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Migration and Transcultural Aspect of Sexual Abuse of Children and Adolescents

  • Cooperative State University Baden-Württemberg


Sexual abuse toward children and adolescents is a global public health and human rights concern. Despite being a crime in most countries, and with well-known physical and mental health consequences, the majority of sexual offences are not reported. Child and adolescents sexual abuse is a maltreatment form characterized by contact or noncontact acts perpetrated by adults or older children toward younger children who have little power to resist. This overview aims to understand the social context of child sexual abuse, and the perceived roles of parents, community, and key professionals in handling such incidents of children and adolescents with a migration background.
Migration and Transcultural Aspect of Sexual Abuse of Children and
Jan Ilhan Kizilhan*
Department of Transcultural Psychosomatic, Cooperative State University Baden-Württemberg, Institute for Psychotherapy and Psych traumatology, Villingen-
Schwenningen, Germany
*Corresponding author: Jan Ilhan Kizilhan, Department of Transcultural Psychosomatic, Cooperative State University Baden-Württemberg, Institute for Psychotherapy
and Psych traumatology, Villingen-Schwenningen, Germany, Tel: +497113206600; E-mail:
Rec date: November 10, 2017; Acc date: December 08, 2017; Pub date: December 11, 2017
Copyright: © 2017 Kizilhan JI. This is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
Sexual abuse toward children and adolescents is a global public health and human rights concern. Despite being
a crime in most countries, and with well-known physical and mental health consequences, the majority of sexual
offences are not reported. Child and adolescents sexual abuse is a maltreatment form characterized by contact or
noncontact acts perpetrated by adults or older children toward younger children who have little power to resist. This
overview aims to understand the social context of child sexual abuse, and the perceived roles of parents,
community, and key professionals in handling such incidents of children and adolescents with a migration
Keywords: Sexual abuse; Migration; Child and adolescents;
Intervention and prevention
Sexual abuse of dependents, particularly of children, is a taboo
subject in the majority of societies [1]. However, it is an issue which
has always preoccupied us, in every culture with diering prevalence
rates, explanations of the causes and the manner in which it should be
handled [2-4].
Whereas research and the public have increasingly addressed this
issue in the Western world in the last thirty years, this same interest is
not to be observed in non-industrialized countries and the Islamic
world [5]. e reaction of the population, social institutions and health
profession in, for example, Iran, to a degree in Turkey, in Arabic
countries, India or even former Soviet republics bear witness – with a
few exceptions – indicates attitudes ranging from little interest in the
suering of victims to a hostile rejection of those aected [6-8]. With
the global migration in the last decades and the ethnic, religion and
national and international conicts like war and ights in Iraq and
Syria the risk of many forms of violence increased [9]. For this and
another reason people are forced to ight from their homeland to a
dierent country in the world. Women and girls, travelling alone or
female headed households with children are particularly vulnerable to
sexual violence [10,11].
A study in 2014 estimated that around 21% of women in 14 conict
countries reported sexual violence [12]. Refugee child and women are
aected by sexual violence not only in areas of conict but also on their
journey to and once they arrive in western countries [13]. eir
cultural perceptions of family and religion, individual biographies and
migration histories possibly make it dicult for them to confront the
issue of the sexual abuse of children and adolescents, both in public
and in institutions. is makes it dicult to develop and implement
concepts for prevention and intervention [13].
We therefore wish to provide an overview in this article of migration
and its causes, the psychosocial situation of dierent migration
generations and the issue of the sexual abuse of children and
adolescents with a migration background, along with a picture of
prevalence rates and options for prevention and intervention. As the
majority of people with a migration background in Europe has a
Muslim background (according to information approximately 7
million Muslims live in Europe), the focus of our attention in this
article is the (inter)cultural factors of sexual abuse among people with
an Islamic background [14].
Migration not only entails an environmental transition from one
place of residence to another, but also a change in external living
conditions, the working and accommodation environment and
associated social and cultural changes [15]. e eects of this are not
only governed by the extent of change. e causes of migration (war,
ethnic and religious conicts, oppression of democratic movements,
environmental exploitation, ight and trauma, natural catastrophes
and epidemics, international economic globalization, poverty and
cultural conicts, etc.) and individual controllability of these factors
play an important role in this respect [16].
Biographic change inuences both individual and collective identity,
the manner in which the past is dealt with and adaptation in the host
country to a considerable degree [17]. How this new life phase is
shaped depends on individual and collective coping mechanisms and
the options to avail of social networks [18]. e building of a new
relationship network in another cultural, ethnic and social context
demands new social resources, a completely new orientation and a new
competence to take necessary actions [19,20].
Migration can therefore be regarded as a life event complex
encompassing numerous interlinked factors and processes specic to
migration (changes, demands and permanent strains) and which,
among other things, depends on the nature and type of migration [16].
ISSN: 2167-1222
Journal of Trauma & Treatment
Kizilhan, J Trauma Treat 2017, 6:5
DOI: 10.4172/2167-1222.1000408
Review Article Open Access
J Trauma Treat, an open access journal
ISSN: 2167-1222
Volume 6 • Issue 5 • 1000408
Refugees generally migrate due to coercion or out of political
necessity. Many adult refugees and children in this context have been
exposed to numerous burdens such as war, torture and ight, sexual
violence and abuse [13].
