Yonsei Med J.  2008 Jun;49(3):372-382. 10.3349/ymj.2008.49.3.372.

Symptoms of Posttraumatic Stress Disorder and Mental Health in Women Who Escaped Prostitution and Helping Activists in Shelters

• Jung YE
• Song JM
• Chong J
• Seo HJ
• Chae JH

• KMID: 724251
• DOI: http://doi.org/10.3349/ymj.2008.49.3.372

Abstract

PURPOSE
This study compared the mental symptoms, especially symptoms of posttraumatic stress disorder (PTSD), of women who escaped prostitution, helping activists at shelters, and matched control subjects. MATERIALS AND METHODS: We assessed 113 female ex-prostitutes who had been living at a shelter, 81 helping activists, and 65 control subjects using self-reporting questionnaires on demographic data, symptoms related to trauma and PTSD, stress-related reactions, and other mental health factors. RESULTS: Female ex-prostitutes had significantly higher stress response, somatization, depression, fatigue, frustration, sleep, smoking and alcohol problems, and more frequent and serious PTSD symptoms than the other 2 groups. Helping activists also had significantly higher tension, sleep and smoking problems, and more frequent and serious PTSD symptoms than control subjects. CONCLUSION: These findings show that engagement in prostitution may increase the risks of exposure to violence, which may psychologically traumatize not only the prostitutes themselves but also the people who help them, and that the effects of the trauma last for a long time. Future research is needed to develop a method to assess specific factors that may contribute to vicarious trauma of prostitution, and protect field workers of prostitute victims from vicarious trauma.

Keyword

Posttraumatic stress disorder; prostitution; mental health

MeSH Terms

Adult
Alcoholism/etiology/psychology
Depression/etiology/psychology
Fatigue/etiology/psychology
Female
Humans
Mental Disorders/etiology/psychology
*Mental Health
Prostitution/*psychology
Questionnaires
Risk Factors
Smoking/psychology
*Social Work
Stress Disorders, Post-Traumatic/complications/*psychology
Stress, Psychological/complications

Figure

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  Fig. 1 Correlation between severity subscale of Davidson Trauma Scale, duration of engagement in the sex trade, and age in ex-prostitutes. Pearson correlation coefficient. *p = 0.047; †p = 0.05.

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  Fig. 2 Correlation between severity subscale of Davidson Trauma Scale and smoking and alcohol drinking degree in ex-prostitutes. Pearson correlation coefficient. *p = 0.01; †p = 0.002; ‡p = 0.032; §p = 0.047.

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  Fig. 3 Correlation between severity subscale of Davidson Trauma Scale and degree of sleep problems in ex-prostitutes. Pearson correlation coefficient. *p < 0.001; †p < 0.001.

Reference

1. Kramer LA. Emotional experiences of performing prostitution: prostitution, trafficking, and traumatic stress. 2003. Binghamton: Haworth Press.

2. Barry K. The prostitution of sexuality. 1996. New York: New York University Press.

3. Farley M, Cotton A, Lynne J, Zumbeck S, Spiwak F, Reyes ME, et al. Prostitution and trafficking in nine countries: an update on violence and posttraumatic stress disorder. J Trauma Pract. 2003. 2:33–74.

4. Romans SE, Potter K, Martin J, Herbison P. The mental and physical health of female sex workers: a comparative study. Aust N Z J Psychiatry. 2001. 35:75–80.

5. Brody S, Potterat JJ, Muth SQ, Woodhouse DE. Psychiatric and characterological factors relevant to excess mortality in a long-term cohort of prostitute women. J Sex Marital Ther. 2005. 31:97–112.

6. Potterat JJ, Brewer DD, Muth SQ, Rothenberg RB, Woodhouse DE, Muth JB, et al. Mortality in a longterm open cohort of prostitute women. Am J Epidemiol. 2004. 159:778–785.

7. Vanwesenbeeck I. Another decade of social scientific work on sex work: a review of research 1990-2000. Annu Rev Sex Res. 2001. 12:242–289.

8. Chen XS, Yin YP, Liang GJ, Gong XD, Li HS, Poumerol G, et al. Sexually transmitted infections among female sex workers in Yunnan, China. AIDS Patient Care STDS. 2005. 19:853–860.

9. Gossop M, Powis B, Griffiths P, Strang J. Female prostitutes in south London: use of heroin, cocaine and alcohol, and their relationship to health risk behaviours. AIDS Care. 1995. 7:253–260.

10. Nguyen AT, Nguyen TH, Pham KC, Le TG, Bui DT, Hoang TL, et al. Intravenous drug use among street-based sex workers: a high-risk behavior for HIV transmission. Sex Transm Dis. 2004. 31:15–19.

11. Alegría M, Vera M, Freeman DH Jr, Robles R, Santos MC, Rivera CL. HIV Infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers. Am J Public Health. 1994. 84:2000–2002.

