The Psychophysiology of Orthostatic Panic in Cambodian Refugees Attending a Psychiatric Clinic

Symptom Presentation and Symptom Meaning Among Traumatized Cambodian Refugees: Relevance to a Somatically Focused Cognitive-Behavior Therapy

“…Under conditions of good health, Wind (a sort of "inner air") is believed to run unimpeded through conduits in the body, much like blood. Cambodians often construe anxiety symptoms as being generated by the disruption of the proper flow of Wind and blood in the body; the Wind ethnophysiology produces multiple catastrophic interpretations of somatic symptoms (Hinton, Um, & Ba, 2001a, 2001b, 2001cHinton, Pich, et al, 2004). For instance, if anxiety causes a feeling of tension at either the knee or elbow (through muscular tension and tight tendons), a Cambodian will attribute these sensations to the blockage of the vascular "tubes" (sâsai); a Cambodian worries that such tubal blockage may lead (a) to the death of the limb distal to the obstruction, owing to the lack of blood flow, and (b) to the dangerous ascent of Wind and blood in the body: first, into the trunk of the body, possibly causing asphyxia and cardiac arrest, second, into the neck, possibly causing rupture of the vessels, and third, into the cranium, possibly causing multiple adverse events such syncope, blindness, or death.…”

“…Recent studies illustrate that dizziness often occurs during the panic attacks of Southeast Asians Hinton et al, 2001aHinton et al, , 2001bHinton, Chau, et al, 2001;Hinton, Pich, et al, 2004); in fact, data suggest that Asian groups may be unusually susceptible to certain types of dizziness, particularly motion sickness and orthostatic dizziness (see Hinton, Chau, et al, 2001;.…”

“…The Panic Disorder Severity Scale (Shear et al, 1997) profiles panic attacks in terms of both distress and frequency (scored on a 0-4 Likert-type scale). At our clinic, we use a Panic Attack Severity Scale (PASS) to assess the severity of orthostatic panic (O-PASS), neck-focused panic (N-PASS), and gastrointestinal panic (G-PASS) (Hinton, Chhean, Pich, Um, et al, 2006;Hinton, Pich, et al, 2004). The PASS includes the distress and frequency scale of the PDSS, and additionally, a question that rates how long the panic attack lasted on a 0-4 Likert-type scale: 0 (none), 1 (less than 5 min), 2 (less than 15 min), 3 (less than 45 min), and 4 (more than 45 min).…”

“…The PASS includes the distress and frequency scale of the PDSS, and additionally, a question that rates how long the panic attack lasted on a 0-4 Likert-type scale: 0 (none), 1 (less than 5 min), 2 (less than 15 min), 3 (less than 45 min), and 4 (more than 45 min). The PASS demonstrates excellent interrater and test-retest reliability for each of the panic attack subtypes (Hinton, Pich, et al, 2004). Also, for each panic subtype, we assess the severity of associated flashbacks along four different dimensions-length, distress, frequency, and degree of dissociation-each rated on a 0-4 Likert-type scale (cf.…”

The Panic Attack–Posttraumatic Stress Disorder Model: Applicability to Orthostatic Panic Among Cambodian Refugees

“…The Panic Attack-PTSD Model (see Figure 1) includes the TCMIE Model of Panic Generation, which we have described in several articles [Hinton et al, 2004[Hinton et al, ,2005c[Hinton et al, ,2006b[Hinton et al, ,2007, and expands the TCMIE Model to demonstrate the relationship of panic attacks to anxiousdepressive distress and PTSD. According to TCMIE Model, panic attacks may be generated by dysphoric associations to somatic sensations.…”