A Psychobiocultural Model of Orthostatic Panic Among Cambodian Refugees: Flashbacks, Catastrophic Cognitions, and Reduced Orthostatic Blood-Pressure Response

This paper investigates cognitive and physiological precursors of orthostatic panic (OP), that is, panic upon standing, which is a key complaint among traumatized Cambodian refugees. Prior research links OP to hypotension (lower blood pressure) and catastrophic cognitions. A clinical sample of 102 Cambodian refugees were assessed for posttraumatic stress disorder (PTSD), recent OP attacks, and anticipatory anxiety before engaging in an orthostatic challenge (OC) task during which they were monitored for blood pressure. After the task, they were assessed for OC-induced culture-related catastrophic cognitions, flashbacks, and panic attacks. We found that participants with recent OP (n = 60) had more PTSD, greater anticipatory anxiety before the OC, a larger drop in systolic blood pressure during the OC, more OC-induced catastrophic cognitions and flashbacks, and more severe OC-induced panic attack symptoms. Regression models showed that the severity of OC-induced panic symptoms was predicted by the magnitude of SBP drop and mediated by more severe catastrophic cognitions and flashbacks. Implications of the findings for cross-cultural psychopathology research and the treatment of both panic and PTSD in Cambodian refugees are discussed.