title: A unique panic-disorder presentation among Khmer refugees: the sore-neck syndrome.
abstract: This article describes a previously unreported cultural syndrome among Khmer refugees. This common presentation of distress centers on the complaint of a sore neck, the sufferer fearing that wind-and-blood pressure may burst the vessels in this area. During an acute episode, a Khmer endures many--if not all--of the following neck-and-head complaints: headache, blurry vision, a buzzing in the ear, and dizziness. While in the throes of the sore-neck attack, the patient frequently experiences palpitations as well as other symptoms of autonomic arousal, such as diaphoresis, shortness of breath, and trembling. A sufferer of sore-neck episodes often meets panic disorder criteria. In a clinic survey, thirty-five out of eighty-five patients (41%) were found to currently suffer the "sore-neck syndrome" (i.e., to have endured at least one episode in the last month), with almost all of these thirty-five patients (80%) fearing death during the acute event. The sore-neck syndrome represents a common and important way in which distress becomes embodied. The clinician must learn this body language; otherwise, the patient's communication of psychic, interpersonal, and physical pain goes unheard--and grave somatic suffering and disability unattended to--discounted as puzzling somatic complaints and unreasonable obsessionalism about blood pressure.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Revere, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Hinton
authors.forename: K
authors.initials: K
authors.lastname: Um
authors.forename: P
authors.initials: P
authors.lastname: Ba
mesh_terms: D000328:Adult; D000739:Anecdotes as Topic; D002160:Cambodia / Q000208:ethnology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D019547:Neck Pain / Q000208:ethnology / Q000503:physiopathology* / Q000523:psychology*; D016584:Panic Disorder / Q000175:diagnosis* / Q000208:ethnology* / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011602:Psychophysiologic Disorders / Q000150:complications; D012036:Refugees / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000208:ethnology; D013577:Syndrome