Olfactory-triggered panic attacks among Cambodian refugees attending a psychiatric clinic

Hinton, Devon E.; Pich, Vuth; Chhean, Dara; Pollack, M.H.; Barlow, David H.

doi:10.1016/j.genhosppsych.2004.04.007

« Previous Next »General Hospital Psychiatry
Volume 26, Issue 5 , Pages 390-397, September 2004

Olfactory-triggered panic attacks among Cambodian refugees attending a psychiatric clinic

Devon E. Hinton, M.D., Ph.D.
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Southeast Asian Clinic, Arbour Counseling Services, 10 Bridge Street, Lowell, MA 01852, USA
- Corresponding author. Arbour Counseling Services, 10 Bridge Street, The Simpson Block, Lowell, MA 01852, USA. Tel.: +1 617 738 9055; fax: +1 978 970 5595.
Vuth Pich, M.S.W.
- Southeast Asian Clinic, Arbour Counseling Services, 10 Bridge Street, Lowell, MA 01852, USA
Dara Chhean, B.A.
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Southeast Asian Clinic, Arbour Counseling Services, 10 Bridge Street, Lowell, MA 01852, USA
M.H. Pollack, M.D.
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
David H. Barlow, Ph.D.
- Center for Anxiety and Related Disorders at Boston University, Boston, MA 02114, USA

Received 19 January 2004; accepted 22 April 2004.

Abstract

Olfactory panic attacks have not been systematically assessed in a psychiatric population by any previous studies. Among Cambodian refugees attending a psychiatric clinic, the present investigation determines the following: (a) 1-month current prevalence of olfactory-triggered panic attacks, (b) associated psychopathology (Hopkins Symptom Checklist and the Structured Clinical Interview for DSM-IV–diagnosed posttraumatic stress disorder [PTSD]), and (c) frequency in events of olfactory panic of catastrophic cognitions (Panic Attack Cognitions Scale [PACQ]) and flashbacks (Clinician-Administered PTSD flashback scale). Forty-five percent of 100 consecutive psychiatric patients were found to have suffered an olfactory-triggered panic attack in the previous month; having current olfactory panic attacks was highly correlated with psychopathology (e.g., to PTSD diagnosis: and χ²=50.0; df=1; p<.001); and during olfactory-triggered panic attacks, catastrophic cognitions and flashbacks were common. Possible mechanisms for generation of high rates of olfactory-triggered panic attacks in this population are discussed (the “traumatic memory/catastrophic cognitions/interoceptive conditioning/escalating arousal” or “TCIE” model of panic generation) as are treatment implications.

Keywords: Olfactory, Panic attacks, Trauma, Panic disorder, Posttraumatic stress disorder, Cambodia, Refugees, Southeast Asia