Understanding Puerto Rico Syndrome or Ataque de Nervios

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Ataque de nervios, also known as Puerto Rico Syndrome or Puerto Rican Syndrome, is a culturally-bound syndrome exclusive to Latino cultures, particularly those of the Caribbean. It is far more likely to occur in women, although symptoms have also been reported in males.

The Spanish phrase literally translates as "attack of the nerves," and often resembles a panic attack, but the two disorders are not precisely the same.


Like all fear responses, ataque de nervios may present differently in different individuals. In general, however, most cases show similar symptoms including:

  • Intense fear and an inability to move
  • Uncontrollable screaming or crying
  • Fainting or seizure
  • Sensation of heat rising from chest to head
  • Verbal attacks and physical aggression
  • Chest tightness or heart palpitations

Ataque de Nervios and Panic Attack

Although they often share similar symptoms, ataque de nervios and panic attack are separate disorders. In a panic attack, the physical and emotional responses are directly caused by intense anxiety and fear. In ataque de nervios, anxiety and fear are considered normal and healthy responses to the occurrence of the syndrome.

Like a panic attack, a wide range of situations trigger ataque de nervios. Upsetting or shocking news about family members is considered the most likely cause, but ataque de nervios may occur in virtually any setting.

Risk Factors

Females over the age of 45 are at the highest risk of ataque de nervios, but men can develop it too. Underlying psychiatric illnesses, particularly mood disorders, greatly increase the chances of developing this psychological disorder.

In addition, those from lower socioeconomic backgrounds, and those who have undergone family distress such as divorce or the death of a loved one, are more likely to develop the condition.

Having an underlying mood disorder may also change the nature of an attack and patients with existing depression or anxiety are more likely to act out aggressively. In contrast, patients with an existing panic disorder are more likely to experience the feeling of suffocation and fear dying during an attack.


Ataque de nervios is often treated as panic disorder or another anxiety disorder. Cognitive-behavioral therapy helps clients learn to recognize and stop their triggering thoughts, as well as use coping skills to work through an attack once it begins. These methods are often effective but must be used within a cultural context.

Some research shows that those who are prone to ataque de nervios may have a tendency to suppress anger and other negative emotions, which then come out inappropriately during an attack. They may also be histrionic and prone to somatization of psychological issues.

Therefore, anxiety and panic treatments are not likely to be successful on their own. Instead, the therapist must carefully examine the client's history and current situation to develop a full understanding of the issues.

A complete treatment plan will address not only the ataque de nervios, but also all other underlying disorders. It will also take into account the client's cultural background and current life circumstances.

3 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Moitra E, Duarte-Velez Y, Lewis-Fernández R, Weisberg R, Keller M. Examination of ataque de nervios and ataque de nervios like events in a diverse sample of adults with anxiety disordersDepress Anxiety. 2018;35(12):1190-1197. doi:10.1002/da.22853

  2. Guarnaccia PJ, Lewis-Fernandez R, Martinez Pincay I, et al. Ataque de nervios as a marker of social and psychiatric vulnerability: results from the NLAASInt J Soc Psychiatry. 2010;56(3):298–309. doi:10.1177/0020764008101636

  3. Lim JA, Lee YI, Jang JH, Choi SH. Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorderMedicine (Baltimore). 2018;97(38):e12422. doi:10.1097/MD.0000000000012422

Additional Reading
  • Boga, Virginia. "Ataque de Nervios: A Defense Against Anger?" ProQuest Dissertations and Theses, 2009.
  • Encyclopedia of Multicultural Psychology. 2006. Thousand Oaks: Jackson. p. 133.

By Lisa Fritscher
Lisa Fritscher is a freelance writer and editor with a deep interest in phobias and other mental health topics.