title: Torture vs other cruel, inhuman, and degrading treatment: is the distinction real or apparent?
abstract: BACKGROUND
  After the reports of human rights abuses by the US military in Guantanamo Bay, Iraq, and Afghanistan, questions have been raised as to whether certain detention and interrogation procedures amount to torture.
  
  
  OBJECTIVE
  To examine the distinction between various forms of ill treatment and torture during captivity in terms of their relative psychological impact.
  
  
  METHODS
  A cross-sectional survey was conducted with a population-based sample of survivors of torture from Sarajevo in Bosnia and Herzegovina, Banja Luka in Republica Srpska, Rijeka in Croatia, and Belgrade in Serbia.
  
  
  METHODS
  A total of 279 survivors of torture accessed through linkage sampling in the community (Banja Luka, Sarajevo, and Rijeka) and among the members of 2 associations for war veterans and prisoners of war (Belgrade).
  
  
  METHODS
  Scores on the Semi-structured Interview for Survivors of War, Exposure to Torture Scale, Structured Clinical Interview for DSM-IV, and Clinician-Administered PTSD (posttraumatic stress disorder) Scale for DSM-IV.
  
  
  RESULTS
  Psychological manipulations, humiliating treatment, exposure to aversive environmental conditions, and forced stress positions showed considerable overlap with physical torture stressors in terms of associated distress and uncontrollability. In regression analyses, physical torture did not significantly relate to posttraumatic stress disorder (odds ratio, 1.41, 95% confidence interval, 0.89-2.25) or depression (odds ratio, 1.41, 95% confidence interval, 0.71-2.78). The traumatic stress impact of torture (physical or nonphysical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors.
  
  
  CONCLUSIONS
  Ill treatment during captivity, such as psychological manipulations, humiliating treatment, and forced stress positions, does not seem to be substantially different from physical torture in terms of the severity of mental suffering they cause, the underlying mechanism of traumatic stress, and their long-term psychological outcome. Thus, these procedures do amount to torture, thereby lending support to their prohibition by international law.
authors.affiliation: Section of Trauma Studies, Institute of Psychiatry, King's College, University of London, De Crespigny Park, Denmark Hill, London, England. spjumeb@iop.kcl.ac.uk
authors.forename: Metin
authors.initials: M
authors.lastname: Başoğlu
authors.forename: Maria
authors.initials: M
authors.lastname: Livanou
authors.forename: Cvetana
authors.initials: C
authors.lastname: Crnobarić
mesh_terms: D017522:Bosnia and Herzegovina / Q000453:epidemiology; D003416:Criminal Law / Q000331:legislation & jurisprudence; D017523:Croatia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D045809:Human Rights Abuses / Q000331:legislation & jurisprudence / Q000523:psychology*; D006801:Humans; D007391:International Cooperation; D008016:Life Change Events; D011329:Prisoners / Q000331:legislation & jurisprudence / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology; D040921:Stress Disorders, Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D014104:Torture / Q000331:legislation & jurisprudence / Q000523:psychology*; D015022:Yugoslavia / Q000453:epidemiology