Skip to main content
SpringerLink
Log in

Dizziness- and Palpitations-predominant Orthostatic Panic: Physiology, Flashbacks, and Catastrophic Cognitions

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Abstract

In an orthostatic challenge, Cambodian patients with orthostatic panic in the last month (OP patients) sometimes panicked during orthostatic challenge, whereas those without orthostatic panic in the last month (NOP patients) did not. Also, OP patients with primarily dizziness during orthostatic challenge panic (OPOCP-D) had a less vigorous physiological response than two other groups: (a) OP patients with primarily palpitations during orthostatic challenge panic (OPOCP-P) and (b) NOP patients who had no symptoms during orthostatic challenge (NOPNOCP-NS). Among the patients experiencing orthostatic challenge–induced panic (i.e., the OPOCP-D and OPOCP-P patients), there were prominent orthostatic challenge–induced flashbacks and catastrophic cognitions, and the severity of orthostatic challenge–induced flashbacks and catastrophic cognitions correlated with the severity of orthostatic panic in the previous month and with the severity of orthostatic challenge–induced panic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Bandelow, B. (1999). Panic and Agoraphobia Scale (PAS). Seattle, WA: Hogrefe & Huber Publishers.

    Google Scholar 

  • Barsky, A. J. (1994). Panic disorder, palpitations, and awareness of cardiac activity. Journal of Nervous and Mental Disease, 182, 63–71.

    Article  PubMed  Google Scholar 

  • Belz, G. G., & Loew, D. (2003). Dose-response related efficacy in orthostatic hypotension of a fixed combination of D-camphor and an extract from fresh crataegus berries and the contribution of single components. Phytomedicine, 10, 61–67.

    Article  PubMed  Google Scholar 

  • Bystritsky, A., Craske, M., Maidenberg, E., Vapnik, T., & Shapiro, D. (2000). Autonomic reactivity of panic patients during a CO2 inhalation procedure. Depression and Anxiety, 11, 15–26.

    Article  PubMed  Google Scholar 

  • Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.

    Article  PubMed  Google Scholar 

  • Coupland, N. J., Wilson, S. J., Potokar, J. P., Bell, C., & Nutt, D. J. (2003). Increased sympathetic response to standing in panic disorder. Psychiatry Research, 118, 69–79.

    Article  PubMed  Google Scholar 

  • DaCosta, J. M. (1871). On irritable heart: A clinical study of a form of functional cardiac disorder and its consequences. American Journal of Medical Science, 61, 17–52.

    Google Scholar 

  • First, M. B., Spitzer, R. L., & Gibbon, M. (1995). Structured clinical interview for DSM- IV axis I disorders. Patient edition. Biometrics Research Department, New York State Psychiatric Institute, 722 West 168th Street, New York, NY, 10032.

  • Friedman, M. (1947). Functional cardiovascular disease, 266 p. Baltimore, MD: Williams and Wilkins.

    Google Scholar 

  • Furman, J. M., & Jacob, R. G. (2001). A clinical taxonomy of dizziness and anxiety in the otoneurological setting. Journal of Anxiety Disorders, 15, 9–26.

    Article  PubMed  Google Scholar 

  • Goldstein, I. B., & Shapiro, D. (1990). Cardiovascular response during postural change in the elderly. Journal of Gerontology, 45, M20–M25.

    PubMed  Google Scholar 

  • Goldstein, I. B., & Shapiro, D. (1995). The cardiovascular response to postural change as a function of race. Biological Psychology, 39, 173–186.

    Article  PubMed  Google Scholar 

  • Hinton, D. E. (2002). Reply to commentaries: “Wind overload” and orthostatic panic among Khmer refugees. Transcultural Psychiatry, 39, 220–227.

    Article  Google Scholar 

  • Hinton, D. E., Ba, P., Peou, S., & Um, K. (2000). Panic disorder among Cambodian refugees attending a psychiatric clinic: Prevalence and subtypes. General Hospital Psychiatry, 22, 437–444.

    Article  PubMed  Google Scholar 

  • Hinton, D. E., Chhean, D., Pich, V., Pollack, M. H., Orr, S. P., & Pitman, R. K. (2006a). Assessment of posttraumatic stress disorder in Cambodian refugees using the Clinician-Administered PTSD Scale: Psychometric properties and symptom severity. Journal of Traumatic Stress, 19, 405–411.

    Article  Google Scholar 

  • Hinton, D. E., Chhean, D., Pich, V., Safren, S. A., Hofmann, S. G., & Pollack, M. H. (2005a). A randomized controlled trial of CBT for Cambodian refugees with treatment-resistant PTSD and panic attacks: A cross-over design. Journal of Traumatic Stress, 18, 617–629.

