who engage in torture have various psychological deviations and often they derive sadistic satisfaction. Torture may fulfill the emotional needs of perpetrators when they willingly engage in these activities. They lack empathy and their victims' agonized painful reactions, screaming and pleading give them a sense of authority and feelings of superiority. Torture can harm not only the victim but the perpetrators as well. After the fact, perpetrators will often experience failing mental health, PTSD, suicidal tendencies, substance dependency and a myriad of other mental defects associated with inducing physical or mental trauma upon their victims. The perpetrators may experience flashbacks of torture, intense rage, suicidal and homicidal ideas, alienation, impulse deregulation, alterations in attention and consciousness, alterations in self-perception, alterations in relationships with others, inability to trust and inability to maintain long-term relationships, or even mere intimacy. Torture victims in healthcare settings For physicians, it is useful to recognize that symptoms of post-traumatic stress can complicate presentation and treatment. Pain predicts greater severity of both PTSD symptoms and major depression, and intrusive memories and flashbacks can exacerbate existing pain. While under-recognition and under-treatment of torture victims is common, there are useful guidelines for evidence-based medical practice, although not specifically concerned with pain, and for evidence-based psychological practice. Some people die during torture; many survivors are too disabled and destitute to find their way to safety. A large element of chance, and, to a lesser extent, resources and resilience, enable a minority to arrive in developed countries. Nevertheless, they often present multiple and complex problems, which the clinician can find overwhelming. For all these reasons, an interdisciplinary approach to assessment and treatment is therefore recommended, guarding against either disregarding significant psychological distress as inevitable in torture survivors or discounting physical symptoms by attributing them to psychological origin. Rehabilitation and reparation are part of the rights of the torture survivor under the United Nations Convention, yet far less attention is paid to health needs on a national or international basis than to legal and civil claims. Collaborative efforts involving survivors themselves are needed to better understand the usefulness and limitations of existing assessment instruments and treatment methods. Some studies exist, such as that by Elsass et al. who interviewed Tibetan Lamas on the quantification of suffering in scales used to evaluate intervention with Tibetan torture survivors. Education of medical and other healthcare personnel needs to address issues concerning treatment of torture survivors,