Dimensionale Erfassung des individuellen Erlebens kriegs- und vertreibungsbezogener sexualisierter Gewalt und ihrer Folgen bei männlichen Betroffenen: Eine narrative Literaturübersicht

Zusammenfassung

Männliche Betroffene von kriegs- und vertreibungsbezogener sexualisierter Gewalt stellen eine aus psychologischer Sicht stark belastete Population dar. Offenlegungshürden seitens der Patienten und eine unzureichende Sensibilität der Behandler[1] für die Betroffenheit von Männern können eine adäquate Traumadiagnostik erschweren. Auf Grundlage einer narrativen Literaturübersicht werden relevante Charakteristika der Gewalt und ihr Bezug zur Diagnostik an acht Dimensionen des individuellen Gewalterlebens (Gewaltform, Häufigkeit und Schweregrad, Täter-Opfer-Kontext, Gesellschaftliche Diskriminierung, Subjektive Bewertung, Männlichkeitskonzept, Kulturspezifische Normen, Traumafolgen) herausgearbeitet. Die exemplarische Darstellung der Dimensionen erfolgt an einem Fallbeispiel. Zur gründlichen Erfassung der sexualisierten Gewalterfahrungen bedarf es der Sensibilität bei praktisch Tätigen für die Anzeichen männlicher Gewaltbetroffenheit und der regelhaften Erfassung sexualisierter Gewalt auch bei männlichen Patienten. Dabei sind die Sicherheit über die Vertraulichkeit der offengelegten Informationen sowie die Anerkennung des Unrechts von zentraler Bedeutung für die Betroffenen. Langfristig bedarf es der Entwicklung spezialisierter Hilfsangebote für männliche Betroffene.

Abstract

From a psychological perspective, male survivors of sexual violence in the context of war and forced displacement represent a highly burdened population. An adequate assessment of traumatic events and trauma related disorders is often hampered by both disclosure barriers from the patient side as well as by lack of awareness on the part of healthcare professionals regarding male victimization. Based on a narrative literature review, relevant characteristics of violence and their relation to the diagnostic process are elaborated on eight dimensions of individual experience of violence (form of violence, frequency and severity, perpetrator-victim context, societal discrimination, subjective evaluation, concept of masculinity, culture-specific norms, and trauma sequelae). The dimensions are delineated in a case study. In order to thoroughly assess sexualized experiences of violence, there is a need for sensitivity on the part of practitioners to the signs of male victimization and regular assessment of sexualized violence in male patients. In this context, certainty about the confidentiality of the information disclosed and recognition of the injustice are of central importance for those affected. In the long term, the development of specialized support services for male victims is needed.

Schlüsselwörter

Sexualisierte Gewalt - Männliche Betroffene - Diagnostik - Stigma - Offenlegung

Key words

Sexual violence - Male survivors - Diagnostics - Stigma - Disclosure

¹ Im Sinne der Lesbarkeit wird die männliche Form verwendet, gemeint sind Personen aller Geschlechter.

