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

that the perpetrators will hurt them or their loved ones those that are cause for concern. The same diagnostic
again in spite of reassurances that they are safe. The categories can be viewed problematic in some ages and
child may develop bedwetting, loss of control of bowel be part of normal behaviour in younger ages. Thus,
movements, social withdrawal, restricted affect, attitude behaviour and symptoms need to be assessed and
changes towards self and others and feelings that there considered within the expected range in a particular
is no future. The child may experience hyperarousal age and developmental stage, as well as within
and have night terrors, problems going to bed, sleep the child’s cultural context. Furthermore, torture
disturbance, heightened startle response, irritability and can worsen pre-existing problems in all domains
significant disturbances in attention and concentration. of functioning and can cause a loss or regression
The child may complain about bodily aches, such as of functioning that has already been attained.
stomach aches, or other physical problems. Fears and
aggressive behaviour that were non-existent before 585. The following list complements the information on
the traumatic event may appear as aggressiveness the diagnostic classification in adults above. It is
towards peers, adults or animals, fear of the dark, fear non-exhaustive and enumerates diagnoses or criteria
of going to the toilet alone and phobias. Children may that are particular to children and adolescents.
demonstrate sexual behaviour that is inappropriate
for their ages. Post-traumatic behavioural changes (i) Post-traumatic stress disorder
can also include risk-taking behaviour, self-harm and
suicide attempts. The child may become avoidant 586. Traumatic events that occurred to a caregiver or other
and/or clingy around parents or caregivers, exhibit trusted adult are often experienced by children as
explosive outbursts or tantrums, or exhibit a trance- seriously disturbing and distressing, even indirectly
like state, lapses in attention, confusion, forgetfulness when the child hears about the events. Because
and unresponsiveness. Anxiety symptoms, such as children need relationships with their parents and
exaggerated fear of strangers, separation anxiety, caregivers to feel safe, such events may be experienced
panic, agitation, temper tantrums and uncontrolled as a threat to the child’s physical and psychological
crying may appear. Distress can be manifest in other survival. 504 Indeed, criterion A in the DSM-5 diagnosis
behaviours, such as nail-biting and thumb-sucking, of PTSD in children aged 6 or younger includes in
and changes in the use of language. The child may also the definition of trauma witnessing the event(s) as
develop eating problems. Teenagers may present very it occurred to others, especially primary caregivers,
differently, initially denying any symptoms and insisting or learning that the traumatic event has occurred
that their level of function is good and that they have to a parent or caregiver. PTSD can develop at any
no need of help. Peer pressure to fit in with others and age after 1 year of age. 505 The diagnosis of PTSD
fear of the stigma of mental illness can be particularly in children younger than 6 excludes symptoms that
evident. Teenagers may have particular difficulty in are dependent on the ability to verbalize cognitive
managing features of PTSD, such as angry outbursts and constructs and complex emotional states, such as
irritability, directing violence at others or themselves. negative self-belief and blame. Therefore, the threshold
The examiner needs to take additional time to build of avoidance and negative cognitions symptoms
trust and rapport and assess carefully for indirect (criterion C) is lowered from three to one symptom. 506
indicators of mental distress, including, for example,
appetite, sleep pattern, ability to form friendships 587. The re-experiencing of trauma can vary according
and confide in others, self-harming behaviour, to the child’s age. In young children, symptoms are
risk-taking behaviour and anger management. more likely to be expressed through play, and fearful
reactions at the time of exposure or re-experiencing
(d) Diagnostic classification of trauma may be lacking. Young children’s
frightening dreams may not be specific to the trauma.
584. When assessing children’s mental health, behaviours Parents may report a wide range of emotional and
and emotions that are consistent with a child’s behavioural changes, including changes in play. 507
developmental age should be differentiated from

504 Research Triangle Institute International, DSM-5 Changes: Implications for Child Serious Emotional Disturbance (Rockville, Maryland, Substance Abuse and Mental Health
Services Administration, 2016).
505 Ibid.
506 Ibid.
507 Ibid.

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