TORTURED BRAINS

www.vivo.org vivo – victims‘ voice University of Konstanz

TORTURED BRAINS

Torture experiences in a sample of survivors of organized violence seeking asylum in Germany 65

being stripped naked

20

rape /penetration with object

45

twisting/ mutilation of genitals

57

being beaten on genitals

39

being hung

23

being burned

29

being submersed under water

52 48

strangling mock execution

% subjects 84

death threats

39 38

being forced to witness torture electric shock

71

being blindfolded

50

Falanga/Falaka

84 84

being beaten on the body being beaten on the head

0

20

40

60

80

100

Torture experiences of refugees in a Ugandan refugee camp 0%

10%

20%

30%

40%

50%

60%

70%

80%

witnessed beatings or torture witnessed injury by weapon witnessed abduction confiscation of property by officials witnessed robbery / extorsion witnessed murder witnessed accident witnessed rape of a woman witnessed act of suicide witnessed combat situation dangerous evacuation beatings or torture witnessed forced circumcision robbery / extorsion

Series1

harassment of armed personel accidents combat situation imprisonment abduction forced isolation experienced injury by weapon forced marriage child marriage beatings from spouse rape forced circumcision sex for food or security forced prostitution / sex. slavery

POST-TRAUMATIC STRESS DISORDER (PTSD)

reexperiencing

avoidance

hyperarousal

vivo outpatient clinic for refugees University of Konstanz, Germany

Prevalence of Post-traumatic Stress Disorder (PTSD) Refugees

Torture survivors

37% 93%

PTSD

vivo outpatient clinic for refugees, Germany

no PTSD

Ongoing epidemiological survey on traumatic life experiences and mental health of refugees & asylum seekers in Northern Italy COUNT RY OF ORIGIN

Sierra Leone; 3% Costa d'Avorio; 6% Guinea; 3% Liberia; 3%

Bosnia; 9% Irak; 3% Turkey; 3%

ngo - Dem. Rep.; 6% Kossovo; 3%

Togo; 12%

Camerun; 38% Etiopia; 3% Sudan (Darfur); 9%

Î

PTSD was more frequently diagnosed in torture survivors compared to other refugees/ asylum seekers.

Predictors of PTSD Symptom Severity in torture survivors BETA

St. Err.

Constant

p

0,7

age

0,07

0,16

0,66

Sex (female)

0,43

0,16

< 0,05

Years of education

0,01

0,16

0,93

Number of arrests

-0,21

0,17

0,25

Months since event

0,31

1,16

0,06

Tot. number of war- and torture related event types ever experienced

0,59

0,17

< 0,005

Linear Regression on ‘PTSD symptom score’ (R² corr.= .33; p < .01)

Î

Strongest predictors of PTSD symptom severity were female sex and number of war and torture event types

Dose – Effect of traumatic stress

Sudanese refugees, Imvepi refugee camp, Uganda

Tamil school children, North-East Sri Lanka

(Neuner et al. 2004, BMC Psychiatry)

(Catani et al., 2005, ESTSS)

ABNORMAL SLOW WAVE ACTIVITY (ASWA) IN TORTURE VICTIMS WITH PTSD Abnormal slow-wave rhythms (delta range 1.5 – 4 Hz) in the brain have been found to be related to brain pathology or dysfunctional neural tissue. Also, ASWA was found in conditions of psychopathology, such as depression and schizophrenia. ⇒ ASWA can be produced by both structural and functional neural networks that are deprived of their inputs. ⇒ Neural generators of slow-wave rhythms can be identified through magnetic source imaging by using dipole density measurements from MEG. (Rockstroh, B. et al.. submitted)

Prefrontal & temporal ASWA focus in torture victims with PTSD

SPEECHLESS TERROR - Indicators of decoupling of frontal affective processors from left cortical language areas in torture victims Psychological dissociation in torture victims and its manifestation within neural networks in the brain ⇒ Dissociative experiences associated with ASWA generated in the left ventrolateral frontal cortex. (Ray, Odenwald et al., 2006)

Torture victims showed elevated production of focally generated slow waves, particularly in left temporal brain regions (peak in the insular cortex).

(Kolassa, Wienbruch, Neuner et al., submitted)

AFFECTIVE STIMULUS PROCESSING IN TORTURE SURVIVORS WITH PTSD Pleasant picture (2 s) ISI & fixation (4-10 s) Neutral picture (2 s)

t Unpleasant picture (2 s)

Pictures taken from the International Affective Picture System (IAPS)

Subjective affective ratings and heart rate responses to emotional visual stimuli Î sustained heart rate acceleration for high arousing unpleasant pictures in PTSD patients

Î unpleasant pictures rated significantly more arousing by PTSD patients

PTSD patients

Significantly enhanced late P3 component for arousing pictures in PTSD patients. Controls

Saleptsi et al, in prep.

MEG data: Grand Mean Activity (rms)for each affective category Schizophrenia patients

MEG in the EPN-M time interval

FAST PICTURE PROCESSING IN TORTURE SURVIVORS WITH PTSD

fMRI

Areas of significant group effect in the 60-110ms time interval

PTSD; Aversive PTSD; Neutral Controls; Aversive Controls; Neutral 0

100

200

300 ms

Junghöfer et al., 2001 Neuner, Junghöfer et al., in prep.