Torture survivors: what to ask, how to document.

Nearly half of the world’s 200 nations torture their citizens. Although survivors have high rates of physical and psychiatric morbidity, and in coming to this country tend to live in highly concentrated refugee groups, physicians rarely discover torture histories. Torture survivors may avoid speaking of it because they do not understand that treatment is available for their physical, psychiatric, and pain disorders. A lack of detection delays the diagnosis and treatment of the sequelae of torture. It may also affect their future safety: Individuals seeking asylum are deprived of the medical documentation needed to support their petitions. Your involvement in recording histories and exam findings and in referring patients for specialized care can restore lives. It can also aid in reversing the “invisibility” of torture survivors that perpetuates inadequate clinical education, research, and development of appropriate therapies. z Are you caring for a survivor—and don’t know it? Approximately 500,000 torture survivors live in the United States. This equals the number of individuals with Parkinson’s disease and outnumbers those with multiple sclerosis. Physicians may encounter torture survivors in primary care settings, emergency departments, or while consulting with colleagues about patients who have specialized medical needs. There are no evidence-based guidelines for assessing and treating torture survivors. Most studies are from single institutions and have modest sample sizes. Most use univariate analyses, and the effect of confounding variables is often unexamined. Moreover, the diversity of torture survivors’ cultures limits the generalizability of findings from particular groups. In this article, we propose an approach—based on studies that address cross-cultural issues or use multicenter, multivariate, meta-analytic methods—that can enable you to better identify survivors of torture, assess and document consequent morbidities, and refer them to appropriate treatment proPRActicE REcoMMEnDAtionS