Women Mental Health

1. IMPACT OF GENDER-BASED VIOLENCE
ON WOMEN MENTAL HEALTH
Dr. Magda Fahmy
Professor of Psychiatry
Suez Canal University

2. Definitions
• Gender-Based Violence (GBV) and violence against
women (VAW) are often used together or
interchangeably, since most violence against women is
gender-based, and most gender-based violence is
perpetrated by men against women and girls.

3. Forms of GBV Against Women
• “Any act of gender-based violence that results in, or is likely
to result in, physical, sexual or psychological harm or
suffering to women, including threats of such acts, coercion
or arbitrary deprivation of liberty, whether occurring in
public or in private life”.
• It affects 15–75% of women across the globe and is a significant
threat to their health, well-being, and rights.
• World Health Organization, PATH; 2005.

4. Vague history of violence against women
• Many kinds of violence against women (specifically rape, sexual
assault, and domestic violence) are under-reported, often due to
societal norms, taboos, stigma, and the sensitive nature of the
subject.

5. Gender-Based Violence
(Violence Against Women and Girls)
• Gender-based violence (GBV) is a global pandemic that
affects 1 in 3 women in their lifetime.
• 35% of women worldwide experienced either physical and/or
sexual violence.
• Globally, as many as 38% of murders of women are committed
by an intimate partner.
• 200 million women have experienced female genital
mutilation/cutting.
September 25, 2019; The World Bank

6. UN Women Egypt
Prevalence Data on Different Forms of Violence against Women
• Lifetime Physical and/or Sexual Intimate Partner Violence :26 % (Ministry
of Health and Population, 2015).
• Child Marriage :17 % UNICEF global databases, 2018
• Female Genital Mutilation/Cutting :87 % UNICEF global databases 2017
Gender Equality Indexes:
• Gender Inequality Index Rank :135 UN Development Programme, Human Development
Report 2016.

8. Why men, in general, use force or violence
against women and girls
• Anatomical differences between men and women circumscribe
certain roles; e.g., women bear children, and men do not. Many roles
and restrictions arise from these biological differences.
• Men have traditionally benefited from discriminatory practices on a
financial level, and it can be hard for them to relinquish the power
that comes along with these benefits.
• Where women lack autonomy, decision making power and access to
income, many other aspects of their lives and health will necessarily
be outside their control.

9. Marie Curie
Cleopatra
Mother Teresa
Helen Adams Keller
Indira Gandhi
Valentina
Margaret Thatcher
Simone de
Beauvoir
Marilyn Monroe
UMM KULTHUM
Samira Moussa
Huda Shaarawi& Safia Zaghlul

10. The Second Sex
• The Second Sex is a 1949 book by the French existentialist Simone de
Beauvoir
• Beauvoir asks "What is woman?"
• She argues that man is considered the default, while woman is
considered the "Other": "Thus humanity is male and man defines
woman not herself but as relative to him.“
• The first French publication of The Second Sex sold around 22,000
copies in a week. It has since been translated into 40 languages.

11. On average, men and women differ psychologically in small
but reliable ways, such as in personality, interests, and
cognitive performance, but the basis of these differences is
up for debate.
Are they innate or due to how we’re socialized?

12. Life experience and brain plasticity
• Growth continues during birth, in childhood and our teenage
years, and beyond. Many neurons and cells are created very early
in development
• Neurons and pathways that are used are strengthened and
maintained and myelinated over time, which increases the speed
and stability of the signals.
• Connections between neurons are affected by practice, life
experiences and other nongenetic factors: Use it or lose it
 Example: Exercise increases muscle capacity, and practicing piano
increases skill levels. (Strengthening of networks in high use).
 In contrast, lack of practice leads to weaker muscle and loss of
skills.
This occurs through pruning and removal of unused connections.
This capacity of the brain and nervous system to change with
experience is known as brain plasticity.

13. Gender violence is a stress
• Gender violence is a continues stress across
women life cycle
• Coping reactions to stressful events as violence are
important links between difficult experiences and the
emergence of psychopathology.