Family Structure
People from traditional family-oriented societies in particular
experience considerable stress at the beginning of their stay in the
migration countries of the western world’s [20]. In contrast to an
individualistic society, a traditional society binds the individual
strongly into a group structure which, on the one hand, provides
protection but, on the other, demands a high degree of loyalty [21,22].
People from traditional rural regions are generally characterized by
a collective mind-set in which the personal wishes, interests and
complaints of an individual member are regarded as secondary.
Harmony and security within the family and peer group are
considerably more important than individual autonomy [23]. e
individual regards him or herself as part of a solidarity community
from which corresponding tasks and obligations arise. His or her main
purpose is to ensure that the solidarity community, and in particular
the core and extended family, is not prejudiced or harmed in any way.
It is therefore logical that personal feelings and complaints should not
be expressed to prevent any possible burden or harm to the family [24].
Hence, relationship structures exist in traditional families which
involve strong interpersonal bonds characterized by deeply collectivist
values [23]. As in all rural communities in Southern Europe and Asia
Minor, the family represents a reliable and eective protective
association in Turkish society. Internal family cohesion is developed to
a far greater degree than in Western European families and acts as an
orientation benchmark in times of great psychological, psychosocial or
economic stress.
However, family support is not always the equivalent of emotional
and instrumental support [25]. During the course of adaptation to the
new living conditions in the host country, family roles are frequently
redistributed, leading to intergenerational conicts which place a
burden on family relationships [26-28].
Customs, values, rules and standards are put to the test in the new
environment, and new ways need to be found to deal with these.
Persistent ambivalence and discord can be the consequences [27]. For
many people, migration also means at least a temporary separation
from that part of the family le behind in the home country and from
acquaintances, friends and supportive social networks [20].
Sexual Abuse of Children and Adolescents with a
Migration Background
When there is a danger of being ostracized by one’s own social
community, sexual abuse as a child and, frequently, also as an adult is
oen impossible to deal with. Feelings of guilt and shame, such as
perceptions of responsibility for the abuse, lack of honor, and loss of
self-worth, inuence disclosure [29].
e concealment of sexual abuse in traditional cultures (e.g. in
Islamic cultures, due to specic religious beliefs regarding sexuality)
can contribute to the development of psychological illnesses as, among
other reactions, sanctions and social exclusion can be expected. Hence,
according to Islamic belief, it is the duty of a woman to enter into
matrimony as a virgin. Virginity is equated with the integrity of the
hymen. Anything else would oend the honour of her family. As a
consequence, many young girls and women oen conceal an abuse of
this nature. e fear of being ostracized by one’s own family makes it
dicult for those aected to conde in a family member or even a
stranger, whether male or female [30].
Some children still suer from depression, trauma and personality
disorders with a risk of suicide many years aer the abuse has taken
place. For example [22] established that, in addition to a trauma
disorder, young migrant girls developed an obsession with washing
following a rape, because they considered their bodies to be unclean
and, consequently, spent several hours every day cleaning it [31]. One
reason among others for this behaviour was that the girls had learnt as
children to perform certain rituals, including washing, prior to daily
prayers, as prescribed in Islam. e dysfunctional conviction that the
body is unclean reinforces this [32].
Shame and Guilt Culture in Islam
To the Western mind, guilt can be understood to be an action or
behavior which is perceived as unjust. e event or occurrence itself
induces feelings of guilt, regardless of the nature of the relationship
between the perpetrator and victim. An admission of guilt and, where
possible, redress may ensue as compensation for perceived guilt [33].
In addition to the act itself, the possible loss of face in the
community in particular plays a signicant role in a shame culture.
e victim can, for example, develop a high level of shame following an
incident of sexual abuse because, rstly, he or she was not in a position
to prevent it and, secondly, this abuse results in the victim’s own family
appearing weak in the eyes of the community because it was not able
to protect the victim. e feeling of having put the family in a dicult
situation as a consequence leads to feelings of perceived “disgrace” and,
not least, also to suicide or suicide attempts by the victims.
at which is regarded as appropriate behavior is not decided by the
individual in the shame culture, but by the community. For this reason,
the thoughts and deeds of an individual are always linked to the
question of the signicance and consequences this can entail for his or
her community [33]. e culture is characterized by this group
orientation and, as a consequence, so is relationships, the interaction
with others, the shaping of conict and psychological processing
In the guilt culture, dierent individual behavior is more likely to be
tolerated than in shame cultures, even if it is inappropriate from a
cultural point of view. Shame cultures regard a possible individual
transgression of prescribed standards as an aront to the community
In addition to psychosomatic ailments which are depicted and
experienced dierently, depending on the specic culture [20,26],
studies have also reported symptoms such as pains aicting the head,
throat, stomach and lower abdomen without discernible organic
causes in children without a migration background. Eating and sleep
disorders, speaking diculties, choking seizures and speech disorders
may also be involved. Sexually abused children who still live in the
family with the perpetrator (male or female) suer particularly
severely from sleep disorders and nightmares, as the abuse here
primarily occurs at night [36].
From an overall societal and political point of view, increasing
incidents of violence motivated by racism are a further aspect which
should be taken into consideration [37]. However, empirical data on a
correlation between sexual violence and violence motivated by racism
Citation: Kizilhan JI (2017) Migration and Transcultural Aspect of Sexual Abuse of Children and Adolescents. J Trauma Treat 6: 408. doi:
Page 2 of 7
J Trauma Treat, an open access journal
ISSN: 2167-1222
Volume 6 • Issue 5 • 1000408
has not yet been compiled to an adequate degree. In war zones, such as
in African and Asian countries, but also during the war in former
Yugoslavia, sexual violence was in part perpetrated against children by
military and paramilitary units in a systematic fashion [36].
Simultaneously, the sexual abuse of children also appears to be an
overall societal problem, as indicated by examples in India which
include the case of a young woman in 2012 who was raped by several
men on a bus, an incident which has captured wide public attention.
e latest study from Human Rights Watch (2013) assumes that 7,200
children are raped in India every day, but the number may be
considerably higher.
Prevalence and Indication Rates
In meta-analyses, which included data from 331 studies
representing nearly 10 million individuals could show that the
prevalence of sexual abuse was 11.8%, with 7.6% of males and 18% of
females. In this analysis, Asia reported the lowest combined prevalence
for both boys and girls, while Africa had the highest prevalence for
boys and Australia the highest prevalence for girls.
Special studies on prevalence and indication rates of sexual child
abuse among migrants of both sexes have to date not been conducted.
However, in a representative sampling of 11,428 individuals all over
Germany aged between 16 and 40, migrants of both sexes were also
asked if they had been victims of dierent crimes and, in particular,
sexual abuse [38]. In this study, almost 20% of those surveyed had a
migration background (10.1% Turkish, 9.6% Russian).
In the case of those individuals with a migration background, it is
noticeable that, in comparison to the sampling of Germans, reports of
experiences of abuse among women with a Turkish migration
background are, in particular, considerably fewer. Whereas, for
example, 7.3% of the German women reported abuse with physical
contact up to the age of 16, this was only admitted by 1.7% of the
Turkish women. e value for women with a Russian migration
background was 6.5% (Table 1). e Russian women had been victims
of exhibitionist acts before the age of 16 more than 1.5 times as oen as
those women without a migration background surveyed [38]. In a
comparison of all abuse categories, women with a Turkish migration
background are most rarely aected by sexual abuse. 3.4% of these had
experienced at least one form of sexual abuse, whereas this applied to
10.2% of those surveyed without a migration background and 12.2%
with a Russian migration background. e number of male individuals
in all three groups is considerably less when compared to female
Variables No migration
With Turkish
With Russian
Acc. to Bienek
et al.
Males Females Males Female
Victims of
hands-on acts
7.3% 1.2% 1.7% 0.7% 6.5% 1.2%
Victims of all
10.2% 2.3% 3.4% 1.2% 12.2% 2.2%
Table 1: Prevalence and indication rates of sexual child abuse among
migrants of both sexes.
Whether the comparatively low prevalence rate of sexual abuse
among those surveyed of Turkish origin can be related to the fact that,
due to traditional cultural perceptions of “honour” and possibly the
fear of being ostracized by their own family and the Turkish
community, they have a higher inhibition threshold and sense of
shame about admitting to this experience in a questionnaire is an
aspect that deserves discussion [39]. Whether other factors (e.g.
unfamiliarity with questionnaires) could be the cause of any possible
reticence on the part of those surveyed is another question which
cannot be answered conclusively. A further consideration is that this
group is also probably exposed to fewer risk situations outside the
family, due to the strict supervision of and close relationship to the
family, and this would explain the low prevalence of abuse with
physical contact of women of Turkish origin outside the family.
However, there are indications that perpetrators are not named
within the immediate family because of the reasons already described.
Many of the victims are married within the extended family (e.g.
female cousins to male cousins, etc.) and therefore remain under the
control of the collective without any possibility of professional helpers
(of both sexes) gaining access to them [40].
High-risk sexual abuse groups include in particular unaccompanied
underage refugees, children of illegal immigrants and children from
war zones who, in their home country, while eeing and, also, in the
host country have no signicant protection and rapidly become
victims of sexual abuse [39,41].
Prevention and Intervention
Prevention aims to prevent sexual violence through appropriate
measures. ere is no sure method of protecting a child, but favourable
educational inuences can aid prevention. ese should also take
specic cultural aspects into consideration when working with
individuals with a migration background [42].
Prevention primarily means focusing on families, schools, the social
environment (e.g. migrant associations and mosque communities) and
the political sphere. Special programmes in kindergartens and schools
could address culturally sensitive issues such as religion, the role of the
family and ways in which children could conde in their child care
workers and teachers of both sexes. It should be explicitly emphasized
in this respect that sexual abuse of children can be perpetrated by one’s
own family members but, at the same time, measures should be taken
to avoid unsettling parents and children. e primary focus, however,
should be on strengthening children in terms of their rights and
competences and their self-condence in exerting these [43]. Taking
specic cultural aspects of the family structure into account,
consideration should be given to whether, in addition to children and
parents, older sisters could, for example, be involved, because they
probably have an adequate mastery of the German language, are
socialized in Germany and, in addition, are more likely to be a partner
in which their younger sisters will conde more readily than in their
own mother, as they do not wish to cause sadness to the latter and
because they fear punishment, etc. Moreover, they frequently have a
greater knowledge of sexuality than their parents who, possibly, have
themselves never been adequately enlightened or, due to their
traditional upbringing, rarely speak about sexuality with their children.
