Psychological disorders in survivors of torture: Exhaustion, impairment and depression

Post-traumatic stress disorder (PTSD) has been described as the characteris tic sequel to extreme events in life such as war and especially torture. Th is limitation to a single approach in regard to diagnosis and treatment has been criticised as being a too narrow concept to describe the effects foll owing extreme events in life, especially as most studies so far were limite d to PTSD and a small range of symptoms or disorders. The study presents da ta on psychiatric disorders in a group of exiled survivors of torture prese nting to an out-patient department for psychiatry. A DSM-lll-R-based psychi atric interview, including the general assessment of functioning scale (GAF ), an open list of symptoms and the Vienna diagnostic criteria in regard to depression were used to evaluate a broader range of possible sequels. The most frequent present diagnosis in 44 patients seen over a period of 3 year s was PTSD (n = 40), but criteria for a present diagnosis of other disorder s were fulfilled in 34 patients, even years after torture, mainly major dep ression or dysthymia (n = 26). Criteria for functional psychosis were fulfi lled in 4 patients. Many patients reported symptoms not assessed by DSM-III -R criteria, including feelings of shame and guilt, and ruminations on exis tential fears. The impairment as indicated by the GAF (mean 59.1) correlate d best with the presence of the endogenomorphic-depressive axial syndrome, but not with duration of imprisonment, age or other factors. Research on se quels to extreme trauma should not be restricted to a simple diagnosis of P TSD, but should continue to look for a broader conceptualisation, including neglected categories like the axial syndrome, as PTSD is common, but might not be the only factor of importance for research and treatment. ICD-10 mi ght offer a more adequate interpretation of sequels. Copyright (C) 2000 S.K arger AG, Basel.