The symptom presentation of panic attacks may vary across cultures, influenced by cultural attributions about their origin or pathophysiology. For example, individuals of Cambodian origin may emphasize panic symptoms attributed to dysregulation of khyâl, a wind‐like substance in traditional Cambodian ethnophysiology (e.g., dizziness, tinnitus, neck soreness).
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There are several notable cultural concepts of distress related to panic disorder, which link panic, fear, or anxiety to etiological attributions regarding specific social and environmental influences. Examples include attributions related to interpersonal conflict (e.g., ataque de nervios among Latin American people), exertion or orthostasis (khyâl cap among Cambodians), and atmospheric wind (trúng gió among Vietnamese individuals). These cultural labels may be applied to symptom presentations other than panic (e.g., anger paroxysms, in the case of ataque de nervios) but they often constitute panic episodes or presentations with partial phenomenological overlap with panic attacks.
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Clarifying cultural attributions and the context of the experience of symptoms can inform whether panic attacks should be considered expected or unexpected, as would be the case in panic disorder. For example, panic attacks may involve specific foci of apprehension that are better explained by another disorder (e.g., social situations in social anxiety disorder). Moreover, the cultural linkage of the apprehension focus with specific exposures (e.g., wind or cold and trúng gió panic attacks) may suggest that acute anxiety is expected when considered within the individual's cultural framework.
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