14. WHO's typology 2013
Violence Throughout the life cycle
Phase Type of violence
Pre-birth Sex-selective abortion; effects of battering during pregnancy on
birth outcomes son-preference
Infancy Female infanticide; physical, sexual and psychological abuse
Girlhood Child marriage; female genital mutilation; physical, sexual and
psychological abuse; incest; child prostitution and pornography
Adolescence and adulthood Dating and courtship violence (e.g. acid throwing and date
rape);, incest; sexual abuse in the workplace; rape; sexual
harassment; trafficking in women; partner violence; marital
rape; dowry abuse and murders; partner homicide;
psychological abuse; abuse of women with disabilities; forced
pregnancy
Elderly Forced "suicide" or homicide of widows for economic reasons;
sexual, physical and psychological abuse

15. Content
Sexual
assault
Norms and
roles
Stereotypes
and prejudices
Attitudes
Sexual
Economical
Intimate partner
violence
Sexual Violence
Rape
Sexual
harassment
Physical
Psychological
Stalking
Trafficking in
human beings
Slavery
Sexual
exploitation
Harmful practices
Forced
marriage
Honour
crimes
Female
genital
mutilation
Online
harassment
Sexual abuse
online
Private life
Work
Community
Public space
Femicide
Violence against women has many forms and
takes place in different spheres

17. Gender violence and depression
Depression is strongly related to several interrelated factors:
• Perceptions of the self as inferior or in an unwanted subordinate
position, with low self confidence.
• Behaving in submissive or in non assertive ways.
• Experiencing a sense of defeat in relation to important battles, and
wanting to escape but being trapped
Feelings of autonomy and control significantly lessen the risk of
depression

18. Mental health consequences of violence
against women

19. WHO
Impact of gender violence
• The severity and the duration of exposure to violence are highly
predictive of the severity of mental health outcomes.
• Rates of depression in adult life are 3 to 4 fold higher in women
exposed to childhood sexual abuse or physical partner violence in
adult life.
• Following rape, nearly 1 in 3 women will develop PTSD.
• Gender-based violence is a significant predictor of suicidality in
women, with more than 20% of women who have experienced
violence attempting suicide.

20. WHO
Impact of gender violence
• There are no marked gender differences in the rates of
severe mental disorders like schizophrenia and bipolar
disorder that affect less than 2% of the population.

21. Sex differences in the prevalence of mental disorders
across the life-cycle
Male : female difference
Mental disorder
Life-cycle stage
Males >> Females
Males >> Females
Males >> Females
Males >> Females
Pervasive developmental disorder
ADHD
Conduct disorders
Learning disability
Childhood
Females >> Males
Females > Males
Females >> Males
Males >> Females
Depression
Deliberate self-harm
Eating disorders
Substance abuse
Adolescence
Females > Males
Males = Females
Males = Females
Males >> Females
Depression and anxiety
Schizophrenia
Bipolar disorder
Substance abuse
Adulthood
Females > Males a
Females > Males
Females >> Males
Dementias
Depression
Psychoses
Old age
> prevalence is approximately two- to threefold greater; >> greater than a threefold difference in prevalence.
a The difference in old age is likely to be due to the greater longevity of women.

22. Psychological abuse
• Difficult to define and to measure
• "Emotional abuse is any kind of abuse that is emotional rather than
physical in nature.
• Emotional abuse can take many forms verbal abuse and constant
criticism, intimidation, manipulation, and refusal to ever be pleased,
refusing to listen, refusing to communicate, and emotionally
withdrawing as punishment," dating and other intimate relationships
• The most common form is IPV

23. Psychological abuse and violence
• Long-term emotional abuse has long term debilitating effects on a
person's sense of self and integrity.
• Double standards in how people tend to view emotional abuse by
men versus emotional abuse by women.
• It can be in intimate relationships, in family and in the workplace

24. Psychological violence criminalization
• Norway (2017) and England (2015) criminalized psychological
violence, making it equally punishable as physical violence.
• No consensus about considering Psychological violence as a
traumatic experience? 2 opinions
Cannot be classified as a trauma, as it does not meet the first
criterion of diagnosing PTSD (i.e. threat to life or physical integrity)
Psychological violence can independently cause PTSD, depression
and anxiety.

25. Complex trauma disorder
• Psychological disorder in response to prolonged, repeated
experience of interpersonal trauma in a context in which the
individual has little or no chance of escape.
• Symptoms, which can include prolonged feelings of terror,
worthlessness, helplessness, and deformation of one's identity and
sense of self, persistent dysphoria, chronic suicidal preoccupation,
self-injury.

26. Why do women after spouse violence
stay (or return)?
• She has great fear of the abuser and has been intimidated.
oA male abuser may threaten if she leaves “I will get the kids.”
• Social or community pressure
• Economic Issues
• Wanting father present for children
• Love
• Sense of helplessness, passivity, loss of control, pessimism, negative
thinking, feelings of guilt, shame, self-blame and depression.

