Transcript PTSD and Credibility - Foundation for Access to Rights

The Complex Trauma of
Refugees
And the Effects of Detention
Lilla Hárdi
Medical Director
Cordelia Foundation for the
Rehabilitation of Torture Victims
Hungary
26.01. 2016.Budapest, STRENGTH
We are going to speak about
 The concept of complex trauma and
torture
 PTSD, CTD and other psychological
problems in the refugee context
 The effects of detention
 Tools to handle the situation
Cordelia Foundation for the
Rehabilitation of Torture Victims
• One of more than 140 active
• rehabilitation centers in the IRCT
network since 1996 in order to:
• elaborate the traumas of uprooting and
torture,
• increase adaptive and coping capacities for
the integration process.
The treatment approaches
• Holistic
• Comprehensive
• Biopsychosocial.
• We try to make our rehabilitation services
available, appropriate and accessible.
Psychological basics
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Stress – distress
Depressive disorders
Anxiety disorders
Trauma and PTSD
STRESS
THE HARMFUL RESULTS OF
STRESS
emotional and physical damages =distress
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somatic
(vegetative symptoms,
cardiovascular symp.,
muscle pain,etc.)
psychological
(anxiety, depression,
panick, etc.)
might lead to illnesses
Psychological/psychiatric
problems
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Trauma and stressor related disorders
Depressive disorders
Anxiety disorders
Drug related and addictive disorders
The traumatic experience
• „The experience of the trauma is not
compatible with the individual’s picture
about reality, therefore s/he cannot fit it to
her/his experience about the world.”
(Dalgleish és Power,
2000.)
COMPLEX TRAUMA
• Bio-psycho-social balance is destroyed
Bio
Psycho
Health
Social
The trauma of the refugee
• Traumatisation at home country
(imprisonment, torture, war etc.)
• Trauma of uprooting
• Trauma of object losses
• Trauma of refuge
• Trauma at arrival to a new country
• Trauma of integration
Refugees’ trauma
• 1.Pre-migratory • 2.Migratory • 3.Post-migratory traumas
Torture is an extreme trauma
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It causes severe pain and suffering,
it is intentionally inflicted with the purpose
to obtain information or a confession,
to punish the person for an act,
to intimidate or coerce him or a third
person.
• Torturers are public officials or other
persons acting in an official capacity.
THE EFFECT OF TORTURE
2017.04.05.
• The very essence of torture is that it
attacks "the seed (the central part) of the
personality", making the victim, then
his/her children, then their children unable
to carry on their daily life (Rauchfleisch,
1996).
• It destroyes trust (basic trust).
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The nature of trauma
• Trauma has an intrusive nature
• It intrudes into the person and overwrites
her/his coping capacity
• It changes the person’s relationship
towards her/himself and towards others
based on dissociation.
THE TRAUMA/TORTURE SURVIVOR
IS DAMAGED ON FIVE LEVELS
psychological
social
somatic
levels
legal
spiritual
(Vesti, Somnier, Kastrup, 1992. )
The consequence of trauma
might be PTSD
How do we consider PTSD?
• Disorder or a strategy to survive?
• It is a „normal reaction” among
abnormal circumstances – but
• a pathological phenomenon among
• „normal” circumstances
PTSD- DSM 5.
It manifests in persons experienced
death, serious damages or sexual
violence personally or as an
eyewittness or through work
exposition.
PTSD-DSM 5
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It is a trauma and stress related disorder
Ego regulation disorder
Intrusive repetition of trauma
Negative changes of cognitive functions
and mood
• Hyperarousal (agressive behavior, self
harm etc.)
• Dissociative type, depersonalisation type
The Symptoms of PTSD
• 1. intrusive thoughts,
• 2.avoidance of traumatic
experiences, thoughts, memories,
• 3.cognitive and mood disorders,
• 4.hyperarousal and hyperreactivity
Cumulative trauma (CTD, Kira
2008) – trauma of the „last drop”
• 1. positive sympt( vis., ac. hallucinations)
• 2. negatív sympt.(apathy, anhedonia,
szoc.ial withdrowal)
• 3. cognitive deficits, memory disturb.
• 4. mood disorders (depr., suic.)
• 5. identity disord.: disssociation,
somat.,agressive manifest., stuck in the
past)
• 6. drug/alc. abuse
Depressive disorders
1.
2.
3.
4.
5.
6.
7.
Low mood
Lack of interest and energy
Anhedonia
Fatigue
Concentration deficits
Low self esteem
Feeling of guit
8. Empty or pessimistic future
9. Suicidal thoughts or self harm – agressive
motivation- ”revenge”
10. Sleep disorders
11. Anxiety
• Diurnal changes are typical,
recurrent/bipolar
Anxiety disorders
• Panick disorder
• GAD
• Phobic disorders
Drug related and addictive
disorders
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Drugs
Alcohol
Nicotine
Etc.
What happens if the symptoms
are not recognised?
• Without the recognition and the right
interpretation of the answers/behavior
modified by the trauma, we are not
able to recognize the real need of
protection (asylum).
What does detention mean?
• It causes extreme stress – and distress
• Previous traumatic experiences are
brought on the surface
Consequences of detention
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Depression
Anxiety disorders
Drug related and addictive disorders
PTSD/CTD– suicidal ideation, self harm,
psychotic episodes
Detention is a harmful practice
for torture survivors
• It should be prevented
– training of the staff to identify
• It should be screened
– monitoring visits
• It’ results should be treated
- local psychosocial services
Tools of prevention
• - trainings with the gov. employees are
needed to raise their psychological
mindedness,
• - supervision of the staff is needed on a
regular basis
Summary
Today we spoke about:
• The concept of complex trauma and
torture
 PTSD, CTD and other psychological
problems in the refugee context
 The effects of detention
 Tools to handle the situation
2017.04.05.
Thank you for your attention
[email protected]
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