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Background: The Cambodian Genocide

Khyl attack as one of 9 Cultural Concepts of Distress
in the Diagnostic and Statistical Manual-5 (DSM-5)
The ethnophysiology of a khyl attack (triggers,
symptoms, and a spectrum of severity)
Treating a khyl attack: coining and doing the vessels
Preventing a khyl attack: Doing the vessels

The 9 Cultural Concepts of Distress in the DSM-5

Ataque de nervios (attack of nerves: Latino group)

Dhat syndrome (semen: South Asians)
Khyl cap (wind attacks: Cambodian speakers)
Kufungisisa (thinking too much: Shona speakers in
Maladi moun (sent sickness: Haitian populations)
Nervios (nerves: Latinos in the United States and Latin
Shenjing shuairuo (weakness of the nervous system:
Mandarin Chinese)
Susto: (fright: Latino group)
Taijin kyofusho (taijin- between people, kyofu- fear,
sho-disorder: Japan)

DSM-5 Glossary Entry for Khyl Cap

Khyl cap. Khyl attacks (khyl cap), or wind attacks, is a syndrome found
among Cambodians in the United States and Cambodia. Common symptoms include those
of panic attacks, such as dizziness, palpitations, shortness of breath, and cold extremities,
as well as other symptoms of anxiety and autonomic arousal (e.g., tinnitus and neck
soreness). Khyl attacks include catastrophic cognitions centered on the concern that khyl
(a wind-like substance) may rise in the bodyalong with bloodand cause a range of
serious effects (e.g., compressing the lungs to cause shortness of breath and asphyxia;
entering the cranium to cause tinnitus, dizziness, blurry vision, and a fatal syncope). Khyl
attacks may occur without warning, but are frequently brought about by triggers such as
worrisome thoughts, standing up (i.e., orthostasis), specific odors with negative
associations, and agoraphobic-type cues like going to crowded spaces or riding in a car.
Khyl attacks usually meet panic attack criteria and may shape the experience of other
anxiety and trauma and stressor-related disorders. Khyl attacks may be associated with
considerable disability.
Related conditions in other cultural contexts: Laos (pen lom), Tibet (srog rlung
gi nad), Sri Lanka (vata), and Korea (hwa byung).
Related conditions in DSM-5: panic attacks, panic disorder, generalized anxiety
disorder, agoraphobia, posttraumatic stress disorder, illness anxiety disorder.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, (Copyright 2013). American Psychiatric Association. All rights reserved.