The Impact of PTSD on Refugee Language Learners

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Running head: Refugees, PTSD, Language Learning
The Impact of PTSD on Refugee Language Learners
Martha Clayton
California State University, Northridge
Refugees, PTSD, Language Learning
The Impact of PTSD on Refugee Language Learners
Currently, there are 60 million people worldwide who have been displaced as a result of
conflict and persecution. Between 2015 and 2017, approximately 250,000 refugees from over a
dozen countries will be resettled in the United States. Refugees experience pre-migration trauma
and post-traumatic stress disorder (PTSD) at much higher rates than other immigrant groups.
Trauma and its residual symptoms can significantly impact learning. This creates a unique set of
challenges for both refugee ESL learners and educators who are supporting refugee language
The purpose of this review is to explore, from an evidence-based perspective, the current
literature pertaining to refugee ESL learners with PTSD in order to better understand their unique
experiences, the specific needs their experiences derive, how these experiences affect learning
processes and outcomes, and the strategies and methods being employed to disrupt the trauma
induced barriers that can limit language learning success.
The scope of the literature reviewed examines several issues related to refugee language
learning and PTSD. These include PTSD as a catalyst for cognitive impairment, the prevalence
of PTSD in refugee populations, the relationship between PTSD and learning outcomes,
considerations for ESL educators, and theoretical implications. A total of 43 articles reviewed
between 1988 and 2015 strongly support the hypothesis that PTSD has a direct affect on refugee
language learning but that ESL educators can implement procedures to minimize impediments to
The structure of this review synthesizes past and current research on the effects of PTSD
and refugees. This includes 1) defining ‘refugee’ and pre-migration trauma experiences; 2)
analysis of PTSD and its symptomatology; 3) exploration of research related to PTSD and
Refugees, PTSD, Language Learning
cognitive processing; 4) the effects of PTSD on refugee language learners; 5) an overview of
successful TESL approaches; and 5) practical considerations for further research on refugee
second language learning.
Global Refugee Crisis
The United Nations High Commission of Refugees Global Trends Report: World at War
(Global Trends, 2015) identified a 58.6% increase in the number of displaced persons in the last
decade, up from 37.5 million to 59.5 million with a 16.2% increase in the last year alone
(UNHCR News). Refugees from Syria, Afghanistan, and Somalia represent more than half
(53%) of all the people who were displaced in 2014 (Desilver, 2015). Although ranked 14th in
number of refugees received relative to size, the United States currently offers humanitarian
protection to more refugees than any other country, having resettled over two million refugees
since 1975 (Cutt, 2000; Desilver, 2015). Conflict conditions in Syria have had a severe impact on
the global refugee crisis causing the United States to implement an incremental admission ceiling
increase from 70,000 in 2014 to 100,000 by 2017 (Zong & Batalova, 2015). Many of these
roughly 250,000 refugees will arrive in the United States having experienced extreme hardship.
Refugees are defined as persons located outside of the United States who are of special
humanitarian concern. According to the Immigration and Nationality Act (INA), section
101(a)(42), a refugee is a person who is persecuted or fears persecution due to race, religion,
nationality, political opinion, or membership in a particular social group. They are not firmly
resettled in another country, often residing in refugee camps. The U.S. Refugee Admissions
Program refers refugees for consideration for classification and resettlement. Upon approval,
refugees receive medical assistance, cultural orientation and travel assistance. Refugees receive
medical and financial assistance after arrival in the United States, and can apply for family
Refugees, PTSD, Language Learning
reunification if separation has occurred. Refugees are permitted to work immediately upon
arrival and can apply for permanent residency after one year (USCIS).
Refugee Experience and Trauma
Unlike immigrants who migrate by choice, refugees are forced to relocate due to
conditions that are unsafe or inhumane. Refugees commonly report having experienced forced
isolation, imprisonment, torture, and the death(s) of loved ones caused by violence, illness or
malnutrition. This often leaves children, who represent 48-53% of the worldwide refugee
population, to assume an adult social role, which increases the likelihood that they will
experience interrupted or terminated formal education. Family separations, both before and
during relocation, are common and leave refugee children vulnerable to kidnappings, forced
marriages or conscription. Refugees are often deprived of basic needs, trapped in combat
situations or confined to refugee camps which are over-crowded, vectors for infectious disease
and poorly designed for long term habitation (Bolton, 2015; Heger Boyle & Ali, 2009; Cranitch,
2010; Gordon, 2011; McDonald, 2000; Nykiel-Herbert, 2010; UNHCR).
