Page 178 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

(vi) Oppositional conduct disorder 596. As parents, many torture survivors fear that the
intensity of their own feelings could overwhelm
593. The diagnostic features of oppositional conduct them and they may feel shame and guilt. 510 Coping
disorder include a frequent and persistent pattern of with the expressed or unexpressed feelings of their
angry/irritable mood, argumentative/defiant behaviour children might also raise difficulties for parents,
or vindictiveness (criterion A). Environmental who may feel guilty about the circumstances their
factors play an important role in causal theories of children endured and continue to endure. 511 Parents
the disorder. First symptoms usually appear during of children who were tortured may also experience
preschool years and rarely later than early adolescence. guilt over their inability to protect their children
and their parenting may be affected by feelings of
(vii) Disruptive mood dysregulation disorder helplessness. Parents’ experience of helplessness can
be reinforced in violent and oppressive environments
594. The diagnostic criteria of disruptive mood that expose children and adolescents to multiple
dysregulation disorder include severe and recurrent risk factors. Such environments may also damage
temper outbursts, expressed verbally and/or adolescents’ perceptions of their parents’ authority.
behaviourally, that are intense and prolonged relative
to the situation or provocation. They are inconsistent 597. The effects of torture on individuals’ abilities to
with the developmental level and occur three or function as parents can take on many forms. It is
four times a week on average. Between outbursts beyond the scope of this chapter to describe these
the mood is persistently irritable most of the day, effects, yet it is important to note that these should be
for at least 12 months, in at least two or three considered with regard to the child’s age, culture and
settings (i.e. school, home and with peers). While development. Safeguarding issues related to general
there is no consensus on the causes of disruptive considerations of parental functioning, including child
mood dysregulation disorder, dysregulation in neglect and physical, sexual and emotional abuse,
childhood has been linked to interpersonal trauma should also be considered and addressed within the
and abuse. 509 Validity for the diagnosis has been appropriate local legal and social frameworks.
established for children between the ages of 7 and 18
and its use should be restricted to this age group. (f) Role of the family

(e) Family context 598. The family plays an important dynamic role in
persisting symptomatology among children. In order
595. Families are profoundly affected by an experience of to preserve cohesion in the family, dysfunctional
torture of a child as well as by torture of other family behaviours and delegation of roles may occur. Family
members. Torture of parents, as well as living in social members, often children, can be assigned the role of
and political contexts of violence and oppression, can patient and develop severe disorders. A child may
have a serious impact on parental functioning and be overly protected or important facts about the
mental health. It is therefore important to consider trauma may be hidden. Alternatively, the child can
the environmental and contextual factors that affect be parentified and expected to care for the parents,
the family and the child, such as separation between which can hamper the development and result in
family members and the circumstances of these a depressive symptomatology or else in aggressive
separations, communication routes during separation, behaviour. In the frame of post-traumatic disorders,
threats to family members, the circumstances of parents may show outbursts of anger and violence
reunification, stress factors in resettlement processes against a child, as well as other forms of domestic
(such as loss of social and economic status), the violence, which the child might experience and witness
impact of acculturation, racism, social supports, and process in a traumatic way. When the child is
and experiences and beliefs related to seeking not the direct victim of torture but only indirectly
support (such as fear of bringing the attention of affected, adults often tend to underestimate the impact
the authorities to the family), to name but a few. on the child’s psyche and development. When loved
ones around children have been persecuted, raped

509 Yael Dvir and others, “Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities”, Harvard Review of Psychiatry, vol. 22, No. 3 (2014), pp. 149–161.
510 Center for Victims of Torture, Healing the Hurt: A Guide for Developing Services for Torture Survivors (Minneapolis, 2005), chap. 2.
511 Ibid.

139