Traumatization, Religious Commitment, and Obsessive–Compulsive Washing in Raped Refugee Women: A Comparative Study
Main Article Content
Abstract
Background: Religious rituals can shape the expression of psychopathology after severe trauma. We examined how religious commitment relates to obsessive compulsive disorder 55, particularly compulsive washing, among women treated for rape-related post-traumatic stress disorder.
Methods: In a comparative study, 32 Kurdish refugee inpatients and 30 German inpatients with rape-related post-traumatic stress disorders were assessed during early hospitalization using validated clinical interviews and questionnaires 84 alongside the Santa Clara Strength of Religious Faith Questionnaire. Thirty-eight healthy Kurdish refugee women served as controls.
Results: Post-traumatic stress disorders severity did not differ significantly between patient groups. Kurdish patients showed higher compulsive disorders severity than German patients (Y-BOCS total mean 18.5 vs. 10.8) and much higher compulsive-action scores (13.7 vs. 6.8); controls scored low (total 3.3; actions 1.5). Religious upbringing and, especially, practicing religion were more prevalent among Kurdish patients than among German patients and controls. Higher religious commitment correlated with greater compulsive washing on multiple Y-BOCS action items among Kurdish patients (e.g., bathing/showering, washing hands/face), with smaller or item-limited associations in German patients.
Conclusions: Cultural background, indexed here by strength of religious commitment, modulates the manifestation of compulsive disorders symptoms, particularly washing compulsions, in women with rape-related PTSD. Culturally sensitive assessment and treatment should explicitly address religious practices and meaning frameworks when planning post-traumatic stress disorders and compulsive disorders interventions for refugee populations.
Keywords:
Post-traumatic stress disorders, obsessive-compulsive disorder, compulsive washing behaviour, sexual abuse, sexual violence, rape, religion, refugees
Article Details
How to Cite
KIZILHAN, Jan Ilhan.
Traumatization, Religious Commitment, and Obsessive–Compulsive Washing in Raped Refugee Women: A Comparative Study.
Medical Research Archives, [S.l.], v. 13, n. 11, dec. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7062>. Date accessed: 16 jan. 2026.
doi: https://doi.org/10.18103/mra.v13i11.7062.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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35. Tek C, et al. Yale–Brown Obsessive Compulsive Scale in Turkish: reliability and validity. Acta Psychiatr Scand.1995;91(6):410–413.
36. Plante TG, et al. The Santa Clara Strength of Religious Faith Questionnaire. Pastoral Psychol. 1995;17:471–479.
37. Akin A, Turan ME, Altundag Y. The validity and reliability of the Turkish version of the Santa Clara Strength of Religious Faith Questionnaire. J Educ Instr Stud. 2015;5(1):35–38.
38. Wittchen HU, et al. Strukturiertes klinisches Interview für DSM-IV, Achse I (SKID). Göttingen: Hogrefe Verlag; 1997.
39. Foa EB. Cognitive behavioral therapy of obsessive–compulsive disorder. Dialogues Clin Neurosci. 2010;12(2):199–207.
40. Tek C, Ulug B. Religiosity and religious obsessions in obsessive–compulsive disorder. Psychiatry Res. 2001;104(2):99–108.
41. Nicolini H, et al. Influence of culture in obsessive–compulsive disorder and its treatment. Curr Psychiatry Rev.2017;13(4):285–292.
42. Inozu M, Karanci AN, Clark DA. Why are religious individuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians. J Behav Ther Exp Psychiatry. 2012;43(3):959–966.
43. Yorulmaz O, Gencoz T, Woody S. OCD cognitions and symptoms in different religious contexts. J Anxiety Disord.2009;23(3):401–406.
44. Lersner U, Kizilhan JI. Kultursensitive Psychotherapie. Göttingen: Hogrefe Verlag; 2017.
45. Engelbrecht A, Jobson L. Exploring trauma-associated appraisals in trauma survivors from collectivistic cultures. SpringerPlus. 2016;5(1):1565.
46. Mahmood HN, et al. PTSD and depression among Syrian refugees residing in the Kurdistan region of Iraq. Confl Health.2019;13:51.
47. Turbott J. The meaning and function of ritual in psychiatric disorder, religion, and everyday behaviour. Aust N Z J Psychiatry. 1997;31(6):835–843.
48. Basoglu M. A multivariate contextual analysis of torture and cruel, inhuman, and degrading treatments. Am J Orthopsychiatry. 2009;79(2):135–145.
49. Yang C, et al. Cross-cultural differences in perception and understanding of OCD in East Asian and Western cultures. Int J Cult Ment Health. 2018;11(4):616–625.
50. Adams TG, et al. The role of stress in the pathogenesis and maintenance of obsessive–compulsive disorder. Chronic Stress. 2018;2:1–10.
51. Gerdau I, Kizilhan JI, Noll-Hussong M. PTSD and related disorders among female Yazidi refugees following Islamic State attacks: a case series and mini-review. Front Psychiatry. 2017;8:282.
