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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

    1. Difficulty either falling or staying asleep;
    2. Irritability or outbursts of anger;
    3. Difficulty concentrating;
    4. Hypervigilance, exaggerated startled response;
    5. Generalized anxiety;
    6. Shortness of breath, sweating, dry mouth or dizziness and gastrointestinal distress.
  • Anxiety, either generalised or specific anxieties
  • Avoidance, emotional numbing, detachment, withdrawal
  • Low mood, depression
  • Paranoia, which may be displayed as increased agitation and anger
  • Nightmares
  • Flashbacks
  • Psychosomatic symptoms - generalised weakness, abdominal discomfort, headaches, nausea
  • Increased rates of substance abuse
  • Damaged self-concept and foreshortened future
  • Dissociation, depersonalization and atypical behaviour
  • Sexual dysfunction
  • Mistrust, fear, shame, rage and guilt are among the typical reactions that torture survivors experience, 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. In addition, in many cases an aim of torture is to disorientate the victim so they don’t have a clear concept of time. Torture survivors may also have difficulties recounting specific details as a result of blindfolding or drugging during torture, fear of endangering themselves or others, a lack of trust between the clinician and patient, depression, or neuropsychiatric impairment from suffocation or direct trauma, such as a blow to the head.
  • Culture-specific syndromes may be apparent through which symptoms are communicated and ideally clinicians should have knowledge of the victim’s culture. Where they don’t, assistance of an interpreter who does is essential.

*Rarely psychosis, however a pre-existing diagnoses may be exacerbated by trauma

Have you ever met victims of torture in your work? If yes, did they show signs of mental health problems? Have you noticed any factors that seem to promote resilience or vulnerability among victims of torture? Kindly share your experiences and reflections below.

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

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Medical Peace Work

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