Refugees who experience extreme traumatic events often develop post-traumatic stress
disorder (PTSD). PTSD is a trauma and stressor-related disorder with symptoms that are divided
into four clusters:
Intrusion: reliving the event with repeated flashbacks or recurring dreams of the
event, frightening or disturbing dreams, trouble sleeping, outbursts of anger,
intense distress if exposed to anything resembling the event
Avoidance: efforts to avoid any people or activities that may arouse recollection
of the trauma
Refugees, PTSD, Language Learning
Negative alterations in cognitions and mood: persistent and distorted blame of self
or others, and persistent negative emotional state
Alterations in arousal and reactivity: hypervigilance, preoccupation with possible
unknown threats, constantly watching and scanning surroundings, startling easily,
persistent sense of insecurity. (DSM-V, 2013)
Psychological research has indicated a link between pre-migration trauma and
resettlement mental health that affects refugees at the individual, family, and collective level.
(Silove, et al., 1999; Smith, et al., 2001; Steel et al., 2002; Terheggen, Stroebe, & Kleber, 2001).
Within specific refugee populations, instances of PTSD can be extremely high. A study of
Cambodian refugees who resettled in Australia revealed 91% of the subject group to be
experiencing at least one PTSD symptom including trouble concentrating, memory loss, and
headaches (Stevens, 2001). Overall, studies have shown significant variation in the rates of
PTSD diagnosis or symptomology with indications that 4-86% of refugees who have been
exposed to traumatic events, such as war, physical abuse, or sexual assault exhibit moderate to
severe symptoms (Bolton, 2015; Heger Boyle & Ali, 2009; Cranitch, 2010; Gordon, 2011;
McDonald, 2000; Nykiel-Herbert, 2010; Yearbook, 2012). This inconsistency is likely the result
of dissimilarity of diagnostic tools, culturally specific expression of trauma, translation problems,
sample size, or research methodologies (Bolton, 2015; Bracken et al., 1995; Terheggen, Stroebe,
& Kleber, 2001; Weine, 2001). Trauma has been shown to be a significant risk factor for
resettlement success, with trauma ‘load’ as well as the trauma ‘type,’ particularly confinement,
isolation, torture and rape, increasing the likelihood of PTSD. A collection of studies that
focused on Cambodian refugee groups demonstrated that PTSD symptoms were more intense
and much longer in duration after exposure to multiple extreme traumatic events, than the control
Refugees, PTSD, Language Learning
subjects who had experienced minimal exposure to traumatic events (Blair, 2001; Hinton et al.,
2011; Mollica et al., 1993). Additionally, epidemiological studies show that refugee groups who
experience torture exhibit increased occurrences of PTSD. Large sample groups from Algeria,
Cambodia, Gaza, and Ethiopia exhibited rates of PTSD ranging from 16% to 37% with the
prevalence of PTSD in the Ethiopian group surveyed (n=1200) being 16% higher for torture
survivors than for those who were not tortured (De Jong et al., 2001).