52. Schaal S, Elbert T. Ten years after the genocide: trauma confrontation and PTSD in Rwandan adolescents. J Trauma Stress. 2006;19(1):95–105.
53. Tekin A, et al. Prevalence and gender differences in symptomatology of PTSD and depression among Iraqi Yazidis displaced into Turkey. Eur J Psychotraumatol. 2016;7(1):28556.
54. Kizilhan JI. PTSD of rape after IS (“Islamic State”) captivity. Arch Womens Ment Health. 2018;21(5):517–524.
55. Kizilhan JI. Trauma and pain in family-oriented societies. Int J Environ Res Public Health.2017;15(1):1–12.
56. Yang C, et al. Cross-cultural perspectives on trauma and mental health. Int J Cult Ment Health. 2019;12(2):231–242.
57. Lersner U, Kizilhan JI. Kultursensible Psychotherapie und Trauma. Stuttgart: Kohlhammer; 2020.
2. Fontenelle LF, et al. Towards a post-traumatic subtype of obsessive–compulsive disorder. J Anxiety Disord.2012;26(2):377–383.
3. Kizilhan JI, Steger F, Noll-Hussong M. Shame, dissociative seizures and their correlation among traumatized female Yazidi with experience of sexual violence. Br J Psychiatry. 2020;216(3):138–143.
4. Kessler RC, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry.1995;52(12):1048–1060.
5. Kilpatrick DG, et al. Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. J Consult Clin Psychol. 2003;71(4):692–700.
6. Clum GA, Calhoun KS, Kimerling R. Associations among symptoms of depression and PTSD and self-reported health in sexually assaulted women. J Nerv Ment Dis. 2000;188(10):671–678.
7. Pagotto LF, et al. The impact of posttraumatic symptoms and comorbid mental disorders on the health-related quality of life in treatment-seeking PTSD patients. Compr Psychiatry. 2015;58:68–73.
8. Coid J, et al. Abusive experiences and psychiatric morbidity in women primary care attenders. Br J Psychiatry.2003;183:332–341.
9. Darves-Bornoz JM. Rape-related psychotraumatic syndromes. Eur J Obstet Gynecol Reprod Biol. 1997;71(1):59–65.
10. Dworkin ER, et al. Sexual assault victimization and psychopathology: a review and meta-analysis. Clin Psychol Rev.2017;56:65–81.
11. Candea DM, Szentagotai-Tatar A. Shame-proneness, guilt-proneness and anxiety symptoms: a meta-analysis. J Anxiety Disord. 2018;58:78–106.
12. Hoffman J, et al. The relationship between moral injury appraisals, trauma exposure, and mental health in refugees. Depress Anxiety. 2018;35(11):1030–1039.
13. Fricke S, et al. Early interpersonal traumatization in obsessive–compulsive disorder: a pilot study. Behav Ther.2007;17(4):243–250.
14. Saunders BE, et al. Child sexual assault as a risk factor for mental disorders among women. J Interpers Violence.2016;7(2):189–204.
15. Cromer KR, Schmidt NB, Murphy DL. An investigation of traumatic life events and obsessive–compulsive disorder. Behav Res Ther. 2007;45(7):1683–1691.
16. Badour CL, et al. Specificity of fear and disgust experienced during traumatic interpersonal victimization in predicting posttraumatic stress and contamination-based obsessive–compulsive symptoms. J Anxiety Disord. 2012;26(5):590–598.
17. Boudreaux E, et al. Criminal victimization, PTSD, and comorbid psychopathology among a community sample of women. J Trauma Stress. 1998;11(4):665–678.
18. Pitman RK. Posttraumatic obsessive–compulsive disorder: a case study. Compr Psychiatry. 1993;34(2): 102–107.
19. Orsillo SM, et al. Current and lifetime psychiatric disorders among veterans with war zone-related PTSD. J Nerv Ment Dis. 1996;184(5):307–313.
20. Sasson Y, et al. Posttraumatic obsessive–compulsive disorder: a case series. Psychiatry Res. 2005;135(2):145–152.
21. Zhong CB, Liljenquist K. Washing away your sins: threatened morality and physical cleansing. Science.2006;313(5792):1451–1452.
22. Abu-Raiya H, Pargament KI. Empirically based psychology of Islam: summary and critique of the literature. Ment Health Relig Cult. 2011;14(2):93–115.
23. Berzengi A, et al. Role of Islamic appraisals, trauma-related appraisals, and religious coping in posttraumatic adjustment of Muslim trauma survivors. Psychol Trauma. 2017;9(2):189–197.
24. Agorastos A, Demiralay C, Huber CG. Influence of religious aspects and personal beliefs on psychological behavior: focus on anxiety disorders. Psychol Res Behav Manag. 2014;7:93–101.