Strong family cohesion and possible “family secrets” make it dicult
for children to speak to strangers – including child carers of both sexes
Citation: Kizilhan JI (2017) Migration and Transcultural Aspect of Sexual Abuse of Children and Adolescents. J Trauma Treat 6: 408. doi:
Page 3 of 7
J Trauma Treat, an open access journal
ISSN: 2167-1222
Volume 6 • Issue 5 • 1000408
and teachers. Issues such as guilt, shame, sexuality and the fact that
adults, including the parents, are not permitted to violate the rights of
children should be discussed with children and their family members,
particularly the parents. is approach should also involve the
addressing of violence against children, but also domestic violence, as
structural violence, war and the glorication of violence in the media
still exist in many countries from which migrants of both sexes
originate, and violence can also be regarded as a method of education
in such countries [44].
It is important during this initial step that state assistance systems,
institutions oriented towards specic cultures, professional helpers,
education, multiplicators of both sexes with a migration background
and, possibly, migrant associations be involved, both in the overall
strategy and with each other. Information material in dierent
languages is also necessary for parents and those aected who have an
inadequate knowledge of the German language. Seminars and
workshops from migrant associations and state institutions involving
experts of both sexes, children and their families are particularly
eective in terms of prevention. Child carers, teachers and other
professionals of both sexes involved in these measures should be
trained with an adequate sensitivity towards cultural questions [45].
Appropriate perpetrator therapy programmes designed to prevent
further abuse are also part of initial preventive measures. However, the
primary objective is to enable girls and boys to protect themselves
against sexual abuse [46].
A further step aims to detect existing abuse in good time and bring
it to an end. Interventions contribute in this respect and help those
aected to deal with the experience of sexual abuse in the long term.
Only where these measures are not eective and children have
already been victims of sexual abuse is it necessary to alleviate the
consequential damage through counselling and treatment. Children
should be helped insofar as they are enabled to deal with these
traumatic incidents and allow them to shape their lives in a reasonably
satisfactory manner.
Intervention measures involving an adequate knowledge of the
cultural background should ensure that concrete cases of sexual abuse
are terminated as quickly as possible. In addition to moderating and –
insofar as possible osetting the negative consequences for the
victim, meaning those children and adolescents aected and family
members not involved in abuse, they should also counteract later
revictimisation. Perpetrators of both sexes should be prevented from
committing further acts.
Naturally enough, intervention can only be eective if culturally
sensitive assistance systems exist and if those aected are aware of and
can take advantage of these. In the case of children and adolescents
with a migration background in particular, careful evaluation would
indicate that this is only the case to a very limited degree. Even gaining
access to migrant families with traditional perceptions and beliefs is
extremely dicult. As already explained, sexual abuse may be
concealed to “protect the collective” and due to the fear of being
ostracised. Parents forbid their children to speak about it. During
medical examinations of, for example, incessant abdominal pains, or
conducted later due to behavioural disorders (aggression, self-inicted
injuries, depression, anxiety, etc.), the reasons for these ailments are
not mentioned [39].
During counselling and therapy discussions, the use of interpreters
of both sexes may be necessary, due to limited knowledge of German.
However, these should not come from the same social community
because, rstly, the family is ashamed to talk about the issue and,
secondly, interpreters, both male and female, could possibly pass on
this information to others. In addition, the interpreter should be
trained to translate technical terms used by doctors and therapists
which do not exist in the respective foreign languages. Interpreters do
not receive any remuneration in many areas of the German counselling
and health system.
Children and adolescents with a migration background who have
been born and grown up in Germany generally speak German well
and, when approached with adequate cultural sensitivity and
appropriate tools, prot from therapy.
Cultural aspects in psychotherapeutic treatment
Regardless of the culture or generation patients of both sexes come
from, the fundamental principles of eective psychotherapy are,
irrespective of these factors, always the same and encompass empathy,
appreciation and a fundamentally open attitude on the part of those
involved in treatment and counselling. is applies to both children
and adults.
ose involved in treatment are traditionally regarded as a motherly
or fatherly friend of the family. ey represent a gure of authority
who cultivates an active, knowledgeable and counselling acquaintance
with the male or female patient and his or her family. e
psychotherapist should accept this cultural transfer” if, for example,
he or she wishes to avoid provoking considerable insecurity. In contrast
to indigenous patients of both sexes, where the mobilizing of one’s own
potential is paramount, this patient group expects greater help from
the authority, and this should be oered. However, this means that the
psychotherapist also needs to develop an awareness of his or her own
cultural identication. He or she should be capable of appreciating his
or her own capacity to engage in this transfer with the patient (whether
male or female) and discerning his or her individual and social
prejudices and stereotypes which arise as collective transfers,
neutralising these in as far as possible before they have a destructive
eect during treatment. Only aer this is it possible to encourage a
readiness on the part of the male or female patient to achieve a
behavioural change on a psychological and physical level.
Eective counselling and treatment also involves the precise analysis
of problem behaviour, the development of an explanatory model and
the denition of common goals. However, there is a particular need in
the case of clients of both sexes with a migration background to
demonstrate intercultural competence and a culturally sensitive
approach to avoid misunderstandings and irritation.