27. Splitting & emotional dysregulation
Psychological phenomenon that occurs in victims of trauma.
• According to the trauma model, anxiety and the experience of danger,
can lead to emotional (dysregulation) that in turn activates splitting as
a defense mechanism.
• Splitting may alter the individual’s self-perception that the victim
considers herself as worthless or responsible for the violent action.
• Emotional dysregulation can also lead to cognitive distortions which
may lead to negative mood states and dysfunctional behaviors.

28. Revictimization
• The victim of abuse has a statistically higher tendency to be victimized
again, either shortly or much later in adulthood
• Maladaptive learning; the initial abuse teaches inappropriate beliefs
and behaviors that persist into adulthood. The victim believes that
abusive behavior is "normal" and comes to expect, or feel they
deserve, it from others, and thus may unconsciously seek out
abusive partners or cling to abusive relationships.
• Another theory draws on the principle of learned helplessness. As
children, they are put in situations that they have little to no hope of
escaping

29. Physiology of Stress response
Two major systems that respond to stress
1. The autonomic nervous system
a. Sympathetic nervous system (sympathoadrenal medullary (SAM) axis ;
activate the fight-or-flight
b. Parasympathetic nervous system returns the body to homeostasis
2. Hypothalamic-pituitary-adrenal (HPA) axis
Regulates cortisol, influences metabolic, psychological and
immunological functions.

30. Sex differences in the circuitry activated by stimuli
with a negative valence
• Anecdotally, it is often remarked that women are more emotional
than men (lay community).
• Scientific evidence showed that women experience emotions,
particularly those with a negative valence (e.g., fear, anger,
sadness), with greater intensity than men.
• Women often engage in emotion-focused coping strategies and
report higher negative affect than men, characteristics that are
predictive of anxiety and depressive symptoms.
• Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms. Kelly MM, et al., Depress Anxiety. 2008;
25(10):839-46.

31. Sex differences in the circuitry activated by stimuli
with a negative valence
• Gender differences of negatively valenced emotional stimuli
revealed that women had greater activation of:
1) Corticolimbic circuits
2) Left amygdala (increase emotional responses to stress in women)
3) Anterior cingulate
4) Medial prefrontal cortex [1].
• Women have greater hippocampal activation than men when
encoding emotional words [2].
1. Sex differences in brain activation to emotional stimuli: a meta-analysis of neuroimaging studies.Stevens JS, Hamann S Neuropsychologia. 2012 Jun; 5
2. An fMRI study of the activation of the hippocampus by emotional memory.Bellace M, Williams JM, Mohamed FB, Faro SH Int J Neurosci. 2013

32. Gender differences of negatively valenced
emotional stimuli and depression
• More prevalent in women, they share three other features:
1. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis
2. Heightened reactivity to emotional stimuli with a negative valence
3. Hyperarousal
• Stress related depression found with features such as anger
attacks/aggression, substance abuse, and risk taking behavior.
• Depressed women ruminate ( recurrent negative thoughts) more
than men . These ruminations are associated with heightened arousal

33. Sex differences in the corticolimbic circuitry in
depression and PTSD
• Traumatic events or chronic stressor exposure have a greater
impact on the female brain, perhaps by initiating a
neuroplasticity that increases female vulnerability to stress-
related psychiatric disorders.
• Negatively valenced stimuli differentially activate corticolimbic
circuitry more in in women than in men
• Mezo PG, Baker RM. Stress Health. 2012 sex differences in brain arousal centers

34. Sex differences in prevalence of stress-related disorders
Lifetime Prevalence Ratio
Female Males Female:Male
Panic 6.2% 3.1% 2.0
Generalized Anxiety 7.1% 4.2% 1.7
Any Anxiety Disorder 36.4% 25.4% 1.4
PTSD 9.7% 3.6% 2.7
Major Depression 20.2% 13.2% 1.5
Any Affective Disorder 24.4% 17.5% 1.4
Alcohol Abuse 7.5% 19.6% 0.4
Drug Abuse 4.8% 11.6% 0.4
Migraine 18.2% 6.5% 2.8
Insomnia 12.9% 6.2% 2.1
Irritable Bowel Syndrome 14.5% 7.7% 1.9
Front Neuroendocrinol. 2014 Aug; 35(3): 303–319.

35. Diseases Related to Stress
• Hypertension
• Stroke
• Coronary Heart Disease
• Ulcers
• Migraine Headaches
• Tension Headaches
• Allergies
• Rheumatoid Arthritis
• Backache
• Asthma

36. Thank you