Dara Chhean

'The ghost pushes you down': sleep paralysis-type panic attacks in a Khmer refugee population.

Among a psychiatric population of Cambodian refugees (N = 100), 42% had current - i.e. at least once in the last year - sleep paralysis (SP). Of those experiencing SP, 91% (38/42) had visual hallucinations of an approaching being, and 100% (42/42) had panic attacks. Among patients with post-traumatic stress disorder (PTSD; n = 45), 67% (30/45) had SP, whereas among those without PTSD, only 22.4% (11/45) had SP (χ2 = 20.4, p < .001). Of the patients with PTSD, 60% (27/45) had monthly episodes of SP. The Cambodian panic response to SP seems to be greatly heightened by elaborate cultural ideas - with SP generating concerns about physical status, ‘good luck’ status,‘bad luck’ status, sorcery assault, and ghost assault - and by trauma associations to the figure seen in SP. Case vignettes illustrate cultural beliefs about, and trauma resonances of, SP. A model to explain the high rate of SP in this population is presented. SP is a core aspect of the Cambodian refugees response to trauma; when assessing Cambodian refugees, and traumatized refugees in general, clinicians should assess for its presence.

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

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 olfactory-triggered 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.

Somatic-focused therapy for traumatized refugees: Treating posttraumatic stress disorder and comorbid neck-focused panic attacks among cambodian refugees.

The authors outline six steps to develop culturally sensitive treatment for traumatized refugees, which focus on somatic symptoms. Among Cambodian refugees with posttraumatic stress disorder, the authors describe a somatic presentation (viz., neck-focused panic attacks) that forms a key aspect of trauma-related disorder, how those panic attacks are generated, and a treatment that specifically targets those panic attacks. Evidence of treatment efficacy is provided through a multiple-baseline, across-subjects design (N = 3), and one treatment case is described to illustrate clinical presentation and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved).