Hidden Scars: The impact of torture, traumatic brain injury, and PTSD on executive functions - a narrative review.

Abstract

Introduction: Victims of torture are often subjected to physical violence, which can result in traumatic brain injury (TBI) and PTSD. Executive functions encompass a complex set of higher cognitive abilities that include memory, inhibitory control, cognitive flexibility, planning, reasoning, and problem solving. This narrative review aimed to outline how torture affects executive functions, particularly in the context of TBI and PTSD.

Methods: We searched the scientific literature using the databases of PubMed, PsycINFO and PsychArticles. The search included combinations of the terms: Torture, Executive Functions, Traumatic Brain Injury, Stress, PTSD, Refugee, Asylum Seeker, Memory, Planning, Motivation, as well as relevant Medical Subline Headings (MeSH).

Results: Both TBI and PTSD have been associated with thinning of the cerebral cortex, hippocampus, and amygdala. Such changes lead to a broad spectrum of cognitive and emotional issues. Victims of torture, for example, might display a lack of coherence, initiative, motivation, and the inability to respond to changes in their environment.

Discussion: In most countries, asylum-seeking is based on interviews in which individuals must provide a detailed and coherent narrative of the events that justify asylum. However, the neurological consequences of torture are rarely considered during asylum-seeking interviews, and a lack of details and coherence might be considered as a proxy for false statements.

Conclusions: Knowledge of the effects of torture on executive functions is critical for the design and implementation of treatment strategies that increase the chances of recovery.