The Panic Attack–Posttraumatic Stress Disorder Model: Applicability to Orthostatic Panic Among Cambodian Refugees

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Abstract
This article examines the ability of the panic attack–posttraumatic stress disorder (PTSD) model to predict how panic attacks are generated and how panic attacks worsen PTSD. The article does so by determining the validity of the panic attack–PTSD model in respect to one type of panic attack among traumatized Cambodian refugees: orthostatic panic (OP) attacks (i.e. panic attacks generated by moving from lying or sitting to standing). Among Cambodian refugees attending a psychiatric clinic, the authors conducted two studies to explore the validity of the panic attack–PTSD model as applied to OP patients (i.e. patients with at least one episode of OP in the previous month). In Study 1, the panic attack–PTSD model accurately indicated how OP is seemingly generated: among OP patients (N = 58), orthostasis‐associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious–depressive distress (Symptom Checklist‐90‐R subscales), and OP severity significantly mediated the effect of anxious–depressive distress on Clinician‐Administered PTSD Scale severity. In Study 2, as predicted by the panic attack–PTSD model, OP had a mediational role in respect to the effect of treatment on PTSD severity: among Cambodian refugees with PTSD and comorbid OP who participated in a cognitive behavioural therapy study (N = 56), improvement in PTSD severity was partially mediated by improvement in OP severity.

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