Phenomenology and cultural aspects of panic attacks and panic disorder among patients attending a psychiatric clinic in Northern India: An exploratory study

Abstract

Introduction The clinical presentation of panic attacks and panic disorder in any culture is influenced by its concepts of physiology and ensuing catastrophic beliefs. Western diagnostic paradigms may be inconsistent with the concept of illness in the eastern world. However, the role of culture in defining expression of panic symptoms in native Asian populations is rarely studied. Objective The study was aimed at exploring the phenomenology of panic attacks and panic disorder in Northern India to understand the culturally relevant qualitative characteristics and contextual features. Methodology Six focus group discussions and five key informant interviews involving various stakeholders were conducted to elicit local concepts and descriptions of the phenomena. Patients' focus groups consisted of 30 participants (age range 23–45 years) presenting with ‘panic attack-like episodes'. They were recruited through purposive sampling from the rural and urban psychiatric clinics of a tertiary care institution. Healthcare professionals' views were explored through focus groups comprising of 12 psychiatrists and 5 key interviews with other medical specialists. The sessions were tape-recorded and transcripts analyzed qualitatively using grounded theory technique. Results Four major themes emerged from the analysis: – differential panic symptom endorsement and culture-specific symptoms; – idioms of distress with underlying unique ethnophysiological concepts; – possible existence of cultural variants of panic attacks not confirming to ICD-10 or DSM-5 classical descriptions; – causal attribution of illness and help seeking. Conclusion This is the first ethnographic study on panic disorder from India. It provides preliminary insights into the issues of diagnostic universality and cultural specificity, which require further systematic investigation.