Orthostatic Panic Attacks Among Vietnamese Refugees

Abstract

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.

Ataques de Nervios and Somatic Complaints Among Island and Mainland Puerto Rican Children

“…The association between ataques and anxiety can partly be explained by new research indicating that atatque sufferers have higher levels of anxiety sensitivity, thus further solidifying the comorbidity between ataques and anxiety [17]. In addition, as with other anxiety disorders, it may be that people with ataques are prone to misinterpreting their bodily sensations and that during times of stress, an atatque sufferer may experience hyperarousal, which may lead to belabored breathing, and subsequently initiate a cycle of further arousal, fear, and catastrophic cognitions [18],…”

Culture and Mental Illness: Social Context and Explanatory Models

“…A growing body of work shows how the vicious circles of excessive self-awareness and expectations of catastrophe that drive panic disorder and other anxiety disorders (including the forms of health anxiety labelled 'hypochondriasis') may be mediated by culture-specific understandings of physical sensations that occur either as normal events or as a consequence of physiological dysregulation [58]. Clinical interventions targeting these specific attributions in ways that are culturally consonant can be effective [59].…”

Anxiety Disorder Presentations in Asian Populations: A Review

“…Not only was “neurasthenia” adopted into Japan from the West, but also, at a later date, “neurocirculatory asthenia”[20]. (In the West during the first half of the 20th century, anxiety states were often diagnosed as “neurocirculatory asthenia”; typical symptoms included palpitations, easily induced fatigue, and orthostatically induced dizziness [for a review, see 20]. ) The diagnosis of neurocirculatory asthenia was adopted in Japan, but with orthostatic dizziness as the central focus, and a new name given: orthostatic dysregulation [21–26].…”