In the case of individuals with a traditional orientation, it is
important to respect their special cultural traits in this context right
from the outset of treatment and counselling when, for example, it is
necessary to explain the correlations between body and mind. For
instance, physical ailments should not be simply reduced to
psychological conicts, even where it is known that the patient
frequently complains of non-specic symptoms. Children and
adolescents in particular among the victims of abuse from other
cultures frequently complain of diuse and ambiguous abdominal
pains without mentioning abuse.
Citation: Kizilhan JI (2017) Migration and Transcultural Aspect of Sexual Abuse of Children and Adolescents. J Trauma Treat 6: 408. doi:
Page 4 of 7
J Trauma Treat, an open access journal
ISSN: 2167-1222
Volume 6 • Issue 5 • 1000408
e sense of shame and physical integrity in Islam
e Islamic faith inculcates an understanding of physical integrity
and intimacy based on a strong sense of shame which has moral and
practical implications for the lives of individuals. is results in a
desire to cover the body in a special manner, to protect oneself from
the gaze of others and avoid physical contact with non-relatives and
unmarried members of the opposite sex (cf. Sure 24/30-31, Sure
33/59). A woman is obliged to cover the entire body almost completely,
with exceptions only being made for the hands, feet and face.
e sense of shame possibly also inuences individual decisions and
behaviour during counselling and treatment, with, for example, the sex
of the doctor or therapist assuming an important role.
A case of illness represents an emergency situation in many
respects, but this also applies to the search for support and help,
particularly in the case of sexual abuse of children and adults. is
leads to the possibility of a partial or temporary suspension of the
Islamic rules which otherwise apply in daily life. Professional helpers of
both sexes should take advantage of this in the interest of male and
female clients.
It is imperative that physical ailments which occur frequently be
taken seriously, and the application of medical diagnostics which,
fundamentally speaking, follow the principles of somatic medicine is
also important for the self-perception of patients of both sexes and
imparting to them a sense that they are being taken seriously.
Simultaneously, in the case of an obviously reactive or psychosomatic
background, one should avoid the hopeless path of the never-ending
and, equally, encumbering instrument-based diagnostics of modern
medicine. Instead, treatment professionals should endeavour to nd an
honorable retreat from the symptomatology which is reconcilable with
the illness concept of the patient, whether male or female. Positive
experience in cases of dissociative paralysis has been gained with, for
example, the suggestive use of physiotherapy and appropriate exercise
treatments. Similar success has been achieved through relaxation
techniques in dierent pain symptomatology cases.
However, the parents of aected children are primarily responsible
for bewailing the distress of the victims and, for example, mix the
suering of the child with family diculties and cares. erefore, a
generous portion of patience is oen required if correlations are to be
understood, the subjective view of the parents appreciated and to win
their cooperation over in order to oer eective help to the client,
whether male or female. A recapitulation of the migration history of
the family realized together in advance generally makes this easier.
Misunderstandings may also arise out of dierent perceptions
regarding, for example, the approach to therapy. e parents or legal
guardians of aected children from traditional societies are oen
unfamiliar with the idea of working together with the therapist and,
possibly, the child to develop a model for explaining ailments and
involvement in treatment. Instead, they tend rather to expect the
professional helper to identify the reasons for ailments and illustrate
dierent assistance options. It is therefore even more important to
explain the type of and procedure involved in support or treatment
right at the outset. Clients value characteristics such as understanding
and patience, politeness and candidness more than the specialized
knowledge of a counsellor or therapist of either sex. Counsellors or
therapists of both sexes should take the need for harmony into account
and demonstrate respect for the family hierarchy, without
compromising their professionalism. e central role of the family
should, in particular, be taken into consideration with regard to the
rst generation.
Another important issue is the fact that the German health system
still demonstrates deciencies in the degree to which it has adapted to
the needs of individuals with a migration background [43]. ese
deciencies include the absence of treatment and counselling services
which address the needs of native languages and specic cultural
aspects. In particular, children and adolescents from war zones who
have been traumatized to a complex degree, including as a result of
sexual abuse, require trained interpreters of both sexes who can
cooperate with male and female trauma therapist and counsellors in an
atmosphere characterized by cultural sensitivity [44].
Conclusion and Considerations
Considerations of specic cultural aspects during therapy
I. Medical and psychotherapeutic aspects
During initial contact, ailments reported by clients of both sexes can
be limited to physical pains and characterized by a xation on these.
e existence of possible psychological conicts and stress can be
initially rejected or denied. Limited knowledge of the German
language can complicate the anamnesis.
e feeling of not been taken seriously enough with regard to
ailments can even strengthen the xation on these (e.g. multiple,
recurrent, uctuating physical symptoms experienced on changing
bodily organs). Abdominal pains are not only encountered frequently
among children, but also aict adults.
A comorbidity with other psychosocial ailments is frequently
encountered. Many clients of both sexes fail to identify a possible
correlation between disorders, or have up until now not been
adequately informed about these.
Psychoeducative measures and information on sexual abuse,
violence, prevention and intervention should be adapted to the culture
of origin of male and female clients and made available to them.
e involvement of family members can be important for both
diagnosis and the treatment and counselling process with regard to
resources, family dynamics, etc. e family can be involved in a
supportive role during treatment and counselling when it comes to
improving skills in the sense of social competence and resources.
