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Transcultural Psychiatry, Vol. 42, No. 1, 46-77 (2005)
DOI: 10.1177/1363461505050710

‘The Ghost Pushes You Down’: Sleep Paralysis-Type Panic Attacks in a Khmer Refugee Population

Devon E. Hinton

Massachusetts General Hospital, Harvard Medical School, devon_hinton{at}hms.harvard.edu

Vuth Pich

Arbour Counseling Services

Dara Chhean

Arbour Counseling Services

Mark H. Pollack

Massachusetts General Hospital, Harvard Medical School

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 ({chi}2 = 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.

Key Words: Khmer refugees • panic attacks • post-traumatic stress disorder • sleep paralysis


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