Cambodians within the U.S. are identified as being at very high risk for psychiatric symptoms because of their collective traumatic experiences. These experiences include witnessing war, separation from and death of family members, cultural destruction, torture, and starvation. These initial experiences have been compounded by terrifying escape and refugee camp experiences, and cultural adjustment to American life, primarily within the inner-city environment. Common stress related problems among this group include somatization, posttraumatic stress disorder, and suicide (Frye and D'Avanzo, 1994).

Related to their political persecution, many suffer from posttraumatic stress disorder (PTSD). Symptoms found consistently in individuals with PTSD include 1) reexperience of the trauma, 2) recurrent intrusive recollections, 3) recurrent dreams and nightmares, 4) acting out or feeling as if the traumatic event were recurring, 5) social numbness or withdrawal, 6) hyperalertness or hyperactive startle reaction, 7) sleep disorders, 8) guilt, 9) memory impairment, 10) avoidance of activities that arouse recollection of the event, and 11) intensification of the symptoms by exposure to similar events (Kinzie et al., 1984).

Cambodians within the U.S. are identified as being at very high risk for psychiatric symptoms because of their collective traumatic experiences. These experiences include witnessing war, separation from and death of family members, cultural destruction, torture, and starvation. These initial experiences have been compounded by terrifying escape and refugee camp experiences, and cultural adjustment to American life, primarily within the inner-city environment. Common stress related problems among this group include somatization, posttraumatic stress disorder, and suicide (Frye and D'Avanzo, 1994).

Related to their political persecution, many suffer from posttraumatic stress disorder (PTSD). Symptoms found consistently in individuals with PTSD include 1) reexperience of the trauma, 2) recurrent intrusive recollections, 3) recurrent dreams and nightmares, 4) acting out or feeling as if the traumatic event were recurring, 5) social numbness or withdrawal, 6) hyperalertness or hyperactive startle reaction, 7) sleep disorders, 8) guilt, 9) memory impairment, 10) avoidance of activities that arouse recollection of the event, and 11) intensification of the symptoms by exposure to similar events (Kinzie et al., 1984).

According to several studies, the Cambodians as a group arrived in the U.S. in poorer health than most other refugees. This is related to the extreme deprivation of food, shelter, and medical care by many. The most common diseases found in this group were tuberculosis, hepatitis B, and intestinal parasites (hookworm, Giardia, and Strongyloides). Hemoglobin E and thalassemia minor have also been observed in Cambodians (Catanzaro and Moser, 1982)

Spiritual healers are found in Seattle and are utilized by some individ uals, however, they are often very expensive. Some individuals go to the Buddhist temple to "get rid of the bad spirit". Cupping, pinching and rubbing are practiced by many local Cambodians.

Any of the previously mentioned concepts of illness may pertain to emotional as well as to physical illness. Unmistakable emotional disturbance is usually attributed to possession by malicious spirits; to bad karma accumulated by misdeeds in past lives; or to the bad luck of familial inheritance. Partially due to its attribution to immoral causes, mental illness is commonly denied and feared. The disturbed individuals are protected by their family and if outsiders become aware of the mental illness, great shame is brought to the family. In consequence, Cambodians who are having emotional problems tend to present themselves for care with physical problems (Muecke, 1983).

ambodians have traditionally dealt with illness through self-care and self-medication. This is related to their having access to most drugs over-the-counter at low cost, having few hospitals and physicians, and to the high cost of Western medical care. In rural Cambodian communities, herbal remedies, dermal techniques, maintenance of hot-cold balance, and rituals are the principal forms of medical treatment. More than one treatment will frequently be used for the same illness. The assistance of a health practitioner is sought if their own remedies don't work.

In Cambodia, herbs are often grown in a home garden. A Khru Khmer (traditional healer) may be sought who will often travel into the jungle for herbs, roots and plants for healing. The presence of spirits is reality to many Cambodians, and often take an active role in an individual's life. Spirit possession or sickness may be the result of evil spells cast by another, mistakes made in various rituals through the life cycle or neglect of rituals. Traditional healers or spiritual healers will be sought for illnesses thought to be caused by spirits (Kemp, 1985). The dermal techniques are perceived as ways to relieve headaches, muscle pains, sinusitis, colds, sore throat, coughs, difficulty breathing, diarrhea, or fever.

Cupping, pinching, or rubbing (also known as coining) are the most commonly used and are thought to restore balance by releasing excessive "air". In cupping, a cup is heated and then placed on the skin usually on the forehead or abdomen; as it cools, it contracts, drawing the skin and what is believed to be excess energy or "air" into the cup; a circular ecchymosis is left on the skin. Pinching uses the same principle, but pressure is applied by pinching the skin between the thumb and index finger to the point of producing a contusion. This usually is done at the base of the nose, between the eyes, on the neck, chest or back. Rubbing is usually in the same areas as pinching and involves firmly rubbing of lubricated skin with a spoon or a coin in order to bring toxic "air" to the body surface. In the hot-cold theory, illness is caused by an alteration in the natural balance between hot and cold elements in the universe. To restore balance and harmony, intake of drugs, herbs and foods is adjusted. Western medicines are generally considered hot, and herbal remedies have cooling properties. Foods are considered to have varying properties with for example, fruits and vegetables being "cold" (Muecke, 1983).