Treatment through medication, operations or physiotherapy
measures can, from the point of view of the male/female client or the
parents of the children, appear to be initially adequate.
II. Social aspects
Linguistic problems (language barriers, the use of male/female
interpreters and payment by health insurance providers)
Adequate knowledge of dierences of a cultural nature (e.g. the
role of family members in collective societies)
Improvement of psychological problems specically related to
migration (generation conicts, integration, etc.)
Improved rights in host societies (e.g. restricted living space,
minimum nancial
support of unaccompanied refugee children and adolescents)
Citation: Kizilhan JI (2017) Migration and Transcultural Aspect of Sexual Abuse of Children and Adolescents. J Trauma Treat 6: 408. doi:
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Facilitating of family reunication (particularly where children are
involved who have already been exposed to warlike or structural
threats and violence in the country of origin or another state).
III. General provision structures
Timely initial identication of vulnerable male/female clients.
e oering of a basic range of psychosocial services (counselling,
low-threshold service oer) for children and adolescents suering
from psychological stress, but also adult victims of sexual violence.
e provision of psychotherapy and counselling services by
persons with special knowledge and skills.
Treatment professionals and counsellors of both sexes trained in
the mother tongue with the undertaking of diagnostics suited to
the specic culture.
Improvement of treatment options for children and adolescents of
traumatized refugees without residence security within regular
health care structures.
Psychiatric and psychosomatic clinics with adequate transcultural
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J Trauma Treat, an open access journal
ISSN: 2167-1222
Volume 6 • Issue 5 • 1000408
... Anhaltende Ambivalenz und Zerwürfnisse können die Folge sein (Haasen und Yagdiran 2000). Für viele bedeutet Migration auch eine zumindest vorübergehende Trennung von dem Teil der Familie, der im Heimatland zurückbleibt, von Bekannten, Freund_innen und unterstützenden sozialen Netzwerken (Kizilhan 2017). ...
... ewalt oder Drohung von mindestens einer Person erzwungene Ehe. In der Regel geht sie mit dem Einverständnis der Eltern einher, die z. B. die Tochter oder den Sohn zu einer Heirat zwingen. Die Zwangsverheiratung ist unabhängig von religiösen Vorstellungen. In patriarchalischen Kulturen sollen solche Ehen dem Kollektiv, etwa der Familie, nutzen (vgl.Kizilhan 2017). Als eine andere Art von "Zwangsheirat" kann eingeordnet werden, wenn Frauen und Männer durch das deutsche Staatsangehörigkeitsrecht dazu gezwungen sind, Ehen aufrechtzuerhalten obwohl ihnen Gewalt oder sexualisierte Gewalt darin widerfährt -weil sie keinen eigenständigen Aufenthaltsanspruch haben.3.1. Folgen sexuellen Missbrauchs bei K ...
... 11,12 This is often because those affected tend to conceal their traumata because of shame and feelings of guilt, but also out of fear of being ostracised by their native community. 13,14 Among individuals who have experienced trauma with body contact, especially in the area of sexual violence, shame plays a particular role in the development of peritraumatic or post-traumatic symptoms, [15][16][17] and is linked to prolonged clinical problems. 18 Emphasising the central affective role of shame, 19 it has been suggested that PTSD, which often results from repetitive victimisation, especially sexual violence, can be conceptualised as both trauma disorder and shame disorder. ...
Background Survivors of Islamic State of Iraq and Syria (ISIS) captivity are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD). Aims This study looks at the correlation between sexual abuse, shame, somatoform or bodily distress disorders, and dissociative seizures (psychogenic non-epileptic seizures). Method The psychological effects of traumatic events and dissociative seizure were assessed in Yazidi women who were held captive by ISIS in Northern Iraq between 2014 and 2018. These effects were examined comparing 64 women who were held captive and sexually abused by ISIS with 60 women suffering from PTSD who were not held captive and sexually abused by ISIS. Structured clinical-psychological interviews and established psychometric questionnaires were used to assess mental disorders especially dissociative seizures and somatoform disorders, and shame related to trauma. Results Women who were held captive by ISIS showed a significantly higher prevalence of dissociative seizures (43.7%; P = 0.02) and somatisation disorder (38.7%; P = 0.02), as well as depressive (75.0%; P = 0.42) and anxiety disorders (62.5%; P = 0.44), than women who were not held captive and sexually abused by ISIS. Dissociative disorders were identified in 40.6% (P = 0.36) of those female Yazidi who experienced sexual violence while being held captive. Conclusions Shame in connection with sexual violence seems to play an important role in negative self-perception after rape. Dissociation not only plays an important role in unprocessed childhood trauma with feelings of shame, but also in more recent trauma experiences with shame.
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Patients from traditional-collective Middle-East cultures have a different understanding of pain and other healing expectations, even in contact with the doctor and psychotherapist, for example, as patients in individualized Western societies. This has not been considered enough in modern multimodal therapy, especially in psychological pain treatment. The pain experience is not limited to a part of the body, but needs to be seen holistically related to the body and the patients can refused any activities, like sports. The slightly access to psychological illness often leads to diffuse and chronic pains. For therapy and the therapist-patient-relationship, it is essential to understand the significance of the experienced pain in interpersonal relationships and cultural, social, collective psychological terms.
