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The first study of posttraumatic stress disorder (PTSD) in prostitutes has revealed high rates of the disorder stemming from physical and sexual assault.
Seventy-three percent of prostitutes questioned in the U.S., South Africa, Thailand, Turkey, and Zambia reported having been physically assaulted, and 73 percent reported having been raped during working hours. Sixty-seven percent met the criteria for a diagnosis of PTSD. Melissa Farley, Ph.D., presented the results of her research in August at the annual meeting of the American Psychological Association.
Farley's study, "Prostitution, Violence, and Posttraumatic Stress Disorder," published this summer in the journal Women & Health (vol. 27, no. 3) describes how she and her team of researchers interviewed about 500 prostitutes in several cities. Subjects included men and women prostitutes ages 12 to 61 who worked on the street and in brothels in San Francisco as well as cities in Africa, Thailand, and Turkey. In the study, Farley noted that PCL scores (a measure of PTSD severity) of prostitutes were higher than those of Vietnam veterans.
The study is not a typical scientific report, said Farley. It is research designed to "document trauma to an extremely marginalized, violated group of women." She said she hopes the research results will stimulate discussion about how prostitution harms those involved, focus attention on prostitution as a traumatic stressor, and raise the awareness of mental health professionals of the need to screen for prostitution and PTSD.
"These people are at great risk for suicidality-40 times higher than the rest of the population," said Farley.
Mental health professionals should screen for prostitution the way they screen for a history of incest or violence, said Farley. If a history of prostitution is discovered, then it is important to screen for symptoms of PTSD.
Farley said that in addition to raising awareness about the link between prostitution and PTSD, the results of her research will be used in program development and needs assessment. Ninety two percent of the people interviewed said they wanted out of prostitution, said Farley. They reported needs for asylum, shelter, substance abuse treatment, and job training in addition to treatment for PTSD.
Roger Pitman, M.D., who is an associate professor of psychiatry at Harvard Medical School and has done research on PTSD in Vietnam veterans, said, "I think it's dangerous to launch comparisons about who is more victimized." He said that though Farley mentioned that PCL scores for PTSD were higher for prostitutes than for Vietnam veterans, her main objective was not to compare PTSD in the two groups. Prostitutes are people who have been exposed to new trauma and have often been abused earlier in life, while veterans may not have been exposed to earlier trauma, said Pitman, making a comparison of PTSD in the two groups problematic.
"The most important thing about the study is that it identifies a mental health problem that needs attention," said Pitman. He agreed with Farley that it is important to screen for prostitution. "It's well known that therapists and psychiatrists often fail to take good trauma histories. We can't rely on patients to bring it up."
In addition, he said, "It's not enough to ask about traumatic events-we need a checklist of trauma history questions, and we need to ask about various traumatic experiences."
Farley noted that because prostitutes are a population often badly hurt by other human beings, it is hard for them to trust health care professionals. They might prefer to work with women, she said. In addition, she said, mental health professionals that work with prostitutes may have to work through their own racist and sexist ideas about prostitution.
"My hope," said Farley, "is that we won't see any more articles about how much prostitutes enjoy sex or about how prostitution is a reasonable job opportunity for poor women." In some social service projects, condoms are distributed, and people turn their heads away from evidence of trauma, she added. Right now, said Farley, people in prostitution can get HIV drugs more easily than help in dealing with trauma or changing jobs.