36 A practical guide to the Istanbul Protocol – for psychologists stress. The stress must be so extreme that it is not necessary to consider personal vulnerability in order to explain its profound effect on the personality. The disorder is characterized by a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of “being on edge” as if constantly threatened, and estrangement. Post-traumatic stress disorder (F43.1) may precede this type of personality change. Personality change after: – concentration camp experiences – disasters – prolonged: · captivity with an imminent possibility of being killed · exposure to life-threatening situations such as being a victim of terrorism – torture post-traumatic stress disorder (F43.1) Excludes: BEHAVIOURAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS (F50-F59) F52 Sexual dysfunction, not caused by organic disorder or disease Sexual dysfunction covers the various ways in which an individual is unable to participate in a sexual relationship as he or she would wish. Sexual response is a psychosomatic process and both psychological and somatic processes are usually involved in the causation of sexual dysfunction. Under “F52 Sexual dysfunction, not caused by organic disorder or disease” see: F52.0 Lack of loss of sexual desire F52.1 Sexual aversion and lack of sexual enjoyment F52.2 Failure of genital response F52.3 Organic dysfunction F52.4 Premature ejaculation F52.5 Nonorganic vaginismus F52.6 Nonorganic dyspareunia Under “Behavioural syndromes associated with physiological disturbances and physical factors (F50-59)”, see also: F50 Eating disorders F51 Non organic sleep disorders ORGANIC, INCLUDING SYMPTOMATIC, MENTAL DISORDERS (F00F09) F07 Personality and behavioural disorders due to brain disease, damage and dysfuncuton Alteration of personality and behaviour can be a residual or concomitant disorder of brain disease, damage or dysfunction.