“Khyâl attacks”: A key syndrome of psychological distress among Cambodian populations

Devon E. Hinton M.D., Ph.D

Siddharth K. Joshi B.Sc.

Khyâl attacks (“wind attacks”) are a key way that Cambodian refugees conceptualize the somatic symptoms caused by psychological distress. The information about khyâl attack on this website aims to educate health care professionals and researchers about this syndrome in order to facilitate successful treatment of Cambodian populations.

“Khyâl Attack” is now one of 9 cultural concepts of distress in the new DSM-V manual (2013).


I. Home
II. Historical background: Cambodian genocide
III. Cultural concepts of distress
IV. Ethnophysiology
     -Animation of  normal flow
     -Animation of pore blockage
     -Animation of an attack
V. Treating and preventing an attack
     The Coining Ritual

     –Film: Coining Khyâl

     –Film: Cupping Khyâl 

     –Film: Pinching Khyâl

Authors and Contact 

Devon E. Hinton M.D., Ph.D.

Staff Psychiatrist, The Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital

Publications by Dr. Hinton

Dr. Devon Hinton is a board-certified psychiatrist and an Associate Professor of Psychiatry at Harvard Medical School. After receiving his M.D., Dr. Hinton completed his medical internship and his residency in psychiatry at Harvard Medical School (Longwood program). He also has a Ph.D. in Medical Anthropology from Harvard University.

Dr. Hinton’s major clinical and research interests include the culturally sensitive assessment and treatment of PTSD and panic disorder in traumatized refugee and ethnic minority populations. He is fluent in several languages, including Cambodian and Spanish. He has served as a principal investigator on numerous studies examining the phenomenology and treatment of PTSD, panic attacks, and panic disorder in Southeast Asian (Cambodian, Laotian, Vietnamese) and Latino populations. Dr. Hinton has been the Principal Investigator on studies funded by the National Institute of Mental Health on developing culturally sensitive treatment of traumatized refugees.

Dr. Hinton is a member of the DSM-V Cultural Study subgroup and an advisor to the Anxiety, OC, Posttraumatic, and Dissociative Disorders Work Group of DSM–V (American Psychiatric Association). He is the co-editor (with Byron Good) of the book Culture and Panic Disorder (Stanford University Press) and is the first author on over 100 chapters or original research articles.

Siddharth K. Joshi B.Sc.

Research Coordinator, C.B.C Medical Center

Siddharth Joshi is a graduate of the University of South Florida, with a Bachelors of Science in Biomedical Sciences and a focus on neuroscience. After having done neuroscience research in college, investigating the pathology of Alzheimer’s disease in the human brain, Siddharth’s interests shifted to the exploration of effective therapies and interventions for improving life quality and reducing suffering.  Much of Siddharth’s recent work has focused on addressing and treating PTSD, both with a community of genocide affected Cambodian refugees, under the direction of Dr. Devon. E. Hinton M.D., Ph.D of Harvard Medical School, and with those affected by the Boston Marathon bombings of 2013 through the organization and leading of trauma relief workshops. Siddharth’s life experiences have led him to be fascinated by the interface of neuroscience, psychiatry, and primary care in a broader quest to relieve suffering. In the future, Siddharth may investigate how different therapies are positively affecting individuals with somatic and psychological complaints in primary care by using brain imaging and behavioral instruments.

Publications by Siddharth

Devon E. Hinton, Sonith Peou, Siddharth Joshi, Angela Nickerson, Naomi M. Simon. Normal Grief and Complicated Bereavement Among Traumatized Cambodian Refugees: Cultural Context and the Central Role of Dreams of the Dead. Culture, Medicine, and Psychiatry 2013; 37: 427.


Hinton, D. E., Pich, V., Marques, L., Nickerson, A., & Pollack, M. H. (2010). Khyâl attacks: A key idiom of distress among traumatized Cambodia refugees. Culture, Medicine and Psychiatry, 34, 244–278.

© Devon E. Hinton, Siddharth K. Joshi and Khyalattack.com, 2013-2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Devon E. Hinton, Siddharth K. Joshi and Khyalattack.com with appropriate and specific direction to the original content.