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© Lee Harvey 2012–2019

Page updated 25 January, 2019

Citation reference: Harvey, L., 2012–2019, Researching the Real World, available at
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A Guide to Methodology

CASE STUDY Prostitution, violence and posttraumatic stress disorder

Melissa Farley and Howard Barkan (1998) used questionnaires in their study of 130 people working as prostitutes in San Francisco (75% women, 13% men, and 12% transgendered).

The prostitutes contacted were asked if they would fill out two questionnaires, which would take about ten minutes (4% of the 130 did not participate). The first was a 23-item questionnaire that asked about their histories of physical and sexual violence and what it would take to leave prostitution. They were also asked to complete a standardized Post-traumatic Stress Disordorder (PTSD) checklist covering the preceding 30 days.

Respondents read and signed a consent form and were offered a telephone number for referral in the event that they were distressed by the questions.

Standard descriptive statistics were used along with measures of association and correlation, which were tested for significance using standard parametric and non-parametric tests.

Over a third of the respondents (39%) were African American, 18% were Latina, 6% were Asian or Pacific Islander, and 5% described themselves as of mixed race or left the question blank. Age ranged from 14 to 61 with a mean of 30.9 and standard deviation of 9.0 yr. Three quarters (75%) reported having a drug abuse problem and 27% reported having an alcohol abuse problem.

Over half (57%) reported a history of childhood sexual abuse, by an average of three perpetrators. The researchers noted that this 'is lower than that reported for those working in prostitution in other research' (Farley and Barkan, 1998, p. 44), although some respondents did not regard non-forced childhood sexual activity as abuse. Some respondents denied being abused as children despite being recruited into prostitution at the age of 12 or 13. Half of the respondents (49%) reported that as children, they had been hit or beaten by a caregiver until they had bruises or were injured in some way.

Most (82%) respondents reported having been physically assaulted since entering prostitution, and 55% had been assaulted by customers. Nine out of ten (88%) had been physically threatened while in prostitution; and most (83%) had been physically threatened with a weapon. Some (8%) reported physical attacks by pimps and customers that had resulted in serious injury (including gunshot wounds, knife wounds, injuries from attempted escapes).

Two thirds (68%) reported having been raped since entering prostitution. Half (48%) had been raped more than five times. Half (46%) of those who reported rapes stated that they had been raped by customers. Half the respondents (49%) reported that pornography was made of them in prostitution; and a third (32%) had been upset by an attempt to make them do what customers had seen in pornography.

Women and transgendered prostitutes were more likely than men prostitutes to experience physical assaults in prostitution (chi square = 8.96, df = 2, p = .01). Women and transgendered prostitutes were more likely than men prostitutes to be raped in prostitution (chi square = 9.68, df = 2, p = .01). We did not find differences in likelihood of physical assaults and rapes on the basis of race.

On the health of the respondents, Farley and Barkan, (1998, p. 45) noted:

Our 130 interviewees' overall mean PCL score of 54.9 (an index of PTSD severity) may be compared to means of several other samples on the same measure: 50.6 for 123 PTSD treatment-seeking Vietnam veterans (Weathers et al., 1993); 34.8 for 1006 Persian Gulf war veterans (Weathers et al., 1993); and in a random sample of women in an HMO, 30.6 for 25 women who reported a history of physical abuse in childhood; 36.8 for 27 women who reported a history of physical and sexual abuse in childhood; and 24.4 for 26 controls in the same study (Farley, unpublished data: Impact of early trauma on somatization and healthcare utilization).

The researchers comment that health research related to prostitution focuses on HIV but that violence and psychological trauma suffered by prostitutes is also a public health crisis. The vast majority (88%) expressed a desire to leave prostitution and 84% reporting current or past homelessness. 'Homelessness is connected with prostitution in that survival may involve the exchange of sexual assault for a place to stay, and food' (np). In conclusion the researchers comment 'Without an understanding of the psychological harm resulting from prostitution, treating prostitution survivors is impossible.' (Farley and Barkan, 1998, p. 47)

Farley, M. and Barkan, H., 1998, 'Prostitution, violence against women, and posttraumatic stress disorder', Women & Health, 27(3), pp. 3749. Available at (accessed 29 November 2015)


Return to Interviewing or questionnaire distribution (Section 8.3.10)