Post-traumatic stress disorder in hostages and victims of torture.

Torture and the taking of hostages for ransom or for political gain have existed since recorded history. Both can produce archetype post-traumatic stress disorder (PTSD) symptoms. Many symptoms, as in the case of those brought on by the Holocaust, can last a lifetime. Torture, although universally condemned, still is used regularly in more than 60 countries, and the stream of refugees to safe havens seems endless. Treatment is effective, specific, and essential but requires extraordinary sensitivity, experience, and patience on the part of therapists. Hostage-taking generates its own unique dynamics on the victims, which again requires experience, understanding, and very specialized knowledge by therapists if they are to provide successful help to these profoundly damaged individuals. PTSD brought on by both torture and hostage taking has been studied extensively in recent years and its similarities and differences from "typical" PTSD are detailed.

Assessment and treatment of torture victims: a critical review.

This paper presents the main issues in the diagnosis and treatment of psychiatric sequelae in torture victims. The concept of post traumatic stress disorder is used to organize literature on psychiatric casualties resulting from massive psychic trauma, e.g., the Nazi Holocaust, the Vietnam and Israeli wars, and the current world epidemic of torture. Torture is a unique human made stressor resulting in category-specific diagnostic symptoms. Medical assessment can be complemented with photographs, x-rays, electroencephalograms, and sleep studies. Individual psychotherapy and group techniques focus on the issues of denial and trust, loss, survivor guilt, and reparation. Programs of psychological and social rehabilitation and treatment with benzodiazepines, tricyclic antidepressants, and other compounds are reviewed. Future research needs include the conceptualization of the trauma of torture and its sequelae in broader terms, the application of standardized measurements to facilitate international comparisons, and the testing of various approaches to intervention in an experimental design. An ethical physician must resist the pressures of totalitarian governments to assume neutrality in the presence of human rights violations affecting his/her patients.