"It's well known in neuropsychology that the frontal and temporal lobes affect executive function - which includes planning, learning, self-monitoring, and flexibility in social interactions," Mollica explains. "It could be that torture survivors who don't do well with standard therapies have head-injury-based cognitive deficits that interfere with standard approaches like behavioral or exposure therapy. It's very rare for patients to relate subsequent health problems to a head injury or to recognize that a head injury is affecting their emotions.

"In some cultures," he adds, "patients and families are relieved to learn that emotional problems are related to a physical injury and may become more committed to working with programs specially designed to treat head injury patients. We hope that our documenting physical effects of brain damage in a group of torture survivors will provide evidence leading to improved diagnostic and treatment approaches. The next steps should be clinical trials comparing the results of head-injury-specific treatment programs with more traditional therapies for emotional disorders in patients with a history of both trauma and head injury."

Mollica also notes the need to improve training for the physicians most likely to treat such patients in the community. "Most primary care physicians are not prepared to identify mild traumatic head injury either in patients who may have experienced trauma or torture - including veterans or refugees - or in survivors of assaults or even auto accidents." He is a professor of Psychiatry at Harvard Medical School.

Source: Massachusetts General Hospital