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Intimate Partner Violence and its physical and psychological effects have been extensively studied. What the literature still lacks is the understanding of the role of Stockholm Syndrome in explaining the relationship between Intimate Partner Violence and Psychological Distress, especially in a non-Western setting. Psychological Distress is considered as a natural consequence of Intimate Partner Violence, the present study explored victims choosing to justify the abuse they experienced, hence, diminishing the negative psychological effects. The current study undertakes Stockholm Syndrome as a mediator between Intimate Partner Violence and Psychological Distress in a community sample of 212 individuals in married or dating relationships (from the cities of Islamabad and Rawalpindi, Pakistan). The three aspects of Stockholm Syndrome; Core Stockholm Syndrome; rationalising abuse through distorted cognitions, Psychological Damage; negative effects of ongoing abuse, and Love-Dependence; the belief that survival is only possible through the love and compassion of the abuser, were tested as mediators. The analyses revealed that Core Stockholm Syndrome did not mediate the relationship between Intimate Partner Violence and Psychological Distress. Although, Psychological Damage fully mediated the said relationship, and Love-Dependence partially mediated the direct effect of Intimate Partner Violence on Psychological Distress.
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Pakistan Journal of Psychological Research, 2018, Vol. 33, No. 2, 541-557
Intimate Partner Violence and Psychological
Distress: Mediating Role of Stockholm Syndrome
Amna Ahmad, Mudassar Aziz, Gulnaz Anjum, and
Farah V. Mir
Quaid-i-Azam University
Intimate Partner Violence and its physical and psychological
effects have been extensively studied. What the literature still lacks
is the understanding of the role of Stockholm Syndrome in
explaining the relationship between Intimate Partner Violence and
Psychological Distress, especially in a non-Western setting.
Psychological Distress is considered as a natural consequence of
Intimate Partner Violence, the present study explored victims
choosing to justify the abuse they experienced, hence, diminishing
the negative psychological effects. The current study undertakes
Stockholm Syndrome as a mediator between Intimate Partner
Violence and Psychological Distress in a community sample of
212 individuals in married or dating relationships (from the cities
of Islamabad and Rawalpindi, Pakistan). The three aspects of
Stockholm Syndrome; Core Stockholm Syndrome; rationalising
abuse through distorted cognitions, Psychological Damage;
negative effects of ongoing abuse, and Love-Dependence; the
belief that survival is only possible through the love and
compassion of the abuser, were tested as mediators. The analyses
revealed that Core Stockholm Syndrome did not mediate the
relationship between Intimate Partner Violence and Psychological
Distress. Although, Psychological Damage fully mediated the said
relationship, and Love-Dependence partially mediated the direct
effect of Intimate Partner Violence on Psychological Distress.
Keywords: Intimate partner violence, Stockholm syndrome,
psychological distress
Amna Ahmad, Mudassar Aziz, Gulnaz Anjum and Farah V. Mir, National
Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan.
Amna Ahmad is now at Bangor University, UK.
Mudassar Aziz is now at Shaheed Zulfiqar Ali Bhutto Institute of Science and
Technology, Karachi, Pakistan.
Gulnaz Anjum is now at Institute of Business Administration, Karachi,
Pakistan.
Correspondence concerning this article should be addressed to Mudassar Aziz,
Institute of Business Administration, Karachi, Pakistan. Email: draziz@nip.edu.pk
542 AHMAD, AZIZ, ANJUM, AND MIR
“None are more hopelessly enslaved than those who falsely believe
they are free.”
Goethe, Die Wahlverwandtschaften.
The significance of Intimate Partner Violence (IPV) or domestic
violence, over the years has been downplayed with taboos and privacy
labels (e.g., Krug, Dahlberg, & Mercy, 2002). Yet, the measurable
cost of the relationships concerning deterioration in physical and
mental health of the victims and the family members involved, the
fatal threat to human life, serious injury, and the repercussion the
children face are now being seen as a crippling economic factor for
individuals involved on all levels, including the national health
services, the community and the family itself (Snively, 1995).
Through the ever growing influx of knowledge, understanding of
violent and traumatic incidences which deviate from the norm and are
increasingly troublesome (for example, Green et al., 2000) indicates
IPV. Zakar, Zakar, and Krämer (2011) stated that IPV previously
experienced and/or being currently experienced has significant
negative implications on both physical and psychological health status
of the victim. Cross-cultural empirical studies have shown high
psychological distress resulting from IPV (McCloskey, Treviso,
Scionti, & Dal Pozzo, 2002). This also goes to show that “violence
makes a significant, independent and nonspurious contribution to the
psychological distress” experienced by victims (Gelles & Harrop,
1989, p. 415).
The term IPV refers to physical violence, threats of physical
violence, sexual and psychological/emotional aggression including
coercive acts by one’s partner or spouse, current or former.
Yoshihama, Bybee, Dabby, and Blazevski (2013) reported that in
Pakistan 64.3% of women are subjected to sexual violence. According
to another research, approximately 70 to 90 percent of Pakistani
women experience some sort of spousal violence i.e., four in every
five women (Chowdhry, 2013).
The term Stockholm Syndrome (SS) was coined based on the
failed 1973 bank heist in Stockholm, Sweden; whence the captives
developed intimate bonds with their captors. This incident led many
mental health professionals to observe a similar pattern in the victims
of multiple scenarios. These terror bound situations include rape,
abusive relationships, incest, and numerous other high threat hostage
situations (Demarest, 2009). This also led the professionals to identify
the central symptom of SS as being the development of positive
feelings in the victims towards the aggressor or abuser which
INTIMATE PARTNER VIOLENCE AND PSYCHOLOGICAL DISTRESS 543
strengthens as the relationship progresses (Graham, Rawlings, &
Rimini, 1994).
Graham (1995) conceptualized SS based on four precursors
necessary for its development; perceived threat to survival, perceived
kindness, perceived isolation, and perceived inability to escape. SS is
considered as a coping mechanism with three main components.
These occur in combination or separately with each other: positive
feelings on part of the captive towards the captor, positive reciprocal
feelings by the captor towards the captives, and negative feelings on
part of the captives towards authority and/or authority figures. This
condition results from specific external settings: power imbalances in
hostage situations, or kidnappings, and abusive relationships
(Auerbach, Kiesler, Strentz, Schmidt, & Serio, 1994; Graham,
Rawlings, & Rimini, 1994).
In the original scale (Graham, 1995) represented the items via
three subscales: Core Stockholm Syndrome, Psychological Damage,
and Love-