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Trauma and loss as determinants of medically unexplained epidemic illness in a Bhutanese refugee camp

M. VAN OMMEREN, ” B. SHARMA, I. KOMPROE, B. N. POUDYAL, G. K. SHARMA,

E. CARDENN A and J. T. V.M. DE JONG

From the Center for Victims of Torture Nepal in KathmanduNepalthe Transcultural Psychosocial

OrganizationVrije UniversiteitAmsterdamThe Netherlandsand the University of TexasPan American,

TXUSA

 

ABSTRACT

 

Background.

 

We sought to identify personal factors that placed people at risk during an epidemic of medically unexplained illness in a Bhutanese refugee camp in southeastern Nepal.

 

Methods.

We conducted a case control study, involving 68 cases and 66 controls. Caseness was deÆned as experiencing at least one attack of medically unexplained fainting or dizziness during the time of the epidemic. We performed hierarchical logistic regression analysis to identify signiÆcant predictors of case status.

 

Results.

 

In terms of Western psychiatric constructs, the illness involved somatoform symptoms of both acute anxiety and dissociation. Sixty per cent reported visual and 28% reported auditory hallucinatory experiences. Cases and controls were similar on all demographic variables, school performance, number of attacks witnessed and psychopathology before the onset of the epidemic. Recent loss, early loss, childhood trauma and pulse-rate were predictors of case status.

 

Conclusion.

We identiÆed trauma, early loss and, especially, recent loss as predictors of attacks during medically unexplained epidemic illness in a Bhutanese refugee community