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p> Background and Objectives: The study examines the extent to which a link exists between forced marriage and the frequency of mental illness. Methods: Female migrants both in forced marriages and not in forced marriages with a Turkish background were compared in psychosomatic clinics in Germany with regard to their psychological complaints. Results: Turkish women in forced marriages suffer from mental health problems with signifi cantly greater frequency and, on average, have attempted suicide at least four times. Conclusion: They suffer the consequences of a forced marriage for their entire lives, and they require special psychosocial counselling and both medical and therapeutic treatment which takes specifi c cultural and migration aspects into consideration.</p
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In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply ‘tunnel vision’. They ignore: a) frequently occurring types of sexual violence, b) victimisation rates across genders and c) specific risk factors within the EU such as migrants’ legal status, gender orientation and living conditions. The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an ‘outsider’ and ‘female only’ issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders. Résumé En Europe, les réfugiés, les demandeurs d’asile et les migrants sans papiers sont plus vulnérables à la victimisation sexuelle que les citoyens européens. Ils rencontrent davantage d’obstacles pour obtenir des soins. Cet examen des publications analyse comment les cadres juridiques et politiques aux niveaux national, européen et international conditionnent la prévention et le traitement de la violence sexuelle touchant ces communautés migrantes vulnérables qui vivent dans l’Union européenne (UE). À l’aide de la méthode de synthèse interprétative critique, nous avons recherché des éléments sur la violence sexuelle dans 187 documents juridiques et politiques et 80 articles publiés dans des revues à comité de lecture sur la santé sexuelle des migrants. Parmi ces documents, nous avons également analysé les 37 articles juridiques et 12 articles de revues à comité de lecture qui traitaient spécifiquement de la violence sexuelle chez les migrants vulnérables dans les 27 pays de l’UE. Les documents politiques et juridiques abordant la violence sexuelle, en particulier, mais pas exclusivement chez les migrants vulnérables, appliquent une « vision étroite ». Ils ignorent : a) les types fréquents de violence sexuelle ; b) les taux de victimisation entre sexes ; et c) les facteurs spécifiques de risque au sein de l’UE, comme la situation juridique des migrants, leur orientation sexuelle et leurs conditions de vie. Actuellement, le paradigme politique de l’UE confine la violence sexuelle chez les migrants vulnérables à une question « extérieure » et « uniquement féminine », alors que les politiques de l’UE en matière de migrations et d’asile renforcent son invisibilité. Pour être opérante, la riposte doit être guidée par des politiques participatives à base factuelle et fondées sur les droits, et par une approche de santé publique, et elle doit reconnaître la réalité et la multiplicité de la victimisation sexuelle des migrants vulnérables de tous les sexes au sein des frontières de l’UE. Resumen En Europa, refugiados, solicitantes de asilo y migrantes indocumentados son más vulnerables a la persecución sexual que la ciudadanía europea. Enfrentan más retos cuando buscan atención médica. Esta revisión de la literatura examina cómo los marcos jurídicos y políticos a nivel nacional, europeo e internacional condicionan la prevención de y respuesta a la violencia sexual que afecta a estas comunidades de migrantes vulnerables que viven en la Unión Europea (UE). Aplicando el método de Síntesis Interpretativa Crítica, revisamos 187 documentos jurídicos y políticos y 80 artículos revisados por pares sobre la salud sexual de migrantes, en busca de elementos de violencia sexual; de estos, analizamos los 37 artículos jurídicos y 12 artículos revisados por pares enfocados específicamente en violencia sexual contra migrantes vulnerables en la UE-27 Estados. Los documentos jurídicos y políticos que tratan sobre violencia sexual, particular pero no exclusivamente en migrantes vulnerables, aplican la ‘visión de túnel’. Hacen caso omiso de: a) los tipos de violencia sexual que ocurren con frecuencia, b) las tasas de persecución de todos los géneros c) factores de riesgo específicos en la UE, tales como el estatus legal, orientación de género y condiciones de vida de cada migrante. El paradigma de formulación de políticas de la UE relega la violencia sexual en migrantes vulnerables como un asunto de ‘extranjeros’ y ‘mujeres únicamente’, mientras que las políticas de migración y asilo de la UE reafirman su invisibilidad. Una respuesta eficaz debe ser guiada por políticas participativas basadas en derechos y evidencia y un enfoque en salud pública, reconociendo la ocurrencia y multiplicidad de la persecución sexual de migrantes vulnerables de todos los géneros dentro de las fronteras de la UE.
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A study conducted on behalf of the German Conference on Islam. This report constitutes the first nationwide representative study of Muslim migrants from 49 countries of origin. A nationwide database on the Muslim population has now been established for the first time by means of interviews conducted directly with migrants.The result of the study based on a household survey of 6.000 migrants from 50 islamic countries in Germans results in an officially accepted estimation of the number of Muslims in Germany. On the basis of these representative data, the estimates of the number of Muslims originating from different regions living in Germany and the respective shares of the different Islamic denominations have been revised. The second part of the study gives insights in social and structural aspects of integration and religion in everyday life of muslim migrants compared to other migrants. These structural data are accompanied by representative findings on the religious practice of Muslims in Germany. The extent to which religious affiliation or regional origin affect integration into the host society has also been examined.On the basis of empirical data, the study demonstrates the diversity of Muslim life in Germany.
