Common psychological signs of torture

What symptoms or signs in a patient should make you as a health professional alert to the possibility that a patient may have experienced torture?

The symptoms and signs of torture are not specific to torture. It is also helpful to keep in mind that the psychological consequences of torture occur in the context of the individual torture survivor’s personality, personal attribution of meaning, and social, political and cultural factors. Common psychological symptoms include:

• Hyperarousal: Difficulty falling or staying asleep; Irritability or outbursts of anger; Difficulty concentrating; Hypervigilance (exaggerated startled response);
• Anxiety, either generalised or specific anxieties
• Avoidance, emotional numbing, detachment, withdrawal
• Low mood, depression
• Paranoia
• Nightmares
• Flashbacks
• Psychosomatic symptoms – generalised weakness, abdominal discomfort, headaches, nausea
• Dissociation, depersonalization and atypical behaviour
• Sexual dysfunction
• Mistrust, fear, shame, rage and guilt, particularly when being asked to recount or remember details of their trauma.
• Errors of recall – this should not be assumed to be an indicator of a falsified testimony. Research has shown discrepancies in recalling traumatic events, commonly blanking out particularly awful details and distorting perceptions of time and place. Torture survivors may also have difficulties recounting specific details as a result of blindfolding or drugging, fear of endangering themselves or others, a lack of trust between the clinician and patient, depression, or neuropsychiatric impairment from suffocation or a blow to the head.
• Culture-specific syndromes and ideally clinicians should have knowledge of the victim’s culture. Where they don’t, assistance of an interpreter who does is essential.

Source: Cohen, 2001; Medical Justice, 2002; REDRESS, 2004; UN, 1999.