Gender differences in victims of war torture: Types of torture and psychological consequences

Uvod/Cilj. Tortura, kao poseban vid političkog nasilja, predstavlja ekstremnu primenu nasilnog ponašanja u interpersonalnim odnosima, koji za posledicu mogu imati ne samo akutne psihijatrijske poremećaje, već, veoma često snažne i dalekosežne negativne posledice po ukupno psihosocijalno funkcionisanje žrtve. Cilj ovog rada bio je ustanovljavanje međupolnih razlika kod osoba koje su pretrpele ratnu torturu, s obzirom na vrste pretrpljenog mučenja i karakteristike psihičkih posledica. Metode. Ispitanike (410 osoba muškog i 76 ženskog pola) činili su korisnici 'Centra za rehabilitaciju žrtava torture' - IAN, koji su pretrpeli mučenje u zatvorima i koncentracionim logorima za vreme građanskih ratova u bivšoj Jugoslaviji 1991-1995. i 1999. godine. Za evidentiranje vrsta mučenja korišćen je Upitnik o vrstama mučenja sa 81 stavkom. Za procenu karaktera i intenziteta psiholoških tegoba korišćena je skala provere simptoma-revidirana verzija (SCL-90-R), a za procenu posttraumatske simptomatologije korišćena je Skala uticaja (traumatskog) događaja - IES. Rezultati. Ustanovljena je međupolna razlika prema tipu pretrpljenog mučenja kod 33 vrste torture; 28 su bili češće zastupljeni kod osoba muškog pola, a 5 kod osoba ženskog pola. Faktorska analiza pokazala je postojanje tri faktora koja objašnjavaju 29% ukupne varijanse i protumačeni su kao 'obična tortura', 'sadistička tortura' i 'seksualna tortura'. Diskriminativna analiza ukazala je na značajno razlikovanje među polovima s obzirom na dobijene faktore: kod muškaraca bili su značajno češće prisutni 'obična tortura' i 'sadistička tortura', a kod žena 'seksualna tortura'. Analizom SCL-90-R ustanovljeno je da su aktuelne psihološke tegobe značajno veće kod osoba ženskog pola u dimenzijama somatizacije, depresivnosti, anksioznosti, opsesivnosti i interpersonalne senzitivnosti. Generalni skor na IES i skor na supskalama 'nametanja' traumatskih događaja i 'izbegavanja' socijalnih interakcija bio je značajno veći kod žena nego kod muškaraca. Zaključak. Žene izložene ratnoj torturi bile su kraće i ređe izložene mučenju nego muškarci, ali imaju značajnije izražene posttraumatske tegobe i druge psihičke smetnje. Ustanovljene međupolne razlike u odnosu na različite forme torture, pri čemu su žene značajno češće bile izložene 'seksualnoj torturi', a muškarci 'sadističkoj' i 'običnoj' torturi, ne mogu u potpunosti objasniti češću pojavu posttraumatskih psiholoških posledica kod žena.Background/Aim. Torture for political reasons is an extreme violence in interpersonal relations resulting in not only acute psychiatric disorders but also very often in very severe and far reaching negative consequences for the overall psychosocial functioning of a victim. The aim of this study was to investigate gender differences in types of torture and psychological consequences in subjects who experienced war torture. Methods. A sample (410 men and 76 women) included clients of 'Centre for rehabilitation of torture victims - IAN, Belgrade' who experienced torture in prisons and concentration camps during civil wars in ex-Yugoslavia 1991-1995 and 1999. Types of Torture Questionnaire with 81 items was used for collecting data about forms of torture. Symptom Checklist 90-Revised (SCL-90- R) was used for assessing type and intensity of psychological symptoms, and Impact of Event Scale (IES) was used to estimate posttraumatic complaints. Results. A gender difference was found for 33 types of torture: 28 more frequent in men, and 5 in women. Factor analysis of torture types revealed three factors explaining 29% of variance: 'common torture', 'sadistic torture', and 'sexual torture'. Discriminant analysis revealed significant gender difference concerning the factors. 'Common torture' and 'sadistic torture' were more prominent in men, and 'sexual torture' was more present in women. Higher scores on depression, anxiety, somatization, interpersonal sensitivity and obsessive-compulsive dimensions on SCL-90-R were found in women. General score and scores of subscales (intrusion and avoidance) on IES were significantly higher in women. Conclusion. Women exposed to war torture experienced less torture techniques and shorter imprisonment than men, but had more frequent and severe symptoms of posttraumatic stress disorder and other psychological symptoms. Gender differences in posttraumatic symptomatology can not be explained exclusively by gender differences in types of torture found in this study

Possibility to predict the development of secondary depression in primary alcoholics during abstinence

