Khyâl attacks: a key idiom of distress among traumatized cambodia refugees

Cult Med Psychiatry. 2010 Jun;34(2):244-78. doi: 10.1007/s11013-010-9174-y.


Traumatized Cambodian refugees with PTSD often complain of khyâl attacks. The current study investigates khyâl attacks from multiple perspectives and examines the validity of a model of how khyâl attacks are generated. The study found that khyâl attacks had commonly been experienced in the previous 4 weeks and that their severity was strongly correlated with the severity of PTSD (PTSD Checklist). It was found that khyâl attacks were triggered by various processes--such as worry, trauma recall, standing up, going to a mall--and that khyâl attacks almost always met panic attack criteria. It was also found that during a khyâl attack there was great fear that death might occur from bodily dysfunction. It was likewise found that a complex nosology of khyâl attacks exists that rates the attacks on a scale of severity, that the severity determines how the khyâl attacks should be treated and that those treatments are often complex. As illustrated by the article, khyâl attacks constitute a key aspect of trauma ontology in this group, a culturally specific experiencing of anxiety and trauma-related disorder. The article also contributes to the study of trauma somatics, that is, to the study of how trauma results in specific symptoms in a specific cultural context, showing that a key part of the trauma-somatic reticulum is often a cultural syndrome.

MeSH terms

  • Adult
  • Anxiety / ethnology
  • Anxiety / psychology
  • Anxiety / therapy
  • Attitude to Death
  • Cambodia / ethnology
  • Cross-Cultural Comparison*
  • Diagnosis, Differential
  • Fear
  • Female
  • Humans
  • Male
  • Models, Psychological
  • Panic Disorder / ethnology*
  • Panic Disorder / psychology
  • Panic Disorder / therapy
  • Refugees / psychology*
  • Semantics*
  • Somatoform Disorders / ethnology*
  • Somatoform Disorders / psychology
  • Somatoform Disorders / therapy
  • Stress Disorders, Post-Traumatic / ethnology*
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy
  • United States