Kuriyama, S. 1999 The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. New York: Zone books.Google Scholar
  28. Lambert, J. 1986 Khmer Refugees in Dallas: Medical Decisions in the Context of Pluralism [Ph.D. dissertation]. Ann Arbor, MI: Southern Methodist University, UMI Dissertation Service.Google Scholar
  29. Leslie, C. 1992 Interpretations of Illness: Syncretism in Modern Ayurveda. In Paths to Asian Medical Knowledge. C. Leslie and A. Young, eds., pp. 209–224. Berkeley: University of California.Google Scholar
  30. Mayer, E. 2007 Somatic Manifestations of Traumatic Stress. Pp. 142–170 in Understanding Trauma: Biological, Clinical and Cultural Perspectives. L. J. Kirmayer, R. Lemelson, and M. Barad, eds., New York: Cambridge University Press.CrossRefGoogle Scholar
  31. Muecke, M. 1979 An Explication of “Wind Illness” in Northern Thailand. Culture, Medicine, and Psychiatry 3:267–300.CrossRefGoogle Scholar
  32. Schmidt, N., T. Joiner, J. Staab, and F. Williams 2003 Health Perceptions and Anxiety Sensitivity in Patients with Panic Disorder. Journal of Psychopathology and Behavioral Assessment 25:139–145.CrossRefGoogle Scholar
  33. Schnurr, P. P., M. J. Friedman, C. C. Engel, E. B. Foa, M. T. Shea, B. K. Chow, P. A. Resick, V. Thurston, S. M. Orsillo, R. Haug, C. Turner, and N. Bernardy 2007 Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in Women: A Randomized Controlled Trial. Journal of the American Medical Association 297:820–830.CrossRefGoogle Scholar
  34. Scott, J. C. 1985 Weapons of the Weak: Everyday Forms of Resistance. New Haven, CT: Yale University Press.Google Scholar
  35. Udomratn, P., and D. Hinton 2009 Gendered Panic in Southern Thailand: Lom (“Wind”) Illness and Wuup (“Upsurge”) Illness. Pp. 183–204 in Culture and Panic Disorder. D. Hinton, and B. Good, eds. Stanford, CA: Stanford University Press.Google Scholar
  36. Wells, A. 2000 Emotional Disorder and Metacognitions: Innovative Cognitive Therapy. West Sussex, England: Wiley.Google Scholar
  37. Young, A. 1995 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Devon E. Hinton
    • 1
  • 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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