Acid attacks, a harrowing form of violence often involving intimate partners, are prevalent in South and South-East Asia and are on the rise in the global north. There are major psychosocial and mental health sequelae for survivors and their families.

This ethnographic study, set in Cambodia, aims to identify the cultural and emotional dynamics surrounding acid attacks. The objectives are to define a taxonomy of acid attacks through the identification of the patterns of attack in intimate relations, and to explore the subjective experience of the informants to elucidate the cultural context of the complex emotions of jealousy and envy.

Over 2 decades, ethnographic fieldwork was conducted with 87 survivors and their families and perpetrators in rural and urban Cambodia. Qualitative analysis was used to identify the taxa and enable a cultural understanding of the attacks.

Three taxa were identified. (a) The most prevalent pattern (n = 56) was driven by romantic jealousy, fuelled by perceived infidelity in the context of an explicit ‘love triangle’ involving a married couple and a rival. (b) The second was intimate partner violence (n = 18), for example, a possessive husband maiming his wife after she had fled the coercive control of an abusive marriage. And (c) the last involved attacks within the community (n = 13), perpetrated acts of envy and vengefulness often arising from disputes and pointing at dysfunctional conflict resolution mechanisms.

Acid attacks are a grotesque example of direct violence that leads to severe mental health consequences, including suicidal ideation. The taxa reveal, ‘inside out’, the cultural construction of the causes and consequences of attacks while demonstrating the cultural architecture of envy and romantic jealousy. This study is relevant to transcultural psychiatry and global health, with implications for culturally responsive psychiatric intervention informed by the intrapsychic, interpersonal and structural dimensions of violence.