PTSD and the Brain
Research between 1991 and 2012 has produced marginally conflicting evidence
regarding the existence of a causal relationship between PTSD and cognitive performance. The
most significant body of research related to this topic has focused on military veterans who have
similar trauma load and trauma type experiences to refugees. August and Gianola (1987)
compared symptomology of Southeast Asian (SEA) refugees and Vietnam veterans and
concluded that both groups were suffering from the same type of war trauma induced PTSD. Of
note was the fact that, regardless of the cultural differences in expression of trauma among
subjects, veterans and SEA refugees exhibited the same symptom clusters with a relationship
between trauma load, symptom intensity and duration (August & Gianola, 1987). Using a control
based on scope of combat exposure, McNally and Shin (1995) reported that the PTSD symptom
load intensity of Vietnam combat veterans was negatively correlated with cognitive performance
on the Shipley Institute of Living Scale (Zachary, 1991). Vasterling et al. (1997) reported that
Gulf War veterans with PTSD had considerably lower scores on the Wechsler Adult Intelligence
Scale in comparison to the control group veterans without PTSD. Neuroimaging analysis of
PTSD subjects has shown structural and functional changes in brain areas that are indexed with
emotional processing and declarative memory function, especially parts of the medial temporal
Refugees, PTSD, Language Learning
lobe such as the hippocampus. Meta-analysis of 21 neuroimaging studies revealed dramatic
reductions of hippocampal volume among subjects with chronic PTSD (Karl et al., 2006). The
correlative relationship between reduction percentages increased with severity of symptoms
(Freeman et al., 2006). Additional studies reporting on verbal memory processing (n=1489, 667
with PTSD and 822 controls) found cognitive impairment related to PTSD manifested as
problems with attention, verbal memory functions, acquisition and encoding (Barrett et al., 1996;
Crowell et al., 2002). Conversely, Sutker et al. (1991) and Zalewski et al. (1994) found no
significant difference in scores on Wechsler Adult Intelligence Scale between PTSD diagnosed
WWII, Korean Conflict prisoners of war, Vietnam veterans, and non-PTSD diagnosed veterans
with similar exposures to trauma. However, several studies that analyzed Event Related
Potentials (ERPs) of PTSD patients with various types of index events indicated an important
correlation between PTSD and alterations in information processing.
ERP research allows for non-invasive measuring of the electrophysiological activity of
the brain during exposure to various specific stimuli or performance of a particular task, and has
enabled the development of associations between perceptual and cognitive processes and
language comprehension and production (Hoff, 2014). Generally, all of the ERP research studies
rely on violation paradigms that compare the same exact stimuli in different contexts. ERP
measurements related to positive (P) and negative (N) peaks and latency (ms) are gathered via
electrodes distributed over the scalp. Researchers have indexed several electrophysiological
events with specific aspects of language processing. P3a studies have shown that persons with
PTSD exhibit higher amplitudes than non-PTSD controls, which indicates an attention bias
toward trauma related stimuli. This demonstrates the neurological process of the PTSD symptom
hypervigilance. Reduced P50 suppression, which relates to deficits in the ability to filter
Refugees, PTSD, Language Learning
irrelevant sensory stimuli, was also observed universally. Lastly, utilization of ‘garden path’
sentence paradigms used as stimuli have enabled observation of N400 ERPs that indicate the
neurological process of negative expectancies related to PTSD symptoms of intrusion. In the
context of language processing, this yielded evidence of considerable information processing
biases (Karl, et al., 2006; Kimble, et al., 2012).
Refugees, PTSD, and Language Learning
Multiple studies have investigated the influence of trauma and PTSD on ESL learners.
Clarke and colleagues (1993) theorized that PTSD symptom-related aversion to involvement in
acculturation behaviors, which would limit exposure to L2 input, could be hindering the
acquisition process (Clarke et al., 1993). Other qualitative research has suggested that the
manifestation of symptoms clusters such as inability to concentrate, headaches, high anxiety, and
reluctance to participate verbally, memory problems, and dissociation, acts as a catalyst for
diminished or delayed learning. (Kosa & Hansen, 2006; Santoro, 1997; Ying, 2001) More
succinctly, Sondergaard & Theorell’s (2004) longitudinal study of Iraqi refugees resettled in
Sweden (n=49) employed the Impact of Events Scale-22, Hopkins Symptom Checklist-25, and
Dissociative Experiences Scale to measure progress in language learning. They concluded that
the symptom load of PTSD during the follow-up testing period is inversely associated to the
speed of language acquisition. From this they surmised that treatment and preventive measures
against worsening of PTSD symptoms are important in order to minimize harmful post-migration
stress during language learning.
Considerations for Educators
As much of the research demonstrates, learners who have experienced extreme traumatic
events may experience symptoms of PTSD that complicate language learning. In response,
Refugees, PTSD, Language Learning
researchers have identified effective methods for creating safe, encouraging, and productive
learning environments. The classroom environment should be configured so that loud noises are
minimized and a quiet area should be made available for students feeling the need to retreat from
potentially overwhelming situations. Additionally, if possible, doors and windows should remain
open in order to minimize intrusive memories of detention. If it is necessary to close doors or
windows, teachers should explain their motivation beforehand (Gordon, 2011; McDonald, 2000).
