Psychological consequences of FGM
Which are the immediate, short and long terms consequences of FGM on the person?
FGM is often experienced as a traumatic experience with immediate psychological consequences as well as short and long-term consequences. Nevertheless, it is important to notice that all women react differently. The psychological consequences are not systematic nor universal and differ from a person to another. They have to be understood in the global life path of the affected girl/woman. How the FGM was practiced, socio-demographic characteristics, the individual story and personal coping mechanisms have an influence on the psychological consequences of FGM (4; 5). The age of cut also has an influence. Girls cut before age two do not remember it whilst those cut after five years are more at risk of experiencing greater complications and pain (5; 12).
Immediate consequences are deeply linked to how FGM was performed. Thus, the more the event is lived as a traumatic experience – if the girl has not been told, prepared, aware in advance, the stronger the shock can be. The girl can feel betrayed when the ones supposed to protect become the ones who hurt. Pain, shock, use of constraint can also be translated in a feeling of fear and powerlessness. Some girls also live an episode of dissociation and see themselves, their emotion as separated from their body and physical experience. This mechanism automatically happens in moments of strong pressure or pain to mentally protect themselves.
Dissociation is defined as follows by the psychanalyst Sandor Ferenczi (6) : “If the quantity and nature of pain exceed the integration strength of the person, then we surrender, we stop tolerating, it does not worth any more to gather all these painful things in a unit, we get fragmented. I do not suffer any more, I even stop existing at least as a global Me.”
In the short term, the cut also has consequences on the psychological well-being. Immediate effects can be intensified by the taboo, silence surrounding the cut preventing girls from expressing their emotions, uneasiness, and pain (5). To the event’s violence is added the violence of the unsaid during the following months and years. Difficulties of adaptation or readaptation at school are also reported (12). But again, consequences depend on the exact context of the practice.
On the long term, consequences can be diverse and happen on different levels in a chronic, more or less frequent and repeated way. The event can be so deeply entrenched in the child’s subconscious that it can finally feeds behavioural disturbances (12). Within clinical disorders we count anxiety, depression, stress and even post-traumatic stress disorder (PTSD) (5 ; 8 ; 11 ; 14, p.257).
What is Post-Traumatic Stress Disorder ?
PTSD is defined by the combination of various factors: “the cognitive, emotional, and physiological re-experiencing of their traumatic event(s) (B- criterion), avoidance of trauma reminders (C-criterion), an alteration of mood and cognition (D-criterion), and hyperarousal (E-criterion)” (9). PTSD includes physical manifestations symptomatic of nervousness, recurring, intrusive and negative memories of the event, nightmares, phobia, anxiety. People concerned will put in place coping mechanisms to limit the confrontation to elements reminding the traumatic event.
Moreover, dysfunctions in the declarative memory occur and make it chaotic and difficult for the person to speak about the event. As a matter of fact, stories of the event often tend to be incoherent, incomplete.
Women living with FGM can experience flash-backs, sensitive illusions, nightmares during which they live again their excision and feel the distress or the fear as if it were happening again – that is what we call traumatic memory.
For some women, painful intercourses and delivery can also trigger traumatic memory. In the same way, being confronted directly or indirectly during a conversation, a TV report or through the vision of her own body can also recall the cutting day (5).
(4) Knipscheer et al., Mental health problems associated with female genital mutilation, BJ Psych Bulletin (2015), 39, 273-277. Access here
(5) Vloeberghs E., Knipscheer J., Van der Kwaak A., Naleie Z., Van Den Muijsenbergh M., Veiled pain. A study in Netherlands on the psychological, social and relational consequences of FGM, 2011, Utrecht, The Netherlands : Pharos.
(6) Adelufosi et al., “Cognitive behavioural therapy for post‐traumatic stress disorder, depression, or anxiety disorders in women and girls living with female genital mutilation: A systematic review”, International Journal of Gynaecology and Obstetrics, 2017;136 Suppl 1:56‐59. Access here
(8) Ferenczi S., Le traumatisme, Petite bibliothèque, Payot, n°580, Paris, mars 2006, 176 pages, cité in GAMS Belgique, – Femmes, excision et exil – Quel accompagnement thérapeutique possible ?, p. 48
(9) Köbach et al. ‘‘Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations’’, BMC Psychiatry, 2018;18(1):187. Published 2018 Jun 13. Access here
(11) Psychological, social and sexual consequences of FGM/C : a systematic review of quantitative studies, Report from Kunnskapssenteret (Norwegian Knowledge Centre for the Health Services), No 13–2010. Access here
(12) Research blog by Serene Chung for 28 Too Many, The psychological effect of FGM, 2016. Access here
(14) OMS, Chapitre 7 : Santé mentale et MGF, in Prise en charge des filles et des femmes vivant avec une mutilation génitale féminine : un guide clinique, 2018. Access here
« The Community of Practice on Female Genital Mutilation » is part of the « Building Bridges between Africa and Europe to tackle FGM » project, supported by the « UNFPA-UNICEF Joint Programme on the Elimination of FGM ». The project is coordinated by AIDOS in partnership with GAMS Belgium.
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