This article reviews typical anxiety presentations in Asia, and among Asian refugees. In Asia, there are multiple functional somatic syndromes that are common anxiety presentations. These distress syndromes often produce catastrophic cognitions about anxiety-type somatic and psychological symptoms. These functional somatic syndromes should be understood, and specifically assessed and addressed, in order to optimize the evaluation and treatment of anxiety disorders among Asian individuals.

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Viewed historically and cross-culturally, orthostatic-induced dizziness, i.e., dizziness caused by standing up from a sitting or a lying position, forms a key aspect of many syndromes: irritable heart (American Civil War), effort syndrome (World War I and World War II), chronic fatigue syndrome (contemporary USA), Gulf War syndrome (contemporary USA), and orthostatic dysregulation (contemporary Japan). Among Vietnamese refugees attending a psychiatric clinic, this study documents a high rate of orthostatic panic (OP), as well as certain processes seemingly generating these panic attacks, viz., flashbacks and culturally specific catastrophic cognitions. Case examples are used to demonstrate OP's phenomenology and relevance to clinical care. To illustrate the mechanisms producing OP, we adduce the multiplex model of panic generation. Culturally appropriate care of Vietnamese refugees should include assessment and treatment of OP.

Asian Americans are one of the most diverse and fastest growing ethnic groups in the United States, having grown 204% between 1980 (U.S. Census Bureau, 2002. Asian Americans consist of over 30 different ethnic groups, comprise approximately 4-4% of the U.S. population, and are expected to continue growing (U.S. Census Bureau, 2003). Although the number of groups that collectively make up Asian Americans is large, unfortunately, the amount of treatment research focused on them is quite limited (Iwamasa, 1996(Iwamasa, , 1999(Iwamasa, , 2003. An additional complication is that because of the diversity within the Asian American population, existing research has limitations.Although people of diverse Asian ethnicities are often grouped together because of a lack of available participants, studies often do not address ethnic or generational differences, and many of the studies are conducted on English-speaking students attending U.S. universities. Thus, any information gleaned from these studies has limited generalizability. Acknowledging these limitations, researchers have identified some similarities across Asian ethnic groups that can be useful to clinicians. In addition, awareness of the marked cultural, political, and environmental differences among and within groups may assist therapists in providing culturally competent treatment. However, it must be stressed that each culture as well as each individual has unique 117