p166: torture as a complex ptsd: an overlook to the treatment

torture entails the deliberate infliction of severe physical and mental pain and suffering through cruel, inhuman, or degrading treatment and punishment to silence individuals and oppositions to the ruling authorities. such victims experience mental death, difficulties in coping, memory and concentration impairment, loss of core beliefs, feelings of shame and guilt, mental defeat, and alienation, which make their symptoms as well as their treatment more complex than other ptsd’s patients. although no specific treatment regimen for complex ptsd has been set yet, comprehensive approach to the treatment of survivors including medical care, psychotherapy and psychopharmacology interventions and social services should be applied. these victims have less therapeutic alliance to exposure therapy in comparison to the ones with standard ptsd. it is noteworthy that the structure of exposure therapy is not adapted to the underlying mechanism of mental death experienced by the survivors of torture. since the main obstacle for these patients to participate in therapy is negative thoughts and mistrust, an essential step toward any kind of treatment is to establish a trustful relationship between the therapist and victims. decreasing the suffering caused by the annoying symptoms may elevate the level of cooperation and trust. for this purpose, pharmacotherapy may be necessary. psychotherapy also provides a foundation for any safer and more trustful therapy. the initial psychotherapy stage should be based on the victim’s stabilizing. according to janoff-bulman, the core beliefs of victims would be damaged by experiencing psychological torture, as a result, an important part of treatment is to help them rebuild their assumptive world including their views of themselves. moreover, individuals with specific psychological manifestations, like alienation or mental defeat, also need special interventions and further evaluations. supportive therapy, cbt, psychodynamic psychotherapy and group therapy are of the main helpful psychotherapy methods. some studies also suggest that there are substantial similarities between the treatment of torture’s survivors and individuals with identity problems, like those with borderline personality disorder.