PART D – Psychological consequences of torture on individuals ous aspects of the trauma (McFarlane, 1995). Elements of the experience are not integrated into a unitary whole, but are stored in memory as isolated fragments and stored as sensory perceptions, affective states or as behavioural re-enactments (van der Kolk & Fisler, 1995). Depersonalisation is a state of feeling detached from oneself or one’s body. The person complains of a feeling of being distant or “not really here”, as if he/she is an outside observer of his/her mental processes or body (e.g. feeling like one is in a dream). For example, the person may complain that his/ her emotions, feelings or experience of the inner self are detached, strange and not his/ her own, or that he/she feels unpleasantly lost as if acting in a play. Impulse control problems result in behaviours that the survivor considers highly atypical compared to his or her pre-trauma personality: a previously cautious individual may engage in high-risk behaviour. Impulse control problems include difficulty in modulating anger, chronic self-destructive and suicidal behaviours, difficulty in modulating sexual involvement, and impulsive and risk-taking behaviours (van der Kolk et al, 1996). (See § 244 in the Istanbul Protocol.) 4. SOMATIC SYMPTOMS Somatic symptoms such as pain, headache or other physical complaints, with or without objective findings, are common problems among tortured and traumatized people. Pain may be the only manifest complaint. It may shift in location and vary in intensity. Somatic symptoms can be directly due to physical consequences of torture or they can be psychological in origin, or reflect an interaction of both factors (Wenzel, 2002). 27 These somatic complaints include headaches, back pain, musculo-skeletal pain (for more information, please see the “Medical physical examination of alleged torture victims: A practical guide to the Istanbul Protocol – for medical doctors”). (See § 245 in the Istanbul Protocol.) 5. SYMPTOMS OF SEXUAL DYSFUNCTION Sexual dysfunction is common among survivors of torture, particularly, but not exclusively, among those who have suffered sexual torture or rape. Symptoms may be of physical or psychological origin, or a mixture of both. Possible symptoms are: lack or loss of sexual desire, sexual enjoyment; decreased interest in or fear of sexual activity; diminished sexual arrousal; inability to trust a sexual partner; fear of having been damaged sexually; fear of being homosexual; failure of genital response like erectile dysfunction or failure of vaginal lubrication; vaginismus, dyspareunia, orgasmic dysfunction, premature ejaculation. (For additional information, see § 246 and chapter V, section D.8, in the Istanbul Protocol.) 6. SYMPTOMS OF PSYCHOTIC DISORDERS Cultural and linguistic differences may be confused with psychotic symptoms. Before labelling someone as psychotic, one must evaluate the symptoms within the individual’s own cultural context. Psychotic reactions may be brief or prolonged and the psychotic symptoms may occur while the person is detained and tortured as well as afterwards. Possible findings are: delusions, hallucinations (auditory, visual, tactile, olfactory); bizarre ideation and behaviour; illusions or perceptual distortions, paranoia