Abstract
BackgroundAnecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM). At present, systematic research on the psychological sequelae of this tradition has remained limited. The study provides preliminary, high-quality psychodiagnostic data on potential psychopathological consequences of FGM, with a focus on posttraumatic stress disorder (PTSD), shutdown dissociation and other stress-related variables.MethodsWe investigated a convenience sample of N = 167 women, supported by the women’s affairs headquarters in Jijiga (capital of the Ethiopian Somali Region) and a local Ethiopian non-governmental organization. Our main outcome measures were PTSD (PSS-I) and shutdown dissociation (ShuD). We also assessed depression and anxiety (HSCL-25), major depression, substance abuse and dependence, suicidality and psychotic disorders (M.I.N.I.; sub-scales A., B., K., and L.). In addition, we collected hair samples to assess hair cortisol concentrations (HCC) as a neuroendocrinological measure.ResultsThe majority of women endured FGM (FGM I: 36%, FGM II/III: 52%) and, regardless of the level of the physical invasiveness, almost all women reported having felt intense fear and/or helplessness. FGM II/III, the more invasive form, was associated with a greater vulnerability to PTSD symptoms (p < .001) and shutdown dissociation (p < .001). Symptoms of depression (p < .05) and anxiety (p < .01) were also elevated. Random forest regression with conditional inference trees revealed evidence of an alteration of the cortisol levels in relation to the age when FGM was experienced (< 1 year) and the invasiveness of the procedure.ConclusionMore extensive forms of FGM are associated with more severe psychopathological symptoms – particularly with an increased vulnerability to PTSD. Higher hair cortisol levels in women who experienced FGM before their first year of age or had more severe forms of FGM indicate long-term neuroendocrinological consequences of FGM and trauma in general on the stress system.
Highlights
Anecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM)
No group differences were found for childhood familial violence (p > .05), but for the number of lifetime traumatic events: women who endured FGM II/III presented with a higher trauma exposure (p < .05)
While 11 (12%) women in the FGM II/III group fulfilled the diagnostic criteria of major depression, none of the other groups presented the required severity of symptoms
Summary
Anecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM). (4) Other practices include all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area [1]. International institutions such as the United Nations (UN) or WHO follow unambiguous anti-FGM policies. Anecdotal evidence from women who have endured FGM provides insight into the traumatic nature of the tradition [4], and recent studies have confirmed that the majority of women with FGM reported having felt intense fear, helplessness and pain during the procedure [5]. More than one third of this group presented with clinically relevant symptoms of PTSD, anxiety and/or depression
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