One in three women in the world has been subjected to physical or sexual violence by her husband or partner. To understand how high a proportion of one in three women is, imagine that every third woman you come across for 15 minutes while walking on the street experiences some form of violence. When psychological violence is added to the violence picture, the number of women who have been subjected to violence by the men they are with increases dramatically. In our previous article, we mentioned that directly experiencing physical injury or sexual violence is considered a traumatic experience in the psychiatric classification system. In this article, our aim is to define violence against women and to describe Post Traumatic Stress Disorder caused by such violence.explaining their problems will be to explain which approach will be effective in the psychological treatment of these women, based on who develops PTSD more.
Violence Against Women
Before defining violence against women, it would be useful to understand violence, which is a complex concept in general. Violence; It is an action that reveals the possibility or the possibility of injury, death, psychological harm, deprivation or developmental inhibition as a result of an individual’s physical force or directing some kind of pressure against himself, another person, a group or community . 1 This definition includes not only physical but also acts such as threats and intimidation, as well as accepting that the consequences of violence are not only physical. In accordance with this definition, physical , sexual , psychological and deprivation or neglect according to the types of acts of violencedivided into four categories. 2 The United Nations Declaration on the Elimination of Violence against Women states violence against women as “ any gender-based act, practice, or threat of such acts, coercion or use that results in or is likely to result in physical, sexual, psychological pain or suffering to women, whether occurring in public or private life. arbitrary deprivation of liberty ”. 3 Today, ‘ depriving women of economic needs ‘ is also included in this definition .
Scientific researches are conducted around the world on how often violence against women occurs. Reviewing 141 studies conducted in 81 countries, the World Health Organization reported that approximately one in three (30%) women over the age of 15 have experienced physical or sexual violence by their spouses or intimate partners at some point in their lives. 4 Another review summarizing 77 studies conducted in 56 countries showed that 7.2% of women over the age of 15 worldwide had been subjected to sexual violence by people with whom they were not in close relationships. 5
Post Traumatic Stress Disorder in Violent Women
It would not be wrong to say that the most common psychological problem in women who have experienced violence is Post Traumatic Stress Disorder (abbreviated PTSD ). We have described this psychological problem in detail in our previous article. Let’s take a look at how women who have experienced sexual and physical violence experience the symptoms of PTSD. A woman who has been subjected to physical violence by her husband and forced into sexual intercourse against her will may exhibit PTSD symptoms after living in an environment where security is provided.
Scenes of those who create the greatest threat to her safety and frighten her from among the violent incidents she has experienced involuntarily come to her mind and cause her to feel fear. Since remembering in this way feels like reliving the events, the woman makes an effort to banish these memories from her mind and tries to occupy her mind and herself with other things so that she does not remember them. For example, he tries not to be alone and tries to prevent memories from coming to mind by talking to others.
Items such as sticks, belts, hoses, knives used during violence, news of violence in the media and images of violence trigger feelings such as intense distress, fear and anger, as they remind them of the events they have experienced, and the woman continues her life by avoiding encountering them as much as possible. Similarly, in a significant number of women who have experienced sexual violence, their own bodies become a reminder of the event, and it is seen that these women often feel shame about looking at and touching their bodies. That’s why they undress in the dark, take a bath, and try not to let their bare hands touch their bodies while bathing. On the other hand, staying close with a stranger in a social environment (e.g. waiting next to each other at the bus stop, sitting next to each other on public transport, having a man in a waiting room), sleeping in the dark, Situations such as sitting alone at home create anxiety along with the perception of threat, and women who have experienced violence avoid such people, places and situations. Although it may seem like a self-protective behavior, this avoidance behavior prevents him from getting into situations that do not contain real threats, and this hinders his life.
Struggling with ongoing negative emotions, the woman has negative thoughts about security, people, and self-confidence. During the day, he waits on the alert in anticipation of threats, constantly watches around while walking on the street, locks the door in the room where he lives or sleeps, leaves the lights on, and keeps things around him that he can protect himself from if he is attacked.