    Article  PubMed  Google Scholar 

  • Hinton, D. E., Chhean, D., Pich, V., Um, K., Fama, J. M., & Pollack, M. H. (2006b). Neck-focused panic attacks among Cambodian refugees: A logistic and linear regression analysis. Journal of Anxiety Disorders, 20, 119–138.

    Article  PubMed  Google Scholar 

  • Hinton, D. E., & Otto, M. W. (2006). Symptom presentation and symptom meaning among traumatized Cambodian refugees: Relevance to a somatically focused cognitive-behavior therapy. Cognitive and Behavioral Practice, 13, 249–260.

    Article  PubMed  Google Scholar 

  • Hinton, D. E., Pich, V., So, V., Pollack, M. H., Pitman, R. K., & Orr, S. P. (2004). The psychophysiology of orthostatic panic in Cambodian refugees attending a psychiatric clinic. Journal of Psychopathology and Behavioral Assessment, 26, 1–13.

    Article  Google Scholar 

  • Hinton, D. E., Pollack, M. H., Pich, V., Fama, J. M., & Barlow, D. H. (2005b). Orthostatically induced panic attacks among Cambodian refugees: Flashbacks, catastrophic cognitions, and associated psychopathology. Cognitive and Behavioral Practice, 12, 301–311.

    Article  Google Scholar 

  • Hinton, D., Um, K., & Ba, P. (2001). Kyol goeu (“wind overload”) part I: A cultural syndrome of orthostatic panic among Khmer refugees. Transcultural Psychiatry, 38, 403–432.

    Article  Google Scholar 

  • Hoehn-Saric, R., McLeod, D. R., Funderburk, F., & Kowalski, P. (2004). Somatic symptoms and physiologic response in generalized anxiety disorder and panic disorder: An ambulatory monitor study. Archives of General Psychiatry, 61, 913–921.

    Article  PubMed  Google Scholar 

  • Honda, K., Nose, T., Yoshida, N., Tanimura, M., & Tanaka, K. (1977). A population study of Japanese junior and senior high school students. Japanese Circulation Journal, 41, 629–641.

    PubMed  Google Scholar 

  • Honsali, E., Benjelloun, H., Coghlan, C. L., & Benomar, M. (2004). Autonomic profile and cardiovascular symptoms. Annales de Cardiologie et d’Angeiologie, 53, 137–143.

    Article  PubMed  Google Scholar 

  • Jones, M. (1948). Physiological and psychological responses to stress in neurotic patients. The Journal of Mental Science, 94, 392–427.

    PubMed  Google Scholar 

  • Lewis, T. (1917). Report upon soldiers returned as cases of ‘disordered action of the heart’ (DAH) or ‘valvular disease of the heart’ (VDH). Medical Research Committee, Special Series, No. 8.

  • Lewis, T. (1919). The soldier’s heart and the effort syndrome 144 p. New York: Hoeber.

    Google Scholar 

  • Lewis, T. (1940). The soldier’s heart and the effort syndrome 103 p. London: Shaw and Sons.

    Google Scholar 

  • Lu, A. Y., Metzger, B. J., & Therrien, B. (1990). Ethnic differences in physiological responses associated with the Valsalva maneuver. Research Nursing and Health, 13, 9–15.

    Article  Google Scholar 

  • Massana, J., Lopez, R., Massana, G., Marcos, T., Gonzalez, L., & Otero, A. (2001). Subtyping of panic disorder patients with bradycardia. European Psychiatry: The Journal of the Association of European Psychiatrists, 16, 109–114.

    Google Scholar 

  • McNally, R. J. (2001). Kyol koeu (“wind overload”) in traumatized Cambodians: A variant of panic disorder. Transcultural Psychiatry, 38, 477–480.

    Article  Google Scholar 

  • Mollica, R. F., Wyshak, G., & Lavelle, J. (1987a). The psychosocial impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry, 144, 1567–1572.

    PubMed  Google Scholar 

  • Mollica, R. F., Wyshak, G., Marneffe, D., Khuon, F., & Lavelle, J. (1987b). Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. American Journal of Psychiatry, 144, 497–500.

    PubMed  Google Scholar 

  • Nardi, A. E., Valença, A. M., Nascimento, I., & Zin, W. A. (2001). Hyperventilation challenge test in panic disorder and depression with panic attacks. Psychiatry Research, 105, 57–65.

    Article  PubMed  Google Scholar 

  • Nixon, R. D., & Bryant, R. A. (2005). Induced arousal and reexperiencing in acute distress disorder. Journal of Anxiety Disorders, 19, 587–594.

    Article  PubMed  Google Scholar 

  • Nozawa, I., Hisamatsu, K., Imamura, S., Fujimori, L., Nakayama, H., & Murakami, Y. (1996a). Psychosomatic aspects of healthy young women with orthostatic dysregulation. Clinical Otolaryngology, 21, 222–225.

