title: 'The ghost pushes you down': sleep paralysis-type panic attacks in a Khmer refugee population.
abstract: 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 (chi2 = 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.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, USA. devon_hinton@hms.harvard.edu
authors.forename: Devon E
authors.initials: DE
authors.lastname: Hinton
authors.forename: Vuth
authors.initials: V
authors.lastname: Pich
authors.forename: Dara
authors.initials: D
authors.lastname: Chhean
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
mesh_terms: D002160:Cambodia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000208:ethnology* / Q000523:psychology*; D012036:Refugees / Q000523:psychology*; D020188:Sleep Paralysis / Q000208:ethnology* / Q000523:psychology*; D013140:Spiritualism; D011795:Surveys and Questionnaires