Classroom procedures should include attendance charts and regularly scheduled authentic
assessments in order to increase learner investment and amplify autonomy (Gordon, 2011).
Teachers should be discreet when asking about personal histories, respect learners’ right to non-
participation by offering alternative assignments such as journaling. Teachers should also be
prepared to deal with controversial or problematic subjects when they arise. Furthermore,
regularly varying topics should be employed in order to assist students who have difficulty
concentrating (Gordon, 2011; McDonald, 2000; Nicholas et al., 2011).
Materials should be designed to promote low-risk tasks such as using image banks to
produce written or oral stories, and textbooks should be evaluated in order to avoid negative
discursive patterning that position the host country as redeemers or emphasize negative qualities
of countries of origin and their cultures (Gulliver, 2010; Nicholas et al., 2011).
Developing a student-centered communicative approach that focuses on learner strengths,
and rejects a deficit model of learner assessment, can encourage autonomy and improve self-
image, especially when applied in conjunction with student-led development of authentic
materials inspired by learner experiences (McDonald, 2000; Nicholas et al., 2011; Wajnryb,
2003). Administrators should develop country files, or backgrounders, that can assist teachers
with contextual understanding of refugee experiences while improving cultural sensitivity.
Refugees, PTSD, Language Learning
Databases of community resources and organizations that can assist refugees with health and
social services should be prepared as well. Lastly, professional boundaries should be maintained
in order to shelter teachers, who aren’t therapists, from overexposure to confidential disclosures
of traumatic events (Gordon, 2011; Gulliver, 2010; McDonald, 2000; Nichols et al., 2011).
Theoretical Implications
Although there is a large body of research related to PTSD and refugee language
learning, there is no theory developed that directly addresses the impact of trauma on second
language learning. Gordon (2011) points out that Schmidt’s Noticing Hypothesis, which states
“only what learners notice in input can be used as intake for second language acquisitions,”
would be inappropriate for developing trauma related research due to the processing and
attention biases that PTSD propagates.
Sociocultural Theory of the Mind (SCT), based on Vygotsky’s work (1986), views
language as a tool which facilitates cognitive development through the process of languaging:
speaking and writing as a mediator of complex cognitive activities could be employed to
cultivate new findings. Swain and Deters (2007) identify languaging as a psychological and
cultural event from which learners can communicate and change their thinking into a form that
can be a source of further reflection and can also be used as a catalyst for developing emotions.
Measurable results using this theory would likely be dependent on the same assessment methods
used in PTSD treatment trials that utilize written exposure therapy, cognitive-behavior therapy,
exposure therapy, narrative exposure therapy, and cognitive processing therapy (Adenauer et al.,
2011; Hinton et al., 2005; Paunovic & Öst, 2001; Shulz et al., 2006Sloan et al., 2013).
Krashen’s Affective Filter Hypothesis (AFH) offers excellent potential for research.
Krashen suggests that affective factors, including stress and self-esteem, influence second
Refugees, PTSD, Language Learning
language acquisition by acting as a barrier that obstructs comprehensible input and the language
acquisition device from interacting (Krashen 1988). The neuroimaging research previously
performed with veterans demonstrates that PTSD does create a barrier to information processing
and memory and if combined, could dispel previous doubts about this hypothesis that were based
on a lack of empirical support while offering new insight and a gateway to the development of
appropriate methodologies.
On a related note, Parson and Kessler’s (2012) laboratory studies of fear learning and
memory elicited positive results for disrupting PTSD symptoms by pharmaceutically blocking
consolidations of reactivated traumatic memories. Although this method has positive
implications for the treatment of symptomatology, the study does not address the ramifications
this type of treatment may have on language learning thus opening the door for an entirely new
area of SLA research.
