Background to FGM‑related mental health problems

Female genital mutilation (FGM) can cause significant lifelong emotional and psychological distress, particularly with Type 2 and Type 3 FGM (Abdalla and Galea, 2019). Trauma may arise from the mutilation itself, memories of the event, and the ongoing impact of painful debilitating physical complications. These experiences shape, how survivors feel about their bodies, relationships, and overall wellbeing.

The mental health impact of FGM

Survivors may experience:

• Fear, shame, embarrassment, humiliation
• Low self‑esteem, body image concerns
• Helplessness, powerlessness, loss of control
• Sleep problems
• Difficulties with relationships and sexual intimacy
• Anger or betrayal toward those involved
• Loneliness and isolation
• Anxiety, depression, phobias, suicidal thoughts
• Post‑traumatic stress symptoms such as flashbacks, intrusive memories, hypervigilance, emotional numbing
• Avoidance behaviours, including avoiding people, memories, medical settings, or using substances to cope

How trauma emerges and re‑emerges

Mind UK (2026) describes trauma as a distressing event or series of events that overwhelms a person’s ability to cope. Trauma can occur at any age and may continue to affect someone for many years. It can take different forms, including childhood trauma, collective or generational trauma, racial trauma, and secondary trauma.

The trauma of FGM can shape how survivors think, feel, and respond to later experiences, creating ongoing patterns of distress, negative beliefs, and unhelpful coping behaviours. Shame and pain may resurface at different life stages, triggered by recalling the event, hearing others discuss FGM, encountering insensitive reactions, or during medical examinations, intimacy, menstruation, pregnancy, and childbirth. Some girls cut at a very young age may not remember it but later experience shock, grief, and a deep sense of violation when they learn what was done to them.

Trauma can also appear as moral distress or moral injury. This may affect some perpetrators who feel guilt or regret for carrying out, witnessing, or not preventing the FGM, including when done under strong cultural pressure. This can leave lasting feelings of responsibility and remorse. 
Healthcare professionals may experience vicarious trauma when hearing survivors’ stories or witnessing the harm caused.

How depression, anxiety and trauma interact in FGM survivors

Depression (low mood) in FGM survivors often develops through the combined effects of trauma, physical complications, and social or cultural pressures. Trauma, anxiety, and depression interact and reinforce one another.

The diagram below outlines the symptoms of depression.

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Anxiety is a common part of this cycle. Persistent worry can disrupt sleep, increase overthinking, and create a constant sense of being on edge. Even without real danger, the body may react as if threatened—raising the heart rate, quickening breathing, and remaining on high alert. Over time, this drains emotional reserves and contributes to low mood, withdrawal from relationships, and reduced confidence.

The diagram below outlines the vicious cycle of anxiety

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When the emotional or physical wounds of FGM are triggered, the body may respond as though the trauma is happening again. This can lead to cycles of fear, panic, hypervigilance, and exhaustion. As survivors withdraw from family, friends, work, or social life to avoid distress, depression deepens, bringing sadness, shame, disconnection, and hopelessness.

Depression then makes it harder to cope with anxiety and trauma symptoms. Low mood can reduce motivation to seek support or use coping strategies, reinforcing the trauma cycle and leaving survivors feeling stuck in patterns of fear, avoidance, and emotional numbness. Without support, depression can become long‑lasting, and some people may turn to substances to cope, increasing isolation and health risks.

Understanding how trauma, anxiety, and depression interact helps explain why survivors may struggle across many areas of life and highlights the importance of trauma‑informed, compassionate mental health care.

Cognitive Behavioural Therapy (CBT) can help

Cognitive Behavioural Therapy (CBT) is a structured talking therapy. The World Health Organization (2025) recommends CBT as part of a holistic, trauma‑informed plan to support FGM survivors with trauma, post‑traumatic stress disorder, depression, and anxiety.

CBT helps survivors understand how their thoughts, emotions, and physical reactions are connected to the trauma of their FGM and its ongoing consequences. It focuses on the distress a person is experiencing in the present and provides practical tools to manage these responses. It helps survivors to process and challenge unhelpful beliefs linked to the trauma, reduce avoidance, and build coping strategies to move forward and make daily life more manageable. It aims to strengthen a survivor’s sense of safety, control, confidence, and emotional stability.

Other therapies, such as Eye Movement Desensitisation and Reprocessing (EMDR), may help survivors explore the origins of their trauma if they wish to do so. CBT differs in that it helps survivors notice unhelpful patterns and break the cycle by teaching practical ways to shift those patterns, manage anxious thoughts, and calm physical reactions. Techniques such as the ABC (Activating Event, Beliefs, Consequences) reframing approach and grounding exercises can help restore steadiness and a sense of control.

The diagram below outlines a model of reversing the vicious cycle of anxiety 

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Edward’s Trauma Cycle (Edwards, 2024) can be a useful trauma‑informed tool within CBT. It can help practitioners understand how:

• Unresolved FGM trauma continues to influence a survivor’s thoughts, emotions, and behaviours.
• How patterns of fear, shame, and avoidance can be triggered repeatedly throughout life.
• The trauma cycle can be used to identify triggers, map links between thoughts, emotions, physical reactions, and behaviours, challenge unhelpful beliefs, develop coping strategies, and normalise trauma responses.

Diagram of Sally Edwards Trauma Cycle

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Conclusion:

The World Health Organization (2025) calls for dedicated mental health support for FGM survivors, yet specialist services across the UK and Ireland remain limited and unevenly accessible. Examples of services include NHS National FGM Support Clinics, the Dahlia Project in London, and organisations such as the Irish Family Planning Association, AKiDwA, and Spirasi in Ireland.

To ensure consistent care, national mental health strategies across the UK and Ireland need to clearly outline how the emotional and psychological needs of FGM survivors will be met within mainstream provision. Survivors require trauma‑informed, sensitive, person‑centred support, including specialist psychotherapy and psychosexual therapy delivered by clinicians trained in FGM‑related trauma, particularly around gynaecological, obstetric and reconstructive procedures.

Mental health support and regular debriefing should also be available for healthcare professionals supporting FGM survivors, to help prevent vicarious trauma, reduce burnout, and maintain professional boundaries and wellbeing.