Page 177 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

(ii) Separation anxiety disorder (iv) Disorders of social functioning with onset specific
to childhood and adolescence
588. Developmentally inappropriate and excessive fear
or anxiety concerning separation from those to 591. ICD-11 lists disorders of social functioning with
whom the child is attached, as evidenced by three of onset specific to childhood and adolescence that are
the following: (a) recurrent excessive distress when associated with gross environmental distortions and
anticipating or experiencing separation from home privations. Among these are elective mutism, reactive
or from major attachment figures; (b) persistent and attachment disorder of childhood and disinhibited
excessive worry about losing major attachment figures attachment disorder of childhood. Elective mutism is
or about possible harm to them, such as illness, injury, a condition characterized by a marked, emotionally
disasters or death; (c) persistent and excessive worry determined selectivity in speaking and is most
about experiencing an untoward event (e.g. getting frequently manifest in early childhood. Reactive
lost, being kidnapped, having an accident or becoming attachment disorder of childhood is characterized by
ill) that causes separation from a major attachment persistent abnormalities in the child’s pattern of social
figure; (d) persistent reluctance or refusal to go out, relationships and relationships with parents that is
away from home, to school, to work, or elsewhere reactive to changes in environmental circumstances,
because of fear of separation; (e) persistent and before the age of 5. Disinhibited attachment disorder
excessive fear of or reluctance about being alone or of childhood is characterized by a diffuse attachment
without major attachment figures at home or in other at around the age of 2 and a clinging behaviour in
settings; (f) persistent reluctance or refusal to sleep infancy, and/or indiscriminately friendly, attention-
away from home or to go to sleep without being near seeking behaviour in early or middle childhood. This
a major attachment figure; (g) repeated nightmares pattern is associated with marked discontinuities in
involving the theme of separation; and (h) repeated caregivers or multiple changes in family placements.
complaints of physical symptoms (such as headaches,
stomach aches, nausea or vomiting) when separation (v) Conduct disorder
from major attachment figures occurs or is anticipated.
592. The DSM-5 diagnostic criteria for conduct disorder
(iii) Specific phobia are violation of social norms or rules or the rights of
others in a persistent and repetitive manner, including
589. A marked fear or anxiety about a specific object aggression towards people and animals, destruction of
or situation that is out of proportion to the property, deceitfulness or theft, and serious violations
actual danger posed by the object. The anxiety of rules. There are two specifiers to the diagnosis,
or fear may be expressed by crying, tantrums, regarding onset and degree of social emotionality. It
freezing or clinging. The phobic object or has been suggested that trauma plays a key role in the
situation almost always provokes this reaction, is development and persistence of conduct disorder and it
actively avoided or endured with intense fear. has been found that young persons who are diagnosed
with conduct disorder often have an experience of
590. It is considered developmentally appropriate for trauma. 508 Environmental risk factors listed in DSM-5
young children to experience fear of specific objects include physical and sexual abuse and environmental
(real or imaginary) or situations (e.g. animals, exposure to violence. A cautionary note in DSM-5
witches, monsters or the dark), and commonly states that the context of the undesirable behaviours
these are transient and have only a mildly associated with conduct disorder should be considered
impairing effect. Therefore, in diagnosing specific and that the diagnosis may potentially be misapplied
phobia, it is important to consider the duration to individuals in settings in which the behaviour is
of the fear, anxiety or avoidance, the degree of viewed as near normative, such as war zones and
impairment and the child’s developmental stage. threatening and dangerous, high-crime areas.

508 Ricky Greenwald, “The role of trauma in conduct disorder”, Journal of Aggression, Maltreatment & Trauma, vol. 6, No. 1 (2002), pp. 5–23; Pratibha Reebye and others,
“Symptoms of posttraumatic stress disorder in adolescents with conduct disorder: sex differences and onset patterns”, Canadian Journal of Psychiatry, vol. 45, No. 8 (2000),
pp. 746–751.

138