Culture, Medicine, and Psychiatry

, Volume 42, Issue 2, pp 244–277 | Cite as

Migraine-Like Visual Auras Among Traumatized Cambodians with PTSD: Fear of Ghost Attack and Other Disasters

  • Devon E. HintonEmail author
  • Ria Reis
  • Joop de Jong
Original Paper


This article profiles visual auras among traumatized Cambodian refugees attending a psychiatric clinic. Thirty-six percent (54/150) had experienced an aura in the previous 4 weeks, almost always phosphenes (48% [26/54]) or a scintillating scotoma (74% [40/54]). Aura and PTSD were highly associated: patients with visual aura in the last month had greater PTSD severity, 3.6 (SD = 1.8) versus 1.9 (SD = 1.6), t = 10.2 (df = 85), p < 0.001, and patients with PTSD had a higher rate of visual aura in the last month, 69% (22/32) versus 13% (7/55), odds ratio 15.1 (5.1–44.9), p < 0.001. Patients often had a visual aura triggered by rising up to the upright from a lying or sitting position, i.e., orthostasis, with the most common sequence being an aura triggered upon orthostasis during a migraine, experienced by 60% of those with aura. The visual aura was often catastrophically interpreted: as the dangerous assault of a supernatural being, most commonly the ghost of someone who died in the Pol Pot period. Aura often triggered flashback. Illustrative cases are provided. The article suggests the existence of local biocultural ontologies of trauma as evinced by the centrality of visual auras among Cambodian refugees.


Aura Migraine PTSD Panic Culture Complex trauma 


Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest.

Ethical Approval

The study was conducted as per in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Center for Anxiety and Traumatic Stress Disorders, Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  2. 2.Leiden University Medical CenterLeidenThe Netherlands
  3. 3.Amsterdam Institute for Social Science ResearchUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.School of Child and Adolescent Health, The Children’s InstituteUniversity of Cape TownCape TownSouth Africa

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