Delusions of fatal contagion were encountered in about 10% of refugee psychiatric patients from Southeast Asia belonging to one ethnic group, the Hmong. Psychotic depression was the most common diagnosis among the Hmong patients with delusions of contagion, whereas paranoid and schizophrenic diagnoses predominate in patients with similar delusions from other refugee groups. Some cases also occurred as a shared delusional disorder. Associated findings included isolation from the community, intrafamilial conflict, failure to acculturate, and sexual frustration or conflict. Most patients responded to tricyclic medication, later supplemented in about half of the cases with a neuroleptic. This syndrome, which does not appear to have been described previously, should be considered in cases of somatizing refugees who present repeatedly to medical facilities.