Abstract
Objective: Ataque de nervios is a common, self-labeled Hispanic folk diagnosis. It typically describes episodic, dramatic outbursts of negative emotion in response to a stressor, sometimes involving destructive behavior. Dissociation and affective dysregulation during such episodes suggested a link to childhood trauma. We therefore assessed psychiatric diagnoses, history of ataque, and childhood trauma in treatment-seeking Hispanic outpatients (N = 70). Significantly more subjects with an anxiety or affective disorder plus ataque reported a history of physical abuse, sexual abuse, and/or or a substance-abusing caretaker than those with psychiatric disorder but no ataque. In some Hispanic individuals, ataque may represent a culturally sanctioned expression of extreme affect dysregulation associated with childhood trauma. Patients with ataque de nervios should receive a thorough traumatic history assessment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC; Author.
Cardeña, E., Lewis-Fernández, R., Bear, D., Pakianathan, I., & Spiegel, D. (1996). Dissociative disorders. In T. A. Widiger, A. J. Frances, H. A. Pincus, R. Ross, M. B. First, & W. W. Davis (Eds.), The DSM-IV sourcebook (pp. 973–1006). Washington, DC: American Psychiatric Press, Inc.
Chaffin, M., Kelleher, K., & Hollenberg, J. (1996). Onset of physical abuse and neglect: Psychiatric, substance abuse and social risk factors from prospective community data. Child Abuse & Neglect, 20, 191–203.
Dill, D. L., Chu, J. A., Grob, M. C., & Eisen, S. V. (1991). The reliability of abuse history reports: A comparison of two inquiry formats. Comprehensive Psychiatry, 32, 166–169.
DiNardo, P. A., Moras, K., Barlow, D. H., Rapee, R. M., & Brown, T. A. (1991). Reliability of DSM-III-R anxiety disorder categories using the Anxiety Disorder Interview Schedule-Revised (ADIS-R). Archives of General Psychiatry, 50, 251–256.
Fernández-Marina, R. (1961). The Puerto Rican syndrome: Its dynamics and cultural determinants. Psychiatry, 24, 79–82.
Guarnaccia, P. J., Canino, G., Rubio-Stipec, M., & Bravo, M. (1993). The prevalence of ataques de nervios in the Puerto Rican disaster study: The role of culture in psychiatric epidemiology. Journal of Nervous and Mental Disease, 181, 157–165.
Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity and adult psychiatric disorder in the U.S. National Comorbidity Survey. Psychological Medicine, 27, 1101–1119.
Lewis-Fernández, R., & Kleinman, A. (1995). Cultural psychiatry: Theoretical, clinical and research issues. Psychiatric Clinics of North America, 18, 433–448.
Lewis-Fernández, R. (1994). Culture and dissociation: A comparison of ataque de nervios among Puerto Ricans and possession syndrome in India. In D. Spiegel (Ed.), Dissociation: Culture, mind, and body. Washington, DC: American Psychiatric Press, Inc.
Liebowitz, M. R., Salmán, E., Jusino, C. M., Garfinkel, R., Street, R., Cardeñas, D. L., Silvestre, J., Fyer, A. J., Carrasco, J. L., Davies, S. O., Guarnaccia, P. J., & Klein, D. (1994). Ataque de nervios and panic disorder. American Journal of Psychiatry, 151, 871–875.
Marshall, R. D., Schneier, F. R., Knight, C. B. G., Abbate, L. A., Fallon, B. A., Goetz, D., Campeas, R., & Liebowitz, M. R. (1998). An open trial of paroxetine in patients with noncombat-related chronic PTSD. Journal of Clinical Psychopharmacology, 18, 10–18.
Salmán, E., Liebowitz, M. R., Guarnaccia, P. J., Jusino, C. M., Garfinkel, R., Street, L., Cardeñas, D. C., Silvestre, J., Fyer, A. L., Carrasco, J. L., Davies, S. O., & Klein, D. F. (1998). Types of ataques de nervios: The influence of coexisting psychiatric diagnosis. Culture, Medicine, and Psychiatry, 22, 231–244.
Saxe, G. N., Van der Kolk, B. A., Berkowitz, R., & Chinman, G. (1993). Dissociative disorders in psychiatric inpatients. American Journal of Psychiatry, 150, 1037–1042.
Schechter, D. S., Tosyali, M. C. (in press). Posttraumatic stress disorder from infancy through adolescence: A review. In C. M. Essau & F. Petermann (Eds.), Anxiety disorders in children and adolescents: Epidemiology, risk factors and treatment. London: Harwood Academic Publishers.
Spitzer, R. L., Williams, J. B.W., Gibbon, M., & First, M. B. (1992). The structured clinical interview for DSM-III-R (SCID), I: History, rationale, and description. Archives of General Psychiatry, 49, 624–629.
Van der Kolk, B. A., Pelcovitz, D., Roth, S., Mandel, F. S., McFarlane, A., & Herman, J. (1996). Dissociation, somatization and affect dysregulation: The complexity of adaptation to trauma. American Journal of Psychiatry, 153, 83–93.
Author information
Authors and Affiliations
About this article
Cite this article
Schechter, D.S., Marshall, R., Salmán, E. et al. Ataque de Nervios and History of Childhood Trauma. J Trauma Stress 13, 529–534 (2000). https://doi.org/10.1023/A:1007797611148
Issue Date:
DOI: https://doi.org/10.1023/A:1007797611148