Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations
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Authors
Köbach, Anke
Ruf-Leuschner, Martina
Elbert, Thomas
Issue Date
2018-06-13
Type
Article
Language
en_US
Keywords
Female Genital Mutilation , FGM , Female Genital Cutting , Posttraumatic Stress Disorder (PTSD) , Dissociation , Depression , Hair Cortisol
Alternative Title
Abstract
Background:
Anecdotal 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.
Methods:
We 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.
Results:
The 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.
Conclusion:
More 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.
Description
Citation
Köbach, A., Ruf-Leuschner, M., & Elbert, T. (2018). Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations. BMC psychiatry, 18(1), 187. https://doi.org/10.1186/s12888-018-1757-0
Publisher
BMC Psychiatry