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Female Genital Mutilation Increases Mental Health Risks and Alters Stress Reactions

Summary: Researchers report female genital mutilation not only increases mental health risks, but also affects the way women’s bodies cope with stress. In women subjected to FGM, cortisol levels were increased, researchers report.

Source: University of Kinstanz.

FGM has been officially recognised as a human rights violation by the United Nations since 1992. Still, efforts to prevent the mutilation of newborns and young girls often meet with little success. Female genital mutilation comes in various degrees of severity, ranging from a cut to the clitoris or its removal (FGM I), through circumcision (FGM II) to the sewing together of the outer labia (FGM III). In the most extreme cases, labia that have grown together as a result of FGM are ripped apart violently during sexual intercourse or childbirth and are then sewn back together (infibulation).

In a pioneering, comprehensive study led by the University of Konstanz neuropsychologist Professor Thomas Elbert, Dr Anke Köbach and Dr Martina Ruf-Leuschner examined the impact that FGM has on the victims’ body and mind. The study was carried out in the Somali Region of Ethiopia among the Somali, Amhara and Oromo people, all cultures that practice FGM at varying levels of severity. The results indicate that the affected women experience FGM as both a physical and mental injury, a so-called traumatic event. They inevitably grow more vulnerable to psychological disorders brought on by trauma such as post-traumatic stress disorder or depression. These consequences are particularly grave in women subjected to the most invasive forms of FGM (type II/III). Nearly 20 percent of young women with an average age of 32 suffer from post-traumatic stress disorders. Individuals who were also exposed to other threats to their lives and physical well-being were found to suffer from particularly severe forms of trauma.

image shows the researchers with a group of women

In a comprehensive and pioneering study led by Professor Thomas Elbert, Dr. Anke Koebach (middle) and Dr. Martina Ruf-Leuschner investigated the effects of female genital mutilation on the body and mind of the affected women. NeuroscienceNews.com image is credited to University of Konstanz.

This also affects their bodies’ ability to cope with stress. The University of Konstanz’s Clinical Psychology and Clinical Neuropsychology working group was able to document this by examining the density of the stress hormone cortisol in the subjects’ hair. In women who had been subjected to severe forms of FGM, cortisol rates were increased. Cortisol density was also found to be higher than usual in women who had had FGM I performed on them when they were infants. As Anke Köbach states: “Even if the women cannot remember the procedure itself, they carry those memories in their biological systems for the rest of their lives”.

Cortisol can increase the release of oxygen, glucose and other nutrients, while also repressing acute stress responses via adrenaline and noradrenaline. At the same time, it inhibits intestinal activity as well as inflammatory and immune responses. This, in turn, can lead to excess weight, muscle and tissue weakness as well as altered brain development. “These results should not only give the medical personnel supporting FGM pause for thought”, says Thomas Elbert.

About this neuroscience research article

Source: Julia Wandt – University of Kinstanz
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is credited to University of Konstanz.
Original Research: Open access research for “Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations” by Anke Köbach, Martina Ruf-Leuschner and Thomas Elbert in BMC Psychiatry. Published June 13 2018
doi:10.1186/s12888-018-1757-0

Cite This NeuroscienceNews.com Article
University of Kinstanz “Female Genital Mutilation Increases Mental Health Risks and Alters Stress Reactions.” NeuroscienceNews. NeuroscienceNews, 13 June 2018.
<http://neurosciencenews.com/fgm-mental-health-stress-9331/>.
University of Kinstanz (2018, June 13). Female Genital Mutilation Increases Mental Health Risks and Alters Stress Reactions. NeuroscienceNews. Retrieved June 13, 2018 from http://neurosciencenews.com/fgm-mental-health-stress-9331/
University of Kinstanz “Female Genital Mutilation Increases Mental Health Risks and Alters Stress Reactions.” http://neurosciencenews.com/fgm-mental-health-stress-9331/ (accessed June 13, 2018).

Abstract

Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations

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.

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