Psycho Sexual Health
Psychological consequences of FGM
What are the immediate, short and long terms consequences of FGM?
FGM is often experienced as a traumatic event 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 one person to another. They have to be contextualized within the overall life path of the victim. How the FGM was practiced, socio-demographic characteristics, the individual story and personal coping mechanisms have an influence on the psychological consequences of FGM (OMS, 2018; Vloeberghs E. et al., 2011). The age of the cut also has an influence. Girls cut before age two do not remember it whilst those cut after the age of five are more at risk of experiencing greater complications and pain (Vloeberghs E. et al., 2011; 28TooMany, 2016).
Immediate consequences are deeply linked to how FGM was performed. The more the event is lived as a traumatic experience – if the girl has not been told and prepared in advance, the stronger the shock can be. The girl can feel betrayed when those supposed to protect her become the ones who hurt her. Pain, shock, use of constraint can also be translated into a feeling of fear and powerlessness. Some girls also experience an episode of dissociation and see themselves and their emotions as separated from their body and physical experience. This mechanism automatically happens in moments of strong pressure or pain in order to mentally protect them.
Dissociation is defined as follows by the psychanalyst Sandor Ferenczi (Adelufosi et al., 2017). :
“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 and silence surrounding the cut, preventing girls from expressing their emotions, uneasiness, and pain (Vloeberghs E. et al., 2011). To the event’s violence is added the violence of that which is unspoken during the following months and years. Difficulties of adaptation or readaptation at school are also reported (28TooMany, 2016). But again, consequences depend on the exact context of the practice.
In 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 feed behavioural problems (28TooMany, 2016). Within clinical disorders we note anxiety, depression, stress and even post-traumatic stress disorder (PTSD) (28Toomany, 2016, 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)” (Köbach et al., 2018).
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 them of 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 relive their mutilation and feel the distress or the fear as if it were happening again – that is what we call traumatic memory.
For some women, painful intercourse and delivery can also trigger the traumatic memory. In the same way, being confronted directly or indirectly during a conversation, a TV report or through the sight of her own body can also recall the day of the cutting (Vloeberghs E., et al., 2011).
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