12. El-Bassel N, Schilling RF, Gilbert L, Faruque S, Irwin KL, Edlin BR. Sex trading and psychological distress in a street-based sample of low-income urban men. J Psychoactive Drugs. 2000. 32:259–267.

13. Farley M, Barkan H. Prostitution, violence, and posttraumatic stress disorder. Women Health. 1998. 27:37–49.

14. Kim HS. Violent characteristics of prostitution and posttraumatic stress disorder of women in prostitution [Unpublished doctoral dissertation]. 2002. Seoul: Sung-Gong-Hoe University.

15. Kaysen D, Resick PA, Wise D. Living in danger: the impact of chronic traumatization and the traumatic context on posttraumatic stress disorder. Trauma Violence Abuse. 2003. 4:247–264.

16. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Text Rev. 2000. 4th ed. Washington, DC: American Psychiatric Association.

17. Bremner JD, Southwick SM, Johnson DR, Yehuda R, Charney DS. Childhood physical abuse and combatrelated posttraumatic stress disorder in Vietnam veterans. Am J Psychiatry. 1993. 150:235–239.

18. McKenzie N, Marks I, Liness S. Family and past history of mental illness as predisposing factors in posttraumatic stress disorder. Psychother Psychosom. 2001. 70:163–165.

19. Brunello N, Davidson JR, Deahl M, Kessler RC, Mendlewicz J, Racagni G, et al. Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment. Neuropsychobiology. 2001. 43:150–162.

20. Schlenger WE, Kulka RA, Fairbank JA, Hough RL, Jordan BK, Marmar CR, et al. The prevalence of posttraumatic stress disorder in the Vietnam generation: A multimethod, multisource assessment of psychiatric disorder. J Trauma Stress. 1992. 5:333–363.

21. In : Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM, editors. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. 1993. Paper presented at the 9th Annual Meeting of the International Society for Traumatic Stress Studies; San Antonio, Texas:

22. Houskamp B. Assessing and treating battered women: a clinical review of issues and approaches. New Dir Ment Health Serv. 1994. 64:79–89.

23. Kemp A, Rawlings EI, Green BL. Post-traumatic stress disorder (PTSD) in battered women: a shelter sample. J Trauma Stress. 1991. 4:137–148.

24. Bownes IT, O'Gorman EC, Sayers A. Assault characteristics and posttraumatic stress disorder in rape victims. Acta Psychiatr Scand. 1991. 83:27–30.

25. Ramsay R, Gorst-Unsworth C, Turner S. Psychiatric morbidity in survivors of organised state violence including torture. A respective series. Br J Psychiatry. 1993. 162:55–59.

26. Tyler KA, Hoyt DR, Whitbeck LB, Cauce AM. The effects of a high-risk environment on the sexual victimization of homeless and runaway youth. Violence Vict. 2001. 16:441–455.

27. Sorscher N, Cohen LJ. Trauma in children of Holocaust survivors: transgenerational effects. Am J Orthopsychiatry. 1997. 67:493–500.

28. Beckham JC, Lytle BL, Feldman ME. Caregiver burden in partners of Vietnam War veterans with posttraumatic stress disorder. J Consult Clin Psychol. 1996. 64:1068–1072.

29. Schauben LJ, Frazier PA. Vicarious trauma: the effects on female counselors of working with sexual violence survivors. Psychol Women Q. 1995. 19:49–64.

30. Sabin-Farrell R, Turpin G. Vicarious traumatization: implications for the mental health of health workers? Clin Psychol Rev. 2003. 23:449–480.

31. McCann L, Pearlman LA. Vicarious traumatization: a framework for understanding the psychological effects of working with victims. J Trauma Stress. 1990. 3:131–149.

32. Pearlman LA, MacIan PS. Vicarious traumatization: an empirical study of the effects of trauma work on trauma therapists. Prof Psychol Res Pract. 1995. 26:558–565.

33. Steed LG, Downing R. A phenomenological study of vicarious traumatisation amongst psychologists and professional counsellors working in the field of sexual abuse/assault. retrieved 2006 Nov 11. 1998-2:Australas J Disaster Trauma Studies [serial online];Available from: URL: http://www.massey.ac.nz/%7Etrauma/issues/1998-2/steed.htm.

34. Figley CR. Stamm BH, editor. Compassion fatigue: toward a new understanding of the cost of caring. Secondary traumatic stress: Self care issues for clinicians, researchers and educators. 1999. 2nd ed. Lutherville, MD: Sidran Press;3–28.

35. Pearlman LA, Saakvitne KW. Trauma and the therapist: countertransference and vicarious traumatization in psychotherapy with incest survivors. 1995. New York, NY: W.W. Norton & Company.

36. Davidson JR, Book SW, Colket JT, Tupler LA, Roth S, David D, et al. Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med. 1997. 27:153–160.

37. Weiss DS, Marmar CR. Wilson JP, Keane TM, editors. The impact of event scalerevised. Assessing psychological trauma and PTSD. 2004. New York, NY: Guilford Press;168–189.

38. In : Lim HK, Woo JM, Kim TS, Kim TH, Yang JC, Choi KS, editors. The reliability and validity of the Korean version of the Impact of Event Scale-Revised (IES-R-K). 2006. Poster session presented at the annual meeting of the Korean Neuropsychiatric Association; Seoul, Korea.

39. Seo HJ, Jung SG, Lim HK, Chee IS, Lee KU, Paik KC, et al. Reliability and validity of the Korean version of the Davidson Trauma Scale. Compr Psychiatry. 2008. 49:313–318.

40. Koh KB, Park JK, Kim CH, Cho S. Development of the stress response inventory and its application in clinical practice. Psychosom Med. 2001. 63:668–678.

41. Kassam-Adams N. Stamm BH, editor. The risks of treating sexual trauma: stress and secondary trauma in psychotherapists. Secondary traumatic stress: Self care issues for clinicians, researchers, and educators. 1999. Lutherville, MD: Sidran Press;37–48.

42. Rich KD. Edmunds SB, editor. Vicarious traumatization: A preliminary study. Impact: Working with sexual abusers. 1999. Brandon, VT: Safer Society Press;75–88.

43. Iliffe G, Steed LG. Exploring the counselor's experience of working with perpetrators and survivors of domestic violence. J Interpers Violence. 2000. 15:393–412.

44. Ghahramanlou M, Brodbeck C. Predictors of secondary trauma in sexual assault trauma counselors. Int J Emerg Ment Health. 2000. 2:229–240.

45. Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: a validational study. J Trauma Stress. 2002. 15:423–432.

46. In : Pearlman LA, MacIan PS, Johnson G, Mas K, editors. Understanding cognitive schemas across groups: empirical findings and their implications. 1992. Paper presented at the 8th annual meeting of the International Society for Traumatic Stress Studies; Los Angeles.

47. Benatar M. A qualitative study of the effect of a history of childhood sexual abuse on therapists who treat survivors of sexual abuse. J Trauma Dissociation. 2000. 1:9–28.

48. Brady JL, Guy JD, Poelstra PL, Brokaw BF. Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: a national survey of women psychotherapists. Prof Psychol Res Pract. 1999. 30:386–393.

49. Chrestman KR. Stamm BH, editor. Secondary exposure to trauma and self reported distress among therapists. Secondary traumatic stress: Self care issues for clinicians, researchers and educators. 1999. 2nd ed. Lutherville, MD: Sidran Press;29–36.

50. Steed L, Bicknell J. Trauma and the therapist: the experience of therapists working with the perpetrators of sexual abuse. . retrieved 2006 Nov 11. 2001-1:Australas J Disaster Trauma Studies [serial online];Available from: URL: http://www.massey.ac.nz/~trauma/issues/2001-1/steed.htm.

51. Follette VM, Polusny MM, Milbeck K. Mental health and law enforcement professionals: trauma history, psychological symptoms, and impact of providing services to child sexual abuse survivors. Prof Psychol Res Pract. 1994. 25:275–282.

52. Chudakov B, Ilan K, Belmaker RH, Cwikel J. The motivation and mental health of sex workers. J Sex Marital Ther. 2002. 28:305–315.

53. Valera RJ, Sawyer RG, Schiraldi GR. Perceived health needs of inner-city street prostitutes: a preliminary study. Am J Health Behav. 2001. 25:50–59.

54. Benoit C, Millar A. Dispelling myths and understanding realities: working conditions, health status and exiting experiences of sex workers. Retrieved 2006 Nov 11. Available from: URL: http://web.uvic.ca/~cbenoit/papers/DispMyths.pdf.

55. Roxburgh A, Degenhardt L, Copeland J. Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia. BMC Psychiatry. 2006. 6:24.

56. Buydens-Branchey L, Noumair D, Branchey M. Duration and intensity of combat exposure and posttraumatic stress disorder in Vietnam veterans. J Nerv Ment Dis. 1990. 178:582–587.

57. Breslau N, Davis GC, Peterson EL, Schultz L. Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry. 1997. 54:81–87.

58. Gilchrist G, Gruer L, Atkinson J. Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland. Addict Behav. 2005. 30:1019–1023.

59. Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry. 1997. 4:231–244.

60. Read JP, Brown PJ, Kahler CW. Substance use and posttraumatic stress disorders: symptom interplay and effects on outcome. Addict Behav. 2004. 29:1665–1672.

61. Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in traumaexposed adults. J Consult Clin Psychol. 2000. 68:748–766.

62. Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. 2003. 129:52–73.

63. Davidson JR. Long-term treatment and prevention of posttraumatic stress disorder. J Clin Psychiatry. 2004. 65:Suppl 1. 44–48.