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ISTANBUL PROTOCOL VI. PSYCHOLOGICAL EVIDENCE OF TORTURE AND ILL-TREATMENT

(b) Dissociative disorders, featuring a partial or establishing conditions under which confessions
complete loss of normal integration among memories may have been forcibly obtained, understanding
of the past, awareness of identity, immediate sensations domestic, regional and international practices of
and control of bodily movements. The capacity of torture, identifying the therapeutic needs of victims,
voluntary and conscious control of movements and supporting claims for reparation and redress and as
attention seems to be distorted and can change within testimony in human rights investigations, fact-finding
short periods of time; missions and inquiries. As the emotional impact
of torture is profound and resulting psychological
(c) Somatic symptoms disorders, characterized by symptoms are so prevalent among torture survivors, it
somatic symptoms, accompanied by excessive and is highly advisable for any evaluation of alleged torture
disproportionate thoughts, feelings and behaviours and victims to include a comprehensive psychological
high distress or significant disruption of functioning. assessment. The overall goal of a psychological
Symptoms may or may not be associated with a evaluation for a medico-legal report in accordance
medical condition. In ICD-11 this is classified as bodily with the Istanbul Protocol is to assess the degree
distress disorder; of consistency between an individual’s account of
torture and the psychological findings obtained
(d) Bipolar disorder featuring manic or hypomanic in the course of the evaluation and to provide an
episodes with elevated, expansive or irritable mood, opinion on the probable relationship between the
grandiosity, decreased need for sleep, flight of ideas, psychological findings and the possible torture or
psychomotor agitation and associated psychotic ill-treatment. Psychological evidence comprises not
phenomena; only the alleged victim’s statement, but a variety of
information, including observations on verbal and
(e) Disorders due to a general medical condition (e.g. non-verbal communication, emotional reactions,
traumatic brain injury) often in the form of brain affective resonance and behaviour. To this end, the
impairment with resultant fluctuations or deficits evaluation should provide a detailed description of
in level of consciousness, orientation, attention, the methods of assessment, current psychological
concentration, memory and executive functioning; complaints, pre- and post-torture history, history of
torture and ill-treatment, past psychological/psychiatric
(f) Psychotic disorders, either as a first manifestation or history, substance use/misuse history, mental status
exacerbation after torture; examination, assessment of social functioning,
results of psychological/neuropsychological testing if
(g) Sexual dysfunction. indicated and the formulation of clinical impressions.
A psychiatric diagnosis should be made, if appropriate.
522. It should also be considered that non-torture-specific,
pre-torture disorders (e.g. recurrent depressive 525. The assessment of psychological status and the
episodes) can worsen or resurface as a result of torture. formulation of a clinical diagnosis should always
be made with an awareness of the cultural context.
Awareness of how the cultural background and
C. Psychological/psychiatric language of the survivor shape the individual
evaluation psychological expression of distress is of paramount
importance for conducting the interview and
1. Ethical and clinical considerations formulating the clinical impression and conclusion.
When the interviewer has little or no knowledge
523. Psychological evaluations can provide critical of the alleged victim’s culture, the assistance of an
evidence of abuse among torture victims for interpreter is essential. Ideally, an interpreter from
several reasons: torture often causes devastating the alleged victim’s country knows the language,
psychological symptoms; torture methods are customs, religious traditions and other beliefs that
often designed to leave no physical lesions; and must be taken into account during the evaluation.
physical methods of torture may result in physical Interviews may induce fear and mistrust on the part
findings that either resolve or lack specificity. of victims and possibly remind them of previous
interrogations. To reduce the risk of retraumatization,
524. Psychological evaluations provide critical evidence the clinician should communicate a sense of
for medico-legal examinations, asylum applications, understanding of the individual’s experiences and

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