Complex Posttraumatic Stress Disorder Among Former Political Prisoners in Iraq

Introduction

The World Health Organization’s working group proposed the inclusion of Complex Posttraumatic Stress Disorder (CPTSD) as a new diagnosis, distinct yet related to Posttraumatic Stress Disorder (PTSD). CPTSD is a sequela of prolonged, repeated, or complex trauma, often occurring under circumstances where escape is impossible due to physical, environmental, or social constraints. In the context of Iraq, political prisoners (IPP) have endured such prolonged, repeated, and complex trauma through regular torture and prolonged imprisonment. This study aims to shed light on the prevalence and impact of CPTSD among former political prisoners in Iraq.

Study Overview

This study involved 400 former political prisoners, with an average age of 55.4 ± 12.6 years. The male-to-female ratio of participants was 4.6:1, and participants were randomly selected from the Political Prisoners Establishment (PPE). To measure the symptoms of CPTSD, the Iraqi version of the Harvard Trauma Questionnaire (HTQ) was used, focusing on feelings of guilt, hopelessness, shame, and the need for revenge—common manifestations of CPTSD.

The study found that 70.3% of participants met the criteria for CPTSD. Importantly, no significant correlation was found between the year of detention and the presence of CPTSD (p=0.9), indicating that the trauma experienced was not significantly tied to the duration of imprisonment. This statistic underscores the severe and lasting psychological consequences of political imprisonment, irrespective of the time frame.

Prevalence of CPTSD

The prevalence of CPTSD among the former political prisoners in this study was striking, with 70.3% of participants exhibiting symptoms. This figure is significantly higher than that observed among university students in Baghdad, Iraq, where the prevalence of PTSD was reported to be only 10%. The high rate of CPTSD among former political prisoners can be attributed to the nature of their experiences, which included prolonged imprisonment and torture, in addition to the broader exposure to complex trauma in Iraq, such as wars, civil conflicts, and widespread violence. Chronic trauma—such as continuous torture and imprisonment—is considered a key predictor of CPTSD, as opposed to PTSD, which typically results from isolated traumatic events.

The Impact of Complex Trauma

While the study found no significant association between the year of detention and CPTSD, this result mirrors similar findings in previous studies on PTSD, further highlighting the prolonged and pervasive effects of such trauma. Research has consistently shown that exposure to repeated or complex trauma predisposes individuals to develop CPTSD, rather than the more traditional PTSD. The ongoing nature of suffering, combined with the helplessness experienced in captivity, leads to long-term psychological distress, which can manifest as guilt, hopelessness, shame, and a desire for revenge—emotions that are characteristic of CPTSD.

The study also emphasized that the high prevalence of CPTSD among former political prisoners aligns with previous reports on the lasting psychological toll of incarceration under harsh and inhumane conditions. These conditions, which include physical and mental abuse, can irreversibly affect the psyche, leaving deep scars that affect survivors well beyond their release from captivity.

Conclusion

The study highlights the severe mental health challenges faced by former political prisoners in Iraq, with a staggering 70.3% prevalence of CPTSD. The prolonged and complex trauma experienced by these individuals, compounded by the broader socio-political instability in Iraq, has left a significant psychological impact. The findings underscore the importance of addressing the mental health needs of survivors of political imprisonment and the need for specialized interventions to mitigate the effects of CPTSD. Furthermore, the study calls for continued research and intervention in post-conflict societies to address the long-term psychological consequences of political violence and imprisonment, ensuring that those affected receive the care and support they need to heal.