Thirteen Cambodian refugees who had survived 2-4 years of concentration camp experience met the DSM-III criteria for posttraumatic stress disorder. Their predominant symptoms were avoidance, hyperactive startle reactions, emotional numbness, intrusive thoughts, and nightmares, which had lasted at least 3 years after the imprisonment. The patients' avoidance of thoughts or discussion of the past and the shame they felt about Cambodia's history made diagnosis and treatment difficult. These findings give cross-cultural validation to the diagnosis of posttraumatic stress disorder and should alert clinicians to its existence in a population not previously studied.
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