Background/Aim. The relationship between alcoholism and depression is observed in clinical trials. The factors which could predict persistence of secondary depression after alcohol withdrawal are not enough explored on admission. The differences between depressed (DA) and non-depressed (NDA) alcoholics regarding the degrees of severity of withdrawal, severity of depression and the intensity of cognitive dysfunctions were explored on admission to investigate possibility of prediction of the development of secondary depression in alcoholics. Methods. A group of primary male alcoholics (n=86) was recruited during inpatient treatment. After 4 weeks alcoholics were divided in the DA group (n=43) and NDA (n=43) group according to the score on the Hamilton Depression Rating Scale (HAM-D). Clinical assessment of withdrawal, scoring on the Alcohol Dependency Severity Scale- ASD, and scoring on the Mini Mental Scale-MMSE were performed in all the participants on admission. The differences between the groups were tested by the Student's t-test. Results. The DA group showed the significantly higher severity of depression, higher levels of alcohol withdrawal symptoms and cognitive dysfunctions than the NDA group on admission. Conclusion. The specific group of depressive alcoholics was shown to be characterized by the higher severity of alcoholism and depression on admission, which could predict prolonged, secondary depression. Early detection and concurrent therapy of secondary depression could improve the treatment, and reduce the relapse of alcoholism

Group art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital

Introduction. The schizophrenics are frequently disinterested and resistant to standard care. Case report. We presented clinical observations of group art therapy of two schizophrenic patients during integrative therapy in Day Hospital. We modified the original “Synallactic collective image technique” (Vassiliou G, Vassiliou V.). The group is open, heterogeneous, meets once a week and discusses on exhibited drawings, drawn by free associations. The patients' drawings and group protocols showed clinical improvement by lowering depressive themes, more human figures and self-confidence. The obvious severity of markedly impairment on Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scales on admission with minimal improvement at discharge was rated. Conclusion. Group art therapy enables visual expression of emotions, perceptions and cognitions, develops creative potentials and support within the group, thus facilitating the integrative therapeutic process of schizophrenics. It may be useful adjunctive therapy for schizoprenic patients

A series of drawings of a patient with schizophrenia-like psychosis associated with epilepsy: Captured illustration of multifaced selfexpression

Introduction. Drawings may give an insight into the complex mental process, however they have been underutilized in patients with psychosis associated with epilepsy. Case report. A 33-year-old, right handed female, diagnosed with schizophrenia- like psychosis associated with epilepsy, was treated in the Day Unit due to psychosocial rehabilitation. Besides other treatments, the patient underwent group analysis of drawings once a week. Qualitative analysis of the form and content of drawings made by free associations were performed. The varying of size and motives with vivid colours and the curve of perspective were documentated in three figures, followed by the last drawing which was without such elements. Conclusion. A series of drawings of patients with psychosis associated with epilepsy is needed to record a possible variations and disturbance of the immediate mental process. Group sessions may additionally contribute to diminish stigma and enhance psychosocial reintegration

The cognitive impairment illustrated in drawings used in gaining insight and motivation in alcoholism treatment

Introduction. The neuropsychological impairment such as different severity of executive deficit and mnestic disturbance among chronic alcoholics is frequent, but usually not explored. Case report. Two clinical vignettes of alcoholics who were not simultaneously treated in day hospital are presented, and they illustrated similar visuospatial impairments in free association drawings of a house made by. In this paper, the focus was on drawing not only as diagnostic tool, but also as a means of a confrontation within the group. Qualitative analysis of drawings and protocols from the group analysis were applied in the integrative day program. After confrontation, one alcoholic increased the insight into his cognitive impairment and strengthened motivation for early abstinence and treatment maintenance. He continued drawing houses as a theme of the following sessions till his obvious visuospatial impairments were repaired. Thus, he spontaneously trained his executive abilities and got group support for their improvement. Conclusion. Drawing could be a simple means of illustration cognitive impairments and the group analysis of drawings may serve as useful adjuvant method of strengthening insight and motivation for abstinence and treatment maintenance with documented cognitive recovery during abstinence

Bridging psychological barriers between the child and the father after his returning from the war: Could group art therapy help?

Introduction. War veterans with chronic post-traumatic stress disorder (PTSD) have poorer family and parenting functioning, but little research has focused on these impairments. Case re-port. This paper presented how the series of drawings and the group art therapy process enhanced bridging the psychological barriers of a 33-year-old male PTSD war veteran to engagement with the child. After two years of deployment he returned home and suffered mostly from PTSD numbness and avoidance symptoms. The veteran had the family readjustment difficulties and felt guilty for being detached from his 3-year-old son. He under-went integrative treatment in the Day Unit Program. The drawings series were made by free associations. Clinical observations and group discussions were recorded in the group art therapy protocols. The presented patient got gratifications and support from the group members for his illustration of popular cartoon heroes, and decided to draw Mickey Mouse at home. On the next session he shared his satisfaction for bridging the gap between him and his son, having done the same drawings with his son at home. Beck's depression inventory (BDI) was used for self-rating of depression and a reduction of BDI score from 18 to 6 during the treatment course was recorded. Conclusions. Series of drawings illustrated shift from war related past toward current family life of the war veteran. Group art therapy gave him gratification and support with hope and a sense of belonging, thus facilitated his parenting readjustment

Posttraumatic stress disorder and art group therapy: Self-expression of traumatic inner world of war veterans