Overall, there is consistency among the literature reviewed, based on both qualitative and
quantitative studies, that PTSD affects cognitive functioning. Given the high rates of PTSD in
refugee populations, this concern must be addressed by ESL educators and researchers. Memory
effects and information processing biases, as a result of PTSD symptoms, are interceding factors
in language learning for refugees and must be taken into account in ESL classrooms. In order to
facilitate the learning process, the language learning experience should be made relevant to
refugees’ lives while respecting learners’ distinctive experiences. Refugee learners should be
offered opportunities, and encouraged, to contribute their knowledge and skills to the classroom
environment. Their culture and linguistic status should be supported, and marginalization should
be circumvented through teacher and community support. Pre-migration history should be
Refugees, PTSD, Language Learning
respected and incorporated into the learning experience as well. Previous research on PTSD,
cognitive function, and refugee education provides some important guidelines that should be
applied in refugee ESL classrooms. However, more research on refugee language learning
processes and post-trauma exposure second language acquisitions is needed, especially with
regard to the effects of pharmacological treatment of PTSD on learning.
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  • ... Environments of subtractive bilingualism, such as the United States, where first languages face likely replacement after one or two generations, further stigmatize users of minority linguistic codes (Bialystok and Hakuta 1994, 191-92). Specific stressors affecting the circumstantial learner's language interaction include impaired cognitive function because of post-traumatic stress disorder (Clayton 2015). Studies of English-language learners from Iraq and elsewhere list a range of PTSD-related classroom behaviors: "inability to concentrate, headaches, high anxiety, and reluctance to participate verbally, memory problems, and dissociation" (8). ...
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    Unprecedented numbers of adult refugee learners are entering ESL classes, many of whom escaped war-torn countries and endured long stays in refugee camps. Research in public health and psychology has documented high levels of depression, anxiety, and posttraumatic stress disorder in refugee populations. Drawing on ethnographic research with Laotian refugee women who experienced pre-settlement trauma during the Vietnam War and interviews with bilingual mental health professionals, this article examines current second language acquisition theories to consider how they elucidate the effect of trauma on second language learning. The article offers cross-cultural perspectives about the impact of trauma on learning and recommendations for working with adult refugee learners who have experienced trauma. Findings have implications for ESL instructors and second language researchers concerned with the impact of pre- settlement experiences on second language acquisition and implications for classroom instruction.
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    The refugee and asylum channel is one of three channels through which aliens can legally immigrate to the United States. The others are through employment and family creation/family reunification (see Spotlight on Legal Immigration to the United States). This updated Spotlight closely examines the data on persons admitted to the United States as refugees or those granted asylum in 2005. It also provides the number of refugees and asylees receiving lawful permanent resident status (LPR) in 2005. The data come from the 2005 Annual Flow Report on Refugees and Asylees and the 2005 Yearbook of Immigration Statistics, published by the Department of Homeland Security's Office of Immigration Statistics (OIS). Note: all yearly data is for the government's fiscal year (October 1 through September 30). Unlike Annual Flow reports, previous OIS publications on refugees and asylees included information on the number of applications submitted, approved, and denied in addition to the number of persons admitted as refugees or granted asylum (see 2004 Yearbook of Immigration Statistics data tables). Click on the bullet points below for more information: Definitions Refugees and asylees are aliens who are unable or unwilling to return to their country of origin or nationality because of persecution or a well-founded fear of persecution. Aliens seeking asylum in the United States can submit an asylum request in one of two ways. Refugee Data The annual ceiling for refugees admitted to the United States through the resettlement program has declined 70 percent in the last 26 years. More than 53,000 refugees were admitted to the United States through the resettlement program during 2005. Nationals of 10 countries accounted for 86 percent of all refugee arrivals in 2005. California, Minnesota, and Florida accounted for more than a third of all refugee resettlements. Asylee Data More than 25,000 individuals (principals and their immediate family members) were granted asylum in 2005. China, Colombia, Haiti, and Venezuela accounted for half of all persons granted asylum in 2005.
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    Immigrant success stories found in English as a second language (ESL) textbooks used in government-funded language instruction in Canada imagine Canada as a redeemer of immigrant newcomers. Through a critical discourse analysis of ESL textbooks used in Language Instruction for Newcomers to Canada classes in Ontario, I identify two primary strategies of legitimation: positive self-representation/negative other-representation (van Dijk, 2000) and the maintenance of a low orientation to difference (Fairclough, 2003), despite a feigning of dialogicality. The stories of these immigrant newcomers follow a very similar narrative pattern that legitimates periods of economic hardship, social exclusion, and personal struggle. However, they overwhelmingly represent hard-working immigrant newcomers as successful and appreciative of the opportunities provided to them by Canada. I conclude by arguing that ESL teachers should recognize that the diverse experiences of newcomers may not align with these repetitive imaginings of Canada as a redeemer of immigrant others.
