24 A practical guide to the Istanbul Protocol – for psychologists chological responses are not known exactly, several dimensions may be of significance in the evaluation of the victims (Istanbul Protocol, § 280). These factors include, but are not limited to the following: 1. GENERAL • The perception, interpretation and meaning of torture by the victim: “[…]The psychological consequences of torture occur in the context of personal attribution of meaning, personality development, and social, political and cultural factors […]” (Istanbul Protocol, § 234). Individuals react to extreme trauma like torture in accordance with what it means to them (Istanbul Protocol, § 236). The generation of these meanings is an activity that is socially, culturally and politically framed. Besides this frame, the unique implications that torture has for each individual influence his/her ability to describe and speak about it. The psychological reactions to trauma are closely linked with the psychological meaning of the trauma to the person. • The social context before, during and after torture (such as political and cultural climate, values and attitudes toward traumatic experiences): • Social supports • Existence of formal and/or informal support system • Access and utilization of the social supports. 2. TORTURE HISTORY • The circumstances and the nature of the torture: –– The severity of the traumatic events. It is difficult to make a hierarchical list of the severity of the atrocities on the individual and it is problematic to estimate objectively the degree of severity. Additionally, the psychological impact of traumatic events on the person depends on how the individual subjectively perceives the severity of the event rather than the objective severity. Humiliation, threat to loved ones or witnessing the torture of another person may have a more profound effect on the victim than to exposure to electric shocks or falanga. There are contradictory reports in the literature about the relationship between the severity of trauma and its consequences. –– The intensity, chronicity, duration, frequency of the traumatic events –– Nature of trauma (cumulative, repeated, prolonged, subsequent, continous...) –– Additional traumas during torture period (such as witnessing atrocities, death of family members or friends during the same event. • The developmental phase and age of the victim • Physical injuries, pain, symptoms related to torture-ill-treatment • Ongoing threat to oneself and/or family members (perceived or actual), risk of persecution and re-arrestment. 3. PRE-TORTURE HISTORY • Previous torture, previous detention history • Previous exposure to different types of trauma • Awareness of and preparedness for torture event • Awareness of psychological response to torture • Vulnerability or resilience traits • Personal variables such as belief system,