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

Background. We sought to identify personal factors that placed people at ri sk during an epidemic of medically unexplained illness in a Bhutanese refug ee camp in southeastern Nepal. Methods. We conducted a case-control study, involving 68 cases and 66 contr ols. Caseness was defined as experiencing at least one attack of medically unexplained fainting or dizziness during the time of the epidemic. We perfo rmed hierarchical logistic regression analysis to identify significant pred ictors of case status. Results. In terms of Western psychiatric constructs, the illness involved s omatoform symptoms of both acute anxiety and dissociation. Sixty per cent r eported visual and 28% reported auditory hallucinatory experiences. Cases a nd controls were similar on all demographic variables, school performance, number of attacks witnessed and psychopathology before the onset of the epi demic. Recent loss, early loss, childhood trauma and pulse-rate were predic tors of case status. Conclusion. We identified trauma, early loss and, especially, recent loss a s predictors of attacks during medically unexplained epidemic illness in a Bhutanese refugee community.