    Article  PubMed  Google Scholar 

  • Nozawa, I., Hisamastu, K., Imamura, S., Fujimori, I., Nakayama, H., & Murakami, Y. (1996b). Study on orthostatic dysregulation and the Schellong test in healthy young females. Journal of Otorhinological and Related Specialties, 58, 110–114.

    Google Scholar 

  • Orr, S. P., Meyerhoff, J., Edwards, J, & Pitman, R. K. (1998). Heart rate and blood pressure resting levels and responses to generic stressors in Vietnam Veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 11, 155–164.

    Article  PubMed  Google Scholar 

  • Peckerman, A., Dahl, K., Chemitiganti, R., LaManca, J. J., Ottenweller, J. E., & Natelson, B. H. (2003). Effects of posttraumatic stress disorder on cardiovascular stress responses in Gulf War veterans with fatiguing illness. Autonomic Neurosciences, 108, 63–72.

    Article  Google Scholar 

  • Rainey, J. M., Aleem, A., Ortiz, A., Yeragani, V., Pohl, R., & Berchou, R. (1987). A laboratory procedure for the induction of flashbacks. American Journal of Psychiatry, 144, 1317–1319.

    PubMed  Google Scholar 

  • Rampini, S. K., Schneemann, M., Rentsch, K., & Bachli, E. B. (2002). Camphor intoxication after cao gió (coin rubbing). Journal of the American Medical Association, 288, 45.

    Article  PubMed  Google Scholar 

  • Roy-Byrne, P., Cowley, D. S., Stein, M. B., Wingerson, D., & Veith, R. (1997). Cardiovascular and catecholamine response to orthostasis in panic and obsessive- compulsive disorder and normal controls: Effects of anxiety and novelty. Depression and Anxiety, 6, 159–164.

    Article  PubMed  Google Scholar 

  • Scupi, B. S., Benson, B. E., Brown, L. B., & Uhde, T. W. (1997). Rapid onset: A valid panic disorder criterion? Depression and Anxiety, 5, 121–126.

    Article  PubMed  Google Scholar 

  • Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., et al. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154, 1571–1575.

    PubMed  Google Scholar 

  • Shipherd, J. C., Beck, J. G., & Ohtake, P. J. (2001). Relationship between the Anxiety Sensitivity Index, the Suffocation Fear Scale, and responses to CO2 inhalation. Journal of Anxiety Disorders, 15, 247–258.

    Article  PubMed  Google Scholar 

  • Skerritt, P. W. (1983). Anxiety and the heart: A historical review. Psychological Medicine 13, 17–25.

    Article  PubMed  Google Scholar 

  • Southwick, S. M., Krystal, J. H., Morgan, C. A., Johnson, D., Nagy, L. M., Nicolaou, A., et al. (1993). Abnormal noradrenergic function in posttraumatic stress disorder. Archives of General Psychiatry, 50, 266–274.

    PubMed  Google Scholar 

  • Tanaka, H., Thulesius, O., Yamaguchi, H., & Mino, M. (1994). Circulatory responses in children with unexplained syncope evaluated by continuous non-invasive finger blood pressure monitoring. Acta Paediatrica, 83, 754–761.

    Article  PubMed  Google Scholar 

  • Taylor, S. (2000). Understanding and treating panic disorder. West Sussex, England: Wiley.

    Google Scholar 

  • Taylor, C., & Brown, G. (1944). Some observations on the validity of the Schneider test. Journal of Aviation Medicine, 13, 214–231.

    Google Scholar 

  • Weathers, F., Keane, T., & Davidson, J. (2001). Clinician-Administered PTSD Scale: A review of the first ten years of research. Depression and Anxiety, 13, 132–156.

    Article  PubMed  Google Scholar 

  • Whishaw, R. (1939). A review of the physical condition of 130 returned soldiers suffering from the effort syndrome. Medical Journal of Australia, 16, 891–893.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 812, Boston, MA, 02114, USA

    Devon E. Hinton & Roger K. Pitman

  2. Southeast Asian Clinic, Arbour Counseling, Lowell, MA, USA

    Devon E. Hinton & Dara Chhean

  3. Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA

    Stefan G. Hofmann

  4. Veteran Affairs Medical Center, Manchester, NH, USA

    Scott P. Orr

Authors
  1. Devon E. Hinton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dara Chhean
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan G. Hofmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scott P. Orr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roger K. Pitman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devon E. Hinton.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hinton, D.E., Chhean, D., Hofmann, S.G. et al. Dizziness- and Palpitations-predominant Orthostatic Panic: Physiology, Flashbacks, and Catastrophic Cognitions. J Psychopathol Behav Assess 30, 100–110 (2008). https://doi.org/10.1007/s10862-007-9059-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10862-007-9059-8

Keywords

Search

Navigation