For a detailed discussion of psychological symptoms and assessment of psychological evidence, see Module 6. Despite the variability due to personal, cultural, social and political factors, certain psychological symptoms and clusters of symptoms have been observed among survivors of torture and other types of violence. The diagnosis of Posttraumatic Stress Disorder (PTSD) has been applied to an increasingly broad array of individuals suffering from the impact of widely varying types of violence. Although the utility of this diagnosis in non-western cultural groups has not been clearly established, evidence suggests that there are high rates of PTSD and depression symptoms among traumatised refugee populations from multiple different ethnic and cultural backgrounds.
The core symptoms and signs of severe trauma and torture across cultures have become increasingly clear. Many are physiological reactions that can persist for years. The main psychiatric disorders associated with torture are PTSD and Major Depression. One does not have to be tortured to develop PTSD and/or Major Depression because these disorders appear in the general population. Similarly, everyone who has been tortured does not develop PTSD and Major Depression.
The course of Major Depression and PTSD varies over time. There can be asymptomatic intervals, recurrent episodes, and episodes during which an individual is extremely symptomatic. Therefore, when conducting an evaluation of a torture survivor, one must consider the following questions:
- What is the timeframe of onset of symptoms; did symptoms occur immediately following the traumatic events or were they delayed for weeks, months or even years?
- Is there a history of recurring episodes of symptomatology?
- How do problems and symptoms emerge over time?
- Where is the survivor in the recovery process at the time of the assessment?