25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
26. Özalp E, et al. Reliability and validity of the Turkish version of the Structured Clinical Interview for DSM-5. Turk J Psychiatry. 2008;19(1):5–12.
27. Foa EB, et al. The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale. Psychol Assess.1997;9(4):445–451.
28. Dikmen-Yildiz P, Ayers S, Phillips L. Screening for birth-related PTSD: psychometric properties of the Turkish version of the PDS. Eur J Psychotraumatol. 2017;8(1):1306414.
29. Beck AT. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561–571.
30. Hisli N. Beck Depresyon Envanterinin geçerliği [A study on the validity of Beck Depression Inventory]. J Psychol.1988;6:118–122.
31. Derogatis LR. SCL-90-R: Administration, Scoring and Procedures Manual-I. Baltimore, MD: Johns Hopkins Univ; 1977.
32. Dağ I. Reliability and validity of the Symptom Check List (SCL-90-R) for university students. Turk J Psychiatry.1991;2(1):5–12.
33. Goodman WK, et al. The Yale–Brown Obsessive Compulsive Scale I: development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006–1011.
34. Goodman WK, et al. The Yale–Brown Obsessive Compulsive Scale II: validity. Arch Gen Psychiatry. 1989;46(11):1012–1016.
35. Tek C, et al. Yale–Brown Obsessive Compulsive Scale in Turkish: reliability and validity. Acta Psychiatr Scand.1995;91(6):410–413.
36. Plante TG, et al. The Santa Clara Strength of Religious Faith Questionnaire. Pastoral Psychol. 1995;17:471–479.
37. Akin A, Turan ME, Altundag Y. The validity and reliability of the Turkish version of the Santa Clara Strength of Religious Faith Questionnaire. J Educ Instr Stud. 2015;5(1):35–38.
38. Wittchen HU, et al. Strukturiertes klinisches Interview für DSM-IV, Achse I (SKID). Göttingen: Hogrefe Verlag; 1997.
39. Foa EB. Cognitive behavioral therapy of obsessive–compulsive disorder. Dialogues Clin Neurosci. 2010;12(2):199–207.
40. Tek C, Ulug B. Religiosity and religious obsessions in obsessive–compulsive disorder. Psychiatry Res. 2001;104(2):99–108.
41. Nicolini H, et al. Influence of culture in obsessive–compulsive disorder and its treatment. Curr Psychiatry Rev.2017;13(4):285–292.
42. Inozu M, Karanci AN, Clark DA. Why are religious individuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians. J Behav Ther Exp Psychiatry. 2012;43(3):959–966.
43. Yorulmaz O, Gencoz T, Woody S. OCD cognitions and symptoms in different religious contexts. J Anxiety Disord.2009;23(3):401–406.
44. Lersner U, Kizilhan JI. Kultursensitive Psychotherapie. Göttingen: Hogrefe Verlag; 2017.
45. Engelbrecht A, Jobson L. Exploring trauma-associated appraisals in trauma survivors from collectivistic cultures. SpringerPlus. 2016;5(1):1565.
46. Mahmood HN, et al. PTSD and depression among Syrian refugees residing in the Kurdistan region of Iraq. Confl Health.2019;13:51.
47. Turbott J. The meaning and function of ritual in psychiatric disorder, religion, and everyday behaviour. Aust N Z J Psychiatry. 1997;31(6):835–843.
48. Basoglu M. A multivariate contextual analysis of torture and cruel, inhuman, and degrading treatments. Am J Orthopsychiatry. 2009;79(2):135–145.
49. Yang C, et al. Cross-cultural differences in perception and understanding of OCD in East Asian and Western cultures. Int J Cult Ment Health. 2018;11(4):616–625.
50. Adams TG, et al. The role of stress in the pathogenesis and maintenance of obsessive–compulsive disorder. Chronic Stress. 2018;2:1–10.
51. Gerdau I, Kizilhan JI, Noll-Hussong M. PTSD and related disorders among female Yazidi refugees following Islamic State attacks: a case series and mini-review. Front Psychiatry. 2017;8:282.
52. Schaal S, Elbert T. Ten years after the genocide: trauma confrontation and PTSD in Rwandan adolescents. J Trauma Stress. 2006;19(1):95–105.
53. Tekin A, et al. Prevalence and gender differences in symptomatology of PTSD and depression among Iraqi Yazidis displaced into Turkey. Eur J Psychotraumatol. 2016;7(1):28556.
54. Kizilhan JI. PTSD of rape after IS (“Islamic State”) captivity. Arch Womens Ment Health. 2018;21(5):517–524.
55. Kizilhan JI. Trauma and pain in family-oriented societies. Int J Environ Res Public Health.2017;15(1):1–12.
56. Yang C, et al. Cross-cultural perspectives on trauma and mental health. Int J Cult Ment Health. 2019;12(2):231–242.
57. Lersner U, Kizilhan JI. Kultursensible Psychotherapie und Trauma. Stuttgart: Kohlhammer; 2020.