title: Gastrointestinal-focused panic attacks among Cambodian refugees: associated psychopathology, flashbacks, and catastrophic cognitions.
abstract: Among Cambodian refugees attending a psychiatric clinic, we assessed psychopathology associated with gastrointestinal panic (GIP), and investigated possible causal mechanisms, including "fear of fear" and GIP-associated flashbacks and catastrophic cognitions. GIP (n=46) patients had greater psychopathology (Clinician-Administered PTSD Scale [CAPS] and Symptom Checklist-90-R [SCL]) and "fear of fear" (Anxiety Sensitivity Index [ASI]) than did non-GIP patients (n=84). Logistic regression revealed that general psychopathology (SCL; odds ratio=4.1) and fear of anxiety-related sensations (ASI; odds ratio=2.4) predicted the presence of GIP. Among GIP patients, a hierarchical regression revealed that GIP-associated trauma recall and catastrophic cognitions explained variance in GIP severity beyond a measure of general psychopathology (SCL). A mediational analysis indicated that SCL's effect on GIP severity was mediated by GIP-associated flashbacks and catastrophic cognitions.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 15 Parkman Street, WACC 812 Boston, USA. devon_hinton@hms.harvard.edu <devon_hinton@hms.harvard.edu>
authors.forename: Devon E
authors.initials: DE
authors.lastname: Hinton
authors.forename: Dara
authors.initials: D
authors.lastname: Chhean
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Fama
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McNally
mesh_terms: D000293:Adolescent; D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D002160:Cambodia / Q000208:ethnology; D002648:Child; D003071:Cognition; D004190:Disasters; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008568:Memory; D019365:Metaphor; D009325:Nausea / Q000453:epidemiology; D016584:Panic Disorder / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology*; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000453:epidemiology / Q000523:psychology; D013217:Starvation / Q000453:epidemiology / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology