Victims of Torture

Torture, the act of inflicting physical and/or mental suffering on an individual, occurs within the context of a collective system or institution that permits, orders, and enforces it. For many torture survivors, torture is a continuous and cumulative experience associated with persistent adverse mental and physical health sequelae, underpinned by neurobiological, psychosocial, cultural, and environmental determinants. A constellation of pre-migratory, peri-migratory, and post-migratory risk factors underlie the symptoms of posttraumatic stress disorder (PTSD), depression, anxiety somatization, dissociation, psychosis, complicated grief, and other mental health problems commonly seen in survivors of war torture, refugees, and asylum seekers. Extreme trauma, such as extended periods of imprisonment and torture, can also result in complex trauma reactions. However, a subset of torture survivors may not develop any mental health problems due to protective and resiliency factors. There is a paucity of randomized controlled trial evidence on the effectiveness of pharmacotherapy for PTSD, depression, and anxiety disorders in this population. Evaluation of non-specialist-delivered evidence-based psychological therapies that are scalable, as well as integrated interventions that are culturally embedded and address the needs and priorities of torture survivors, is also needed, especially in low- and middle-income countries. This chapter focuses on the mental health outcomes of torture – prevalence rates, diagnostic and measurement issues, cultural considerations, and management (pharmacotherapy, psychotherapy, and rehabilitation).