Deficit and defence – Gedächtnisstörungen nach Schödel-Hirn-Trauma unter Folter

Abstract

The complex nature of posttraumatic memory disturbances is an essential diagnostic and forensic issue in the treatment of traumatised individuals. Torture survivors show several mental and physical symptoms of varying specificity. Considerations on differential diagnosis regarding ICD-10 and DSM-IV criteria are presented, and the necessity of a thorough clinical assessment of torture survivors including neuroimaging and neuropsychological testing is stressed. Memory disturbances in torture survivors are frequent and complex: fragments of traumatic memory may present within the period that defines posttraumatic amnesia. Moreover, a putative protective effect of posttraumatic amnesia regarding the development of a posttraumatic stress disorder has been suggested. Unstructured interviews and examinations of torture survivors can re-traumatise the patients. On the basis of the Istanbul Protocol we offer recommendations on handling severely traumatised patients, and address the basic forensic dilemma of the credibility of a torture survivor's accounts.