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This study aimed to determine the frequencies of negative childhood experiences in the past years and negative childhood experiences throughout life in 11, 13 and 16 year-age group children who attended school in three separate provinces. Approval was obtained from the provincial National Education Directorates and educated investigators applied the ISPCAN child abuse screening tool questionnaire form which measures negative childhood events experienced at home in children. Statistical analysis was performed with chi-square test using SPSS 16.0 program. Approval from the ethics committee was obtained from İzmir Tepecik Education and Research Hospital Chief Physician Office Local Ethics Committee (29/11/2011-29). The study was conducted with 7 540 children in İzmir, Denizli and Zonguldak. The frequency of psychological and physical negative childhood experiences and neglect throughout life was found to be 70.5%, 58.3% and 42.6% in the 11, 13 and 16-year age groups, respectively; the frequencies in the last one year was found to be 62.7%, 46.0% and 37.5%, respectively. Psychological negative childhood experiences were found with a higher rate in children who lived in urban areas compared to children who lived in rural areas. Neglect was found with a higher rate in girls and physical negative childhood experiences were found with a higher rate in boys. The frequency of negative childhood experiences increased proportionally with the age of the child independent of the type of experience. The frequencies of negative childhood experiences for the last one year and for the life-long period were determined using ISPCAN child abuse screening tool in Turkey for the first time in three provinces and in such a large population. The frequency of negative childhood experiences related with child abuse and neglect screened were found to be 42%-70% and it was elucidated that we are confronted with a very significant public health problem and adult health risk in these regions of Turkey.
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On the basis of self-determination theory (R. M. Ryan & E. L. Deci, 2000) and cultural descriptions drawn from H. C. Triandis (1995), the authors hypothesized that (a) individuals from different cultures internalize different cultural practices; (b) despite these differences, the relative autonomy of individuals' motivation for those practices predicts well-being in all 4 cultures examined; and (c) horizontal practices are more readily internalized than vertical practices across all samples. Five hundred fifty-nine persons from South Korea, Russia, Turkey and the United States participated. Results supported the hypothesized relations between autonomy and well-being across cultures and gender. Results also suggested greater internalization of horizontal relative to vertical practices. Discussion focuses on the distinction between autonomy and individualism and the relative fit of cultural forms with basic psychological needs.
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Patients from collective cultures with a tradition-bound Islamic cultural background (e.g. people from the Middle East and some Far-East countries such Pakistan and Indonesia), have a different perception of disease and different conceptions of healing, which up till now have not been sufficiently appreciated in modern multimodal therapeutic approaches and health management. Taking patients’ value systems into consideration in a culture-sensitive way, with reference to their notions of magic, healing ceremonies and religious rituals and especially patterns of relations and experience in the treatment of psychological diseases in medical psychotherapeutic work, with due regard to scientific psychotherapeutic standards, can be used as an intercultural resource and lead to establishing partnership-like relationships between patients and therapists.
Purpose: The aim of this study was to explore associations between internalized stigma, exposure to physical abuse, experiences with sexual abuse, and depression in Muslim women residing in the United States. Materials and methods: We analyzed self-reported data collected online in late 2015. Women who self-identified as Muslim, were at least 18 years old, and were residents of the United States met the inclusion criteria (n = 373). Logistic regression models were used to estimate associations between socioeconomic status, nativity, and the abovementioned indicators. Results: Internalized stigma measured through heightened vigilance was associated with depression. Each increase in the abbreviated heightened vigilance scale (higher scores indicate lower vigilance) was associated with 7.6% lower odds of meeting the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10) cutoff for depression (OR = 0.924, 95% CI = 0.888-0.962, p < 0.001). Among individual factors, education, household income, experience with physical abuse, and exposure to sexual abuse were associated with depression. Respondents who reported experiencing physical abuse had almost two times higher odds of meeting the cutoff for depression relative to respondents who had not experienced physical abuse (OR = 1.994, 95% CI = 1.180-3.372, p < 0.01). Likewise, respondents who reported exposure to sexual abuse had over two times higher odds of depression compared with respondents who had not been exposed to sexual abuse (OR = 2.288, 95% CI = 1.156-4.528, p < 0.05). Conclusions: These findings were from a group of well educated wealthy respondents; however, experience with negative exposures and rates of depression were high. Further research replicating these findings and evaluating evidence-based interventions designed to improve screening for mental illnesses and retention in care with this hard-to-reach population could produce valuable outcomes, particularly for clinicians and public health practitioners committed to improving population health.
This book provides an overview of recent trends in the management of trauma and post-traumatic stress disorders that may ensue from distressing experiences associated with the process of migration. Although the symptoms induced by trauma are common to all cultures, their specific meaning and the strategies used to deal with them may be culture-specific. Consequently, cultural factors can play an important role in the diagnosis and treatment of individuals with psychological reactions to extreme stress. This role is examined in detail, with an emphasis on the need for therapists to bear in mind that different cultures often have different concepts of health and disease and that cross-cultural communication is therefore essential in ensuring effective care of the immigrant patient. The therapist’s own intercultural skills are highlighted as being an important factor in the success of any treatment and specific care contexts and the global perspective are also discussed.