Publication History

Received: 12 May 2021

Accepted after revision: 21 March 2022

Article published online:
06 July 2022

• Literatur

• 1 United Nations. Conflict related sexual violence. Report of the United Nations Secretary-General (30.03.2021). Im Internet: https://www.un.org/sexualviolenceinconflict/wp-content/uploads/2021/04/report/conflict-related-sexual-violence-report-of-the-united-nations-secretary-general/SG-Report-2020editedsmall.pdf Stand: 10.01.2022
• 2 Zalewski M, Drumond P, Prügl E. et al. (eds) Sexual violence against men in global politics. 1. Aufl New York: Routledge; 2020
• 3 Misra A. The landscape of silence: Sexual violence against men in war. 1. Aufl London: C. Hurst & Co; 2015
• 4 Sivakumaran S. Sexual violence against men in armed conflict. Eur J Int Law 2007; 18: 253-276 DOI: 10.1093/ejil/chm013.
• 5 UN High Commissioner for Refugees (UNHCR). “We Keep It in Our Heart” – Sexual Violence against Men and Boys in the Syria Crisis. (22. 11. 2017). Im Internet: https://www.refworld.org/docid/5a128e814.html Stand: 10.05.2021
• 6 Lončar M, Henigsberg N, Hrabac P. Mental health consequences in men exposed to sexual abuse during the war in Croatia and Bosnia. J Interpers Violence 2010; 25: 191-203 DOI: 10.1177/0886260509334288.
• 7 Dolan C. Into the mainstream: Addressing sexual violence against men and boys in conflict. A briefing paper prepared for a workshop held at the Overseas Development Institute (14.05.2014). Im Internet: https://reliefweb.int/report/world/mainstream-addressing-sexual-violence-against-men-and-boys-conflict Stand: 10.05.2021
• 8 Stemple L. Male rape and human rights. Hastings Law J 2009; 60: 605-646
• 9 Carpenter RC. Recognizing gender-based violence against civilian men and boys in conflict situations. Secur Dialogue 2006; 37: 83-103 DOI: 10.1177/0967010606064139.
• 10 Ferrales G, Nyseth Brehm H, McElrath S. Gender-based violence against men and boys in Darfur: The gender-genocide nexus. Gend Soc 2016; 30: 565-589 DOI: 10.1177/0891243216636331.
• 11 Peel M. Rape as a Method of Torture. London: Medical Foundation for the Care of Victims of Torture; 2004
• 12 Nesterko Y, Glaesmer H. Sexualisierte Gewalt gegen Männer im Kontext von Krieg und Vertreibung. Trauma & Gewalt 2020; 14: 182-196 DOI: 10.21706/tg-14-3-182.
• 13 Touquet H, Chynoweth S, Martin S. et al. From ‘It Rarely Happens’ to ‘It’s Worse for Men’. Journal of Humanitarian Affairs 2020; 2: 25-34 DOI: 10.7227/JHA.049.
• 14 Ba I, Bhopal RS. Physical, mental and social consequences in civilians who have experienced war-related sexual violence: a systematic review (1981–2014). Public Health 2017; 142: 121-135 DOI: 10.1016/j.puhe.2016.07.019.
• 15 Johnson K, Scott J, Rughita B. et al. Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo. Jama 2010; 304: 553-562 DOI: 10.1001/jama.2010.1086.
• 16 Nesterko Y, Schönenberg K, Glaesmer H. Sexual violence and mental health in male and female refugees newly arrived in Germany. Dtsch Arztebl Int 2021; 118: 130-131 DOI: 10.3238/arztebl.m2021.0120.
• 17 Keygnaert I, Guieu A. What the eye does not see: a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants. Reprod Health Matters 2015; 23: 45-55 DOI: 10.1016/j.rhm.2015.11.002.
• 18 Kavemann B. Erinnerbarkeit, Angst, Scham und Schuld als Grenzen der Forschung zu Gewalt. In: Helfferich C, Kavemann B & Kindler H (eds). Forschungsmanual Gewalt. 1. Aufl Wiesbaden: Springer VS; 2016: 51-67 DOI: 10.1007/978-3-658-06294-1
• 19 Mosser P. Erhebung (sexualisierter) Gewalt bei Männern. In: Helfferich C, Kavemann B & Kindler H (eds). Forschungsmanual Gewalt. 1. Aufl Wiesbaden: Springer VS; 2016: 177-190 DOI: 10.1007/978-3-658-06294-1
• 20 Nesterko Y, Kaiser M, Glaesmer H. Kultursensible Aspekte während der Diagnostik von psychischen Belastungen bei Flüchtlingen – Zwei kommentierte Fallberichte. Psychother Psych Med 2017; 67: 109-118 DOI: 10.1055/s-0042-107802.
• 21 Maercker A, Hecker T. Trauma- und Gewaltfolgen – psychische Auswirkungen. Bundesgesundheitsblatt 2016; 59: 28-34 DOI: 10.1007/s00103-015-2259-6.
• 22 Oosterhoff P, Zwanikken P, Ketting E. Sexual torture of men in Croatia and other conflict situations: an open secret. Reprod Health Matters 2004; 12: 68-77 DOI: 10.1016/s0968-8080(04)23115-9.
• 23 Kiss L, Quinlan-Davidson M, Pasquero L. et al. Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries. Confl Health 2020; 14: 1-26 DOI: 10.1186/s13031-020-0254-5.
• 24 Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med 2006; 5: 101-117 DOI: 10.1016/S0899-3467(07)60142-6.
