Claudio Mencacci, MD. PRESIDENTE SOCIETÀ ITALIANA DI PSICHIATRIA Affiliated to World Psychiatric Association

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1 Claudio Mencacci, MD PRESIDENTE SOCIETÀ ITALIANA DI PSICHIATRIA Affiliated to World Psychiatric Association

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5 Violenza di genere: conseguenze sulla salute Abuso del partner - Violenza sessuale - Abuso sex minori CONSEGUENZE FATALI CONSEGUENZE NON FATALI Omicidio Suicidio Morbilità AIDS SALUTE MENTALE Disturbi da stress post-traumatico Stati depressivi Ansie, fobie, attacchi di panico Disturbi ossessivi -compulsivi Disturbi del sonno Disturbi sessuali Bassa autostima, perdita di controllo Difficoltà di concentrazione Comportamenti negativi per la salute Tabagismo Abuso di droghe e alcool Comportamenti sessuali a rischio Inattività fisica Abuso alimentare, disturbi dell alimentazione M.Amorosi 2012 CONDIZIONI CRONICHE Sindromi di dolore cronico Sindrome dell intestino irritabile Disordini gastrointestinali Disturbi somatici SALUTE FISICA Lesioni traumatiche Danni funzionali Lacerazioni, fratture Scarsa cura di sé Invalidità permanenti Obesità Emicranie Asma Disturbi dell apparato riproduttivo Gravidanza indesiderata Hiv ed infezioni Aborto spontaneo Gravidanza a rischio Basso peso del feto alla nascita Malattia infiammatoria pelvica Dolore cronico pelvico 5

6 Chen L P et al. Mayo Clin Proc. 2010;85:

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9 Howard LM, Oram S, Galley H, Trevillion K, Feder G (2013) Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta- Analysis. PLoS Med 10(5): e

10 Sexual Abuse and Lifetime Diagnosis of Somatic Disorders, 2009 Sexual abuse and lifetime diagnosis of: functional gastrointestinal disorders (OR, 2.4), nonspecific chronic pain (OR, 2.2), psychogenic seizures (OR, 2.9), and chronic pelvic pain (OR, 2.7). Rape and a lifetime diagnosis of: fibromyalgia (OR, 3.4), chronic pelvic pain (OR, 3.3), and functional gastrointestinal disorders (OR, 4.0).

11 Trafficked and Sexually Exploited Girls and Women Injuries and sexual violence during trafficking were associated with higher levels of PTSD, depression, and anxiety Sexual violence was associated with higher levels of PTSD [AOR]=5.6 More time in trafficking was associated with higher levels of depression and anxiety (AOR=2.2) Hossain et al. Am J Public Health 2010

12 Hossain et al. Am J Public Health 2010

13 Jovanovic, et al 2010

14 In this model, reexperiencing/hyperarousal reactivity to traumatic reminders is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition of limbic regions. In contrast, the dissociative reactions to traumatic reminders are described as a form of emotion dysregulation that involves emotional overmodulation, mediated by midline prefrontal inhibition of the same limbic regions Lanius et al, Am J Psychiatry 2010; 167:

15 Physical injury DOES NOT protect against PTSD Possible explanations are that injury during the traumatic event intensifies the horror and threat to life experienced, and that re-integration into normal life is delayed by physical recovery and rehabilitation, thus making it harder to move on from the initial trauma

16 Sexual Abuse Emotional Stress Abuse Leaves Its Mark on the Brain Science, 2009 Early Life Stress Substance Abuse

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19 Exposure to violence during childhood is associated with telomere erosion from 5 to 10 years of age: a longitudinal study Shalev 2012-Biggio 2013 Mol. Psychiatry, 2013

20 La violenza domestica, subita prima e durante e dopo la gravidanza, comporta non solo gravi conseguenze sul cervello della donna, ma anche sul bambino che ne risente dalla fase fetale all età adulta. UNA VIOLENZA CHE TENDE A REPLICARSI, UNA CATENA DA ARRESTARE

21 People with disabilities: the forgotten victims of violence Violence against disabled adults, including individuals with disabilities associated with mental health disorders and intellectual impairments with mental health disorders (OR=24) with intellectual impairments (OR=8)

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25 Perpetration of violence in the past year (%) Victimization (%) persons without a mental disorder 2 3 persons with severe mental illness 7 25

26 IL FEMINICIDIO IN EUROPA E LA PRIMA CAUSA DI MORTE PER LE DONNE DAI 15 AI 60 ANNI PIU DEL CANCRO, PIU DEGLI INCIDENTI STRADALI E L 80% AVVIENE IN FAMIGLIA IN ITALIA OGNI 3 GIORNI UNA DONNA VIENE UCCISA

27 NON CHIAMATELO AMORE

28 Una Catena di Violenza da Arrestare..Il mondo è pericoloso non a causa solo di chi fa del male, ma a causa di chi guarda e lascia fare Albert Einstein