A multivariate contextual analysis of torture and cruel, inhuman, and degrading treatments: implications for an evidence-based definition of torture.

Current thinking on what constitutes torture in a detention/interrogation setting focuses solely on particular procedures, without regard for contextual factors that mediate traumatic stress. The present study examined stressor interactions that determined severity and psychological impact of captivity stressors in 432 torture survivors in former Yugoslavia countries and Turkey. A principal components analysis of 46 captivity stressors measured by an Exposure to Torture Scale identified meaningful stressor clusters, which suggested that multiple detention procedures were used in combination to maximize their impact. Perceived torture severity related to 'cruel, inhuman, and degrading' treatments (CIDT) but not to physical torture. Posttraumatic stress disorder related to war-related captivity, deprivation of basic needs, sexual torture, and exposure to extreme temperatures, isolation, and forced stress positions but not to physical torture. CIDT increased posttraumatic stress disorder risk by 71%. Fear- and helplessness-inducing effects of captivity and CIDT appear to be the major determinants of perceived severity of torture and psychological damage in detainees. Considerations on what constitutes torture need to take into account the contextual processes in a captivity setting that mediate these effects.