Background/Aim. Art therapy and drawings may serve as alternative means of expression and release from trauma among veterans diagnosed with posttraumatic stress disorder (PTSD). Methods. The retrospective clinical study of drawings of war veterans was performed. A total of 89 war veterans met the Diagnostics and Statistical Manual of Mental Disorders (DSM-IV) PTSD criteria and were consecutively admitted to the Day Hospital during 5 years. Art group therapy as part of integrative treatment was performed once a week. The group was open and heterogeneous. Qualitative analysis of drawings content and group protocols were obtained. The drawings were made by free associations. War related themes were explored and descriptive statistics were applied. Results. The most frequent type of common themes of combat stress presented battle and witnessing wounded and killed combatants. Less frequent were themes of graves, destroyed cities and broken trees. The veterans preferred black and red colors with association to death, blood, wounds and destroyed objects. Conclusion. Drawing could provide a unique, complex, visual illustration of war traumatic experiences and memories of posttraumatic stress disorder veterans. Art group discussion might enhance war veterans’ verbal expression due to group support in safe setting. As adjuvant psychotherapy, art group therapy could enrich awareness and the ability of clinicians to treat hard posttraumatic stress disorder symptoms related to uncovered war trauma

Correlation and characteristics of self-rating and clinical rating of depression among alcoholics in the course of early abstinence

Background/Aim. Depression is an alcoholism relapse risk factor, but frequently stays underdiagnosed among treated alcoholics. The correlation and characteristics of self-reported and clinically assessed depression in the course of early alcohol abstinence were explored. Methods. A total of 100 inpatient, primary male alcoholics (20-60 years) diagnosed according to Classificaton of Mental and Behavioural Disorders (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were recruited consecutively. The Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) were scored on admission (T1), after 4 weeks (T2) and after 8 weeks (T3). Student's t-test, repeated measures ANOVA and Pearson's correlation between the scores were done (p < 0.05). Factor analyses of symptoms were performed. Results: On HDRS T1, T2, T3 90,7%, 39.5%, 17.4% alcoholics were depressive, respectively. The mean HDRS vs BDI scores on T1, T2 and T3 were 15.16 ± 6.34, 7.35 ± 4.18, 4.23 ± 2.93 vs 14.20 ± 9.56, 8.14 ± 7.35, 5.30 ± 4.94, respectively. Depression severity significantly lowered in the course of abstinence (ANOVA). The HRDS and BDI correlations on T1, T2 and T3 were significant (r1 = 0.763, r2 = 0.684, r3 = 0.613 respectively). Dysphoric mood, anxious, vegetative and cognitive HDRS subscales on T1, T2 and T3 were detected, but not BDI factors, thus BDI symptoms were analysed. Conclusions. The majority of alcoholics had depression on admission. A predominant mild-degree with a significant lowering of depression severity and positive significant correlations between HRDS and BDI scores in the course of abstinence were detected. The dysphoric mood on the HDRS sub-scale, and self-blame, anhedonia and guilt BDI symptoms were most prominent and persisted. The BDI could be a useful tool not only for routine screening and reassessment of depression, but also for exploring emotional content during early abstinence and planning tailored integrative therapy and relapse prevention for alcoholics

The assessment of personality dimensions, tobacco smoking and depression among tretment-seeking male alcoholics

Background/Aim. The co-occurrence of depression and tobacco smoking among treated alcoholics is frequent, but understudied. Some findings suggest that there are some shared etiological factors, but a few clinical researches of personality dimensions among patients with these comorbidities were done. The personality dimensions, the pattern of cigarette use and depression and correlation of personality and depression among inpatient alcoholics were explored. Methods. One hundred primary male inpatient alcoholics were consecutively recruited. The eighty-six of them completed study and were compared with 30 age-matched, healthy male subjects. A semi-structured clinical interview related to sociodemographics, the pattern of cigarette and alcohol use and family history data was applied. According to cut-off on the Hamilton Depression Rating Scale (HDRS), the alcoholics were divided into depressive and non-depressive subgroups resulting in half of alcoholics in each subgroup. The Eysenck personality questionnaire (EPQ) was completed. Student's t-test for differences and Pearson's test for correlation were used. Results. There were no significant sociodemographic differences between groups. Alcoholics were more frequent smokers (86% vs. 50%). They did not start drinking earlier, but they started smoking earlier, with higher daily cigarettes use than controls. On average, alcoholics had mild depression after detoxification. The personality dimensions did not show differences between groups, except neuroticism. The neuroticism showed significantly higher level among alcoholics vs. controls (12.72 ± 5.19 vs. 5.00 ± 3.36 respectively) and among depressive vs. non-depressive alcoholics (15.07 ± 4.89 vs. 10.37 ± 4.40 respectively). The depression correlated only with neuroticism (r = 0.487, p < 0.001). Conclusions. The majority of detoxified alcoholics were smokers who started smoking earlier, with mild depression and higher neuroticism compared to controls. Our results suggest that the alcoholics with high neuroticism may experience higher depression and may require more intensive integrative treatment