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August 7, 2013

Recovery After Violence and Human Rights Abuses

Author Affiliations
  • 1University of North Carolina at Chapel Hill
  • 2Executive Managing Editor, JAMA
  • 3Associate Editor, JAMA
JAMA. 2013;310(5):486-487. doi:10.1001/jama.2013.218058

Quality of life after trauma is shaped by the capacity for physical and psychological healing and recovery, which may be facilitated by evidence-based treatment of physical and psychological injuries and their sequelae. This and previous JAMA theme issues on violence and human rights have included several evaluations of interventions to promote recovery after exposure to trauma.

In a case-based review in this issue, Crosby1 discusses the clinical management of a patient with chronic weakness, pain, and posttraumatic stress disorder (PTSD) as a consequence of the trauma she experienced as a refugee from the civil war in Somalia. This management includes a multidisciplinary approach designed to be culturally acceptable to the patient. Also in this issue, 2 related Viewpoints summarize new evidence-based guidelines from the World Health Organization (WHO) to help with clinical management of patients exposed to trauma and violence. Van Ommeren and colleagues2 discuss new WHO recommendations, many based on substantial evidence, for management of acute stress symptoms after trauma exposure, especially in low- and middle-income countries with limited resources. For example, these guidelines recommend cognitive behavioral therapy with a trauma focus for trauma-exposed adults with acute stress symptoms and PTSD and recommend against the use of benzodiazepines for acute stress and against the use of antidepressants as first-line treatment for PTSD unless there is concurrent moderate to severe depression. Feder and coauthors3 summarize other WHO recommendations, primarily based on low to moderate levels of evidence, to assist clinicians with decisions about and management of women exposed to intimate partner violence. The guidelines recommend cognitive behavioral therapy or eye movement desensitization and reprocessing interventions, delivered by health care professionals with a good understanding of violence against women, for those with PTSD who are no longer experiencing violence.

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