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    There is a need to identify alternative treatment options for posttraumatic stress disorder (PTSD), especially among veterans where PTSD tends to be more difficult to treat and dropout rates are especially high. One potential alternative is written exposure therapy, a brief intervention shown to treat PTSD among civilians effectively. This study investigated the feasibility and tolerability of written exposure therapy in an uncontrolled trial with a sample of 7 male veterans diagnosed with PTSD. Findings indicated that written exposure therapy was well tolerated and well received. Only 1 of the 7 veterans dropped out of treatment, no adverse events occurred during the course of treatment, and veterans provided high treatment satisfaction ratings. Clinically significant improvements in PTSD symptom severity were observed for 4 veterans at posttreatment and 6 veterans at the 3-month follow up. Moreover, 5 of the 7 veterans no longer met diagnostic criteria for PTSD 3 months following treatment. These findings suggest that written exposure therapy holds promise as a brief, well tolerated treatment for veterans with PTSD. However, additional research using randomized controlled trial methodology is needed to confirm its efficacy.
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    War stress frequently leads to the subsequent development of psychopathology including posttraumatic stress disorder (PTSD), but recent research has indicated that individual difference factors may alter vulnerability to trauma-related distress. In an effort to examine the potential buffering effects of intellectual resources on PTSD development, this study assessed intellectual functioning in subsets of Persian Gulf War zone veterans with and without PTSD diagnoses. The two subsets, comprised of 18 PTSD-diagnosed and 23 psychopathology-free Persian Gulf War veterans, were compared on a multi-faceted test of intellectual functioning, the Wechsler Adult Intelligence Scale-Revised. As compared to psychopathology-free veterans, PTSD-diagnosed veterans performed significantly more poorly on tasks of verbal intellectual functioning including those tasks thought to reflect premorbid functioning. The two groups did not differ on visuospatial tasks or on a task of attention. Findings suggest that intellectual resources, particularly verbal skills, may buffer development of stress-related psychopathology following trauma exposure.
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    How have the ideas raised by Firth and Wagner (1997) influenced the construction of second language acquisition (SLA) theories? In this article, we take the position that prior to and since 1997, there was and has been a notable increase in SLA research and theory that prioritizes sociocultural and contextual factors in addition to acknowledging individual agency and multifaceted identities. This article focuses on 4 major influences on a growing body of SLA research: sociocultural theory of mind, situated learning, poststructural theories, and dialogism. We highlight aspects of these perspectives that have been used in SLA theory, and provide examples of research that illustrate the richness and complexity of constructs such as languaging, legitimate peripheral participation, subjectivity, and heteroglossia. These perspectives and constructs address Firth and Wagner's call for a reconceptualization of SLA by offering alternative understandings of language and language learning.
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    Environmental stressors place refugees at risk of mental ill health and this article examines the meaning of selected symptoms such as sleeping problems, nightmares, breathing problems, pain, headaches, dizziness, fatigue and lethargy, trouble with concentration and memory loss among a random sample of 150 male and female Cambodians aged 20 to 75 years in South Australia. Respondents were interviewed in their own homes by the author, accompanied by a Cambodia-born research assistant who interpreted where necessary. The interview schedule used was devised in collaboration with a Cambodia-born advisory committee. Understanding of the meaning of the symptoms experienced was explored through two main approaches. First, analysis of their social, demographic and health correlates provided an objective view of those who suffer. This revealed that older people, individuals with large families and those who lacked the support of a spouse were more likely than others to experience the symptoms, while young single people who reported they were in good health were least likely to experience symptoms. Second, respondents’ ideas on the causes of their symptoms provided subjective insights into the meaning for those who suffer. Current stressors predominated in the accounts given of causes by the Cambodians themselves, with family relationships and medical problems the most common factors.