Complex post-traumatic stress disorder in the context of human rights abuse

We propose to bring together a review of current understanding of the concept of complex post-traumatic stress disorder (PTSD) in the context of human rights abuse. There is increasing research evidence that adult survivors of human rights atrocities respond with psychological difficulties (and biological, neuro-pharmacological and neuro-imaging abnormalities) similar to those described in the literature on developmental trauma – on which the concept of complex PTSD has until recently been focussed. There are also important commonalities in the clinical response to different forms of human rights abuse such as torture, human trafficking and domestic violence. The process of abuse is often continued through the challenge of negotiating legal protection (i.e. the asylum process) and the adverse mental health consequences of enforced detention to which many such victims are subjected while their asylum and human rights claims are being considered. Although there is a good degree of consensus on the principles of psychological treatment for complex PTSD, there is a paucity of evaluative clinical studies and of correlations between clinical response and changes in biomarkers. There are also no established pharmacological treatments though several compounds have shown promise in animal models and in exploratory human studies. Political and public health initiatives in the aftermath of conflict and collective violence may also play an important role in mitigating the mental health effects of the trauma.