• 25 Kapella O, Baierl A, Rille-Pfeiffer C. et al. Gewalt in der Familie und im nahen sozialen Umfeld. Österreichische Prävalenzstudie zur Gewalt an Frauen und Männern. Wien: 2011. Im Internet: https://www.gewaltinfo.at/uploads/pdf/bmwfj_gewaltpraevalenz-2011.pdf Stand: 11.01.2022
• 26 Chynoweth SK, Buscher D, Martin S. et al. Characteristics and Impacts of Sexual Violence Against Men and Boys in Conflict and Displacement: A Multicountry Exploratory Study. J Interper Violence 2020; DOI: 10.1186/s13031-020-00288-8.
• 27 Bastick M, Grimm K, Kunz R. Sexual Violence in Armed Conflict, Global Overview and Implications for the Security Sector. Geneva: Geneva Centre for the Democratic Control of Armed Forces; 2007
• 28 Cohen DK, Nordås R. Sexual violence in armed conflict: Introducing the SVAC dataset, 1989–2009. J Peace Res 2014; 51: 418-428 DOI: 10.1177/0022343314523028.
• 29 Alessi EJ, Kahn S, Woolner L. et al. Traumatic stress among sexual and gender minority refugees from the Middle East, North Africa, and Asia who fled to the European Union. J Trauma Stress 2018; 31: 805-815 DOI: 10.1002/jts.22346.
• 30 Chynoweth S. “More Than One Million Pains”: Sexual Violence against Men and Boys on the Central Mediterranean Route to Italy (21.03.2019). Im Internet: https://www.womensrefugeecommission.org/research-resources/more-than-one-million-pains-sexual-violence-against-men-and-boys-on-the-central-mediterranean-route-to-italy/ Stand: 11.01.2022
• 31 Shidlo A, Ahola J. Mental health challenges of LGBT forced migrants. Forced Migr Rev 2013; 42: 9-11
• 32 Goffman E. Stigma. Über Techniken der Bewältigung beschädigter Identität. Frankfurt am Main: Suhrkamp Taschenbuch Verlag; 1967/2018
• 33 Alessi EJ, Kahn S, Chatterji S. ‘The darkest times of my life’: Recollections of child abuse among forced migrants persecuted because of their sexual orientation and gender identity. Child Abuse Negl 2016; 51: 93-105 DOI: 10.1016/j.chiabu.2015.10.030.
• 34 The International Lesbian, Gay, Bisexual, Trans and Intersex Association. Sexual Orientation Laws in the World (15.12.2020). Im Internet: https://ilga.org/map-sexual-orientation-laws-december-2020 Stand: 10.05.2021
• 35 Onyango MA, Hampanda K. Social constructions of masculinity and male survivors of wartime sexual violence: an analytical review. Int J Sex Health 2011; 23: 237-247
• 36 Kavemann B, Rothkegel S. Trauma Sexualisierte Gewalt in Kindheit und Jugend. Trauma & Gewalt 2014; 8: 202-213
• 37 De Schrijver L, Vander Beken T, Krahé B. et al. Prevalence of sexual violence in migrants, applicants for international protection, and refugees in Europe: a critical interpretive synthesis of the evidence. Int J Environ Res Public Health 2018; 15: 1979
• 38 Holbrook TL, Hoyt DB, Stein MB. et al. Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome. J Trauma Acute Care Surg 2001; 51: 287-293
• 39 Clark JN. Masculinity and male survivors of wartime sexual violence: A Bosnian case study. Confl Secur Dev 2017; 17: 287-311 DOI: 10.1080/14678802.2017.1338422.
• 40 Connell R. Der gemachte Mann. Konstruktion und Krise von Männlichkeiten. 4. Aufl Wiesbaden: Springer VS; 2015. DOI: 10.1007/978-3-531-19973-3
• 41 Forde C, Duvvury N. Sexual violence, masculinity, and the journey of recovery. Psychol Men Masc 2017; 18: 301-310 DOI: 10.1037/men0000054.
• 42 Turchik JA, Edwards KM. Myths about male rape: A literature review. Psychol Men Masc 2012; 13: 211-226 DOI: 10.1037/a0023207.
• 43 Teram E, Stalker C, Hovey A. et al. Towards malecentric communication: Sensitizing health professionals to the realities of male childhood sexual abuse survivors. Issues Ment Health Nurs 2006; 27: 499-517 DOI: 10.1080/01612840600599994.
• 44 Kirmayer LJ, Young A. Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosom Med 1998; 60: 420-430 doi:0.1097/00006842-199807000-00006
• 45 Tewksbury R. Effects of Sexual Assault on Men. Physical, Mental and Sexual Consequences. Int J Mens Health 2007; 6: 22-35 DOI: 10.3149/jmh.0601.22.
• 46 Russell W, Hilton A, Peel M. Care and Support of Male Survivors of Conflict-Related Sexual Violence: Background Paper (01.03.2010). Im Internet: https://www.svri.org/sites/default/files/attachments/2016-01-12/CareSupportofMaleSurviv.pdf Stand: 11.01.2022
• 47 Wilson JP, Droždek B, Turkovic S. Posttraumatic shame and guilt. Trauma Violence Abuse 2006; 7: 122-141
• 48 Johnson K, Asher J, Rosborough S. et al. Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. Jama 2008; 300: 676-690 DOI: 10.1001/jama.300.6.676.
• 49 Glaesmer H, Sierau S, Böttche M. Die Konsequenzen traumatischer Erfahrungen. Trauma & Gewalt 2020; 14: 266-276 DOI: 10.21706/tg-14-4-266.
• 50 Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000; 68: 748-766 DOI: 10.1037//0022-006x.68.5.748.