Olfactory-Triggered Panic Attacks among Khmer Refugees: A Contextual Approach

Abstract

One hundred Khmer refugees attending a psychiatric clinic were surveyed to determine the prevalence of olfactory-triggered panic attacks as well as certain characteristics of the episodes, including trigger (i.e. type of odor), frequency, length, somatic symptoms, and the rate of associated flashbacks and catastrophic cognitions. Forty-five of the 100 patients had experienced an olfactorytriggered panic attack in the last month. Trauma associations and catastrophic cognitions (e.g. fears of a 'wind attack,' 'weakness,' and 'weak heart') were common during events of olfactory panic. Several case examples are presented. A multifactorial model of the generation of olfactory panic is adduced. The therapeutic implications of this model for the treatment of olfactory panic are discussed. KeywordsCambodians; olfactory; panic attacks; panic disorder; post-traumatic stress disorderThe human ritual of renewal meant relearning old habits from her 'former' or preAuschwitz life: how to use a toothbrush, toilet paper, handkerchief, knife, and fork; how to smile, first with the lips, then with the lips and eyes; how to recapture forgotten odors and tastes, like the smell of rain.Implicit in the procedure of renewal, however, annealed to it with the epoxy of disruptive memory, is the 'counter-time' of Auschwitz, where the rain stank of diarrhea and beat down on the camp, the victims, 'the soot of the crematoriums and the odor of burning flesh.' (Langer, 1991, p. 3) In this quotation, Langer highlights the salience of olfaction in the Holocaust traumatic ontology and its centrality in attempted recovery. Traumatic events are encoded into memory by auditory, olfactory, and visual cues (e.g. Ledoux, 1996;van der Kolk, 1996). The sensory modality of olfaction -whose afferent tracts connect directly to the limbic system -seems to play a pre-eminent role in emotion and alerting to threat (Ledoux, 1996). Though sights and sounds are commonly assessed triggers of flashbacks (Kline & Rausch, 1985), odor cues in individuals diagnosed with post-traumatic stress disorder (PTSD) and panic disorder have been NIH Public Access

Is it possible to carry out high-quality epidemiological research in psychiatry with limited resources?

“…A high rate of childhood maltreatment was related to physical and mental health symptoms in Haitian adults [58 ]. A study from rural Ethiopia reported that there were no differences in sociodemographic correlates compared with the urban population [62]. Studies have examined the etiological factors involved in suicide in Brazil, Hong Kong, Trinidad and Turkey [63-65,66 ,67], social factors associated with chronic depression among Pakistani women [68 ], factors contributing to psychosocial issues among children and adolescents in Nigeria [69], social inequality and alcohol consumption in Brazil [70 ] and frequency of brain injury in a forensic psychiatry population [71].…”

Gas masks: material culture, memory, and the senses

“…This can take the extreme form of panic attacks, particularly in people suffering from post‐traumatic stress disorder (e.g. Hinton, Pich, Chhean & Pollack 2006: 73‐4). Like Hoskins's conjunction of life stories and object stories, we can expect this connection to cut both ways: if sensory stimuli can conjure up memories of objects, then discussions of objects encountered early in life are likely to evoke the child's original aesthetic responses.…”

Orthostatic Panic as a Key Vietnamese Reaction to Traumatic Events: The Case of September 11, 2001

“…In other cultural contexts, certain somatic symptoms are a key part of trauma-related disorder: dizziness among Chinese populations (Park and Hinton 2002), tinnitus among Cambodian refugees (Hinton et al 2006a), gastrointestinal upset among Rwandan genocide survivors [Taylor 2002]), and sleep paralysis among Cambodian refugees (Hinton et al 2005c). And in some cases, certain somatic-type cultural syndromes are an important part of trauma-related disorder: among Spanish-speaking populations of the Caribbean, ataque de nervios (Guarnaccia et al 1993;Norris et al 2001); among Central Americans, a feeling of inner heat (Jenkins 1991); among civil war victims in Sierra Leone, a "hypertension" (haypatεnsi) syndrome (Henry 2006); or among Cambodian and Vietnamese refugees, weak heart and various culturally specific panic attacks-from orthostatic, to "hit-by-the-wind," to neck-focused panic (Hinton et al 2000;Hinton et al 2001bHinton et al , 2001cHinton et al , 2001dHinton et al 2003;Hinton et al 2004a;Hinton et al 2004b;Hinton et al 2004c). Kleinman (1986) uses the term category fallacy to refer to the mistake of assuming that our diagnostic categories (as in the DSM-IV-defined PTSD [American Psychiatric Association 1994]) adequately depict the response to adverse events in other cultural groups.…”

“…Among traumatized Cambodian refugees, the complaint of "thinking a lot" (kut caraeun) is very common, suggesting a mind that is overactive, a mind that thinks about current problems and past traumas, a mind that is in a vortex of dizzying concerns Hinton et al 2004a); thinking a lot is believed to weaken the body, predisposing to bodily dysfunction, and to disturb the mind, possibly leading to insanity. Among traumatized Cambodian and Vietnamese refugees, weak heart (in Cambodian, khsaoy beh doung; in Vietnamese, iw tim) is a common complaint; it encompasses a wide spectrum of symptoms: a feeling of energy depletion, startle, uncontrollable worry, and fear of death from bodily dysfunction, especially cardiac arrest Hinton et al 2003;Hinton et al 2004a). Somali returnees in Ethiopia frequently use the term niyad jab to describe the mood experienced after traumas-a feeling of broken will, of demoralization (Zarowsky 2004).…”