Department of Clinical and Neuropsychology, University Konstanz, Universitätsstraße 10, 78457, Konstanz, Germany.
Vivo international e.V., Postfach 5108, 78430, Konstanz, Germany.
BMC Psychiatry. 2018 Jun 13;18(1):187. doi: 10.1186/s12888-018-1757-0.
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.
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.
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.
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.
有传闻证据表明，女性外阴残割（FGM）的性质常常具有创伤性。目前，关于这一传统的心理后果的系统研究仍然有限。本研究提供了 FGM 的潜在心理病理学后果的初步、高质量的心理诊断数据，重点是创伤后应激障碍（PTSD）、分离性关闭和其他与压力相关的变量。
我们调查了一个方便的样本，N=167 名妇女，由吉吉加（埃塞俄比亚索马里州首府）的妇女事务总部和当地的一个埃塞俄比亚非政府组织支持。我们的主要结局指标是创伤后应激障碍（PSS-I）和分离性关闭（ShuD）。我们还评估了抑郁和焦虑（HSCL-25）、重度抑郁症、物质滥用和依赖、自杀意念和精神病障碍（MINI；A、B、K 和 L 子量表）。此外，我们收集了头发样本，以评估头发皮质醇浓度（HCC）作为神经内分泌学指标。
大多数妇女都经历过 FGM（FGM I：36%，FGM II/III：52%），无论身体侵入的程度如何，几乎所有妇女都报告说感到强烈的恐惧和/或无助。FGM II/III，更具侵入性的形式，与 PTSD 症状（p<0.001）和分离性关闭（p<0.001）的易感性增加有关。抑郁症状（p<0.05）和焦虑症状（p<0.01）也升高。条件推理树的随机森林回归显示，FGM 发生年龄（<1 岁）和程序侵入性与皮质醇水平变化有关的证据。
更广泛形式的 FGM 与更严重的心理病理症状相关 - 特别是与 PTSD 的易感性增加有关。在 1 岁之前经历过 FGM 或经历过更严重形式的 FGM 的妇女的头发皮质醇水平较高，表明 FGM 和一般创伤对压力系统的长期神经内分泌后果。
