as one of the four required symptoms. Frequency of each of the 13 symptoms varies cross-
culturally (e.g., higher rates of paresthesias in African Americans and of dizziness in sev-
eral Asian groups). Cultural syndromes also influence the cross-cultural presentation of
panic attacks, resulting in different symptom profiles across different cultural groups. Ex-
amples include khyâl  (wind) attacks, a Cambodian cultural syndrome involving dizziness,
tinnitus, and neck soreness; and trúng gió  (wind-related) attacks,  a Vietnamese cultural
syndrome associated with headaches. Ataque de nervios (attack of nerves) is a cultural syn-
drome among Latin Americans that may invo lve trembling, uncontrollable screaming or
crying, aggressive or suicidal behavior, and depersonalization or derealization, and which
may be experienced for longer than only a few minutes. Some clinical presentations of
ataque de nervios fulfill criteria for conditions other than panic attack (e.g., other specified
dissociative disorder). Also, cu ltural expectations may influe nce the classification of panic
attacks as expected or unexpected, as cultural syndromes may create fear of certain situa-
tions, ranging from interpersonal arguments (associated with ataque de nervios ), to types of
exertion (associated with khyâl attacks), to atmospheric wind (associated with trúng gió  at-
tacks). Clarification of the details of cultural  attributions may aid in distinguishing ex-
pected and unexpected panic attacks. For more information ab out cultural syndromes, see
“Glossary of Cultural Concepts of Distress” in the Appendix to this manual.
Gender-Related Diagnostic Issues
Panic attacks are more common in  females than in males, but clinical features or symp-