When he goes to bed at night, he cannot fall asleep because of the memories of his experiences, fear and being alert with the perception of threat. The tiredness caused by lack of sleep for a long time, the preoccupation of his mind with memories, and the feeling of fear prevent him from concentrating and disrupt his work. Especially, women who have been subjected to sexual violence in childhood may exhibit self-harming behaviors such as cutting, injuring, burning themselves in order to reduce feelings such as fear, shame and anger.
Rates of PTSD in Violent Women in Turkey
Studies in Western countries show that experiencing partner violence increases the probability of PTSD four times and the probability of depression three times in women. 6, 7 In a study we conducted with 220 women who were subjected to violence by their relatives and settled in women’s shelters in Turkey, we found that women were exposed to 21 different stressors of physical, sexual and psychological violence (i.e. a type of violence that causes stress and distress) in an average of 11 years. 8
We found that almost half (48%) of these women developed PTSD and approximately one-third (33%) developed depression. Similarly, in two community-based studies conducted with 601 women who have experienced sexual violence such as rape, attempted rape, and unwanted physical contact by their relatives or strangers at some point in their lives, and 1012 women who have experienced physical, sexual and psychological violence in their close relationships, the rate of PTSD developing in these women is found to be 1%. We found it to be 50. 9, 10 The findings of all these studies indicate that one out of two women who have experienced violence in Turkey needs psychological treatment for PTSD.
Another important finding from these studies is that 85% of women have experienced psychological violence in their close relationships. Psychological violence;
- neglect of physical and emotional needs (e.g. ignoring feelings, insensitivity to sexual needs, disregarding opinions, hurtful criticism, etc.),
- restriction of freedom (e.g. controlling behaviors, interference with his clothing, preventing him from interacting with people),
- degrading behavior (e.g., belittling, belittling, mocking, etc.),
- threats to harm himself or his family (e.g., killing, spreading information, committing suicide, etc.),
- accusation (e.g. words that make you feel guilty for doing or not doing),
- distrustful behavior (e.g. cheating, lying)
includes behaviors such as In this study, it was observed that PTSD developed in one third (35%) of women who had not experienced any sexual or physical violence and had only experienced psychological violence. The prevalence of psychological violence and its negative effects on mental health shows that the concept of violence should be considered multidimensional and that all stressors that create a perception of threat can have a traumatic effect.
Fear, Helplessness and PTSD
The three studies mentioned above showed that women’s current fear of the perceived threat to their safety and feelings of helplessness to survive are the most important determinants of PTSD and depression. The fact that some women are not yet divorced/separated, their spouses/partners stalking them and receiving threats from them can make them feel a realistic threat.It makes them feel under. On the other hand, it can be said that even though the realistic threat disappears to a certain extent, many women are afraid of what they have been through, their anxiety about re-experiencing similar events, and the avoidance behaviors they engage in to reduce these fears and anxieties maintain the perception of threat. As a matter of fact, 65% of women living in women’s shelters stated that they were afraid of experiencing the same events again, and 38% said that they could not return to their normal lives because of fear. In addition, we determined that women avoid an average of 13 situations, environments, people and places that remind them of the events they have experienced, and that these avoidance behaviors are closely related to their current fear and general feelings of helplessness due to threat perceptions.
Psychological Treatment of Violent Women
The fact that the fear related to the current threat perception and the feelings of helplessness to continue their lives are the most important factors determining PTSD and depression in women exposed to violence sheds light on the psychological treatments that should be used in these women. Psychological therapies that will help survivors of violence overcome their ongoing fears and develop control over their lives by empowering them after providing security are expected to be effective in the recovery of PTSD and depression. It should not be forgotten that the fear that must be overcome is the fear that is triggered in unrealistic situations (eg, the object, situation, place that reminds them of the events they have experienced), which causes women to lose control over their lives and limits their functionality. The most beneficial treatments for overcoming this fear aretrauma-focused psychotherapies . Providing the necessary material and moral support to women whose fear is increased and their perception of control increases to rebuild their lives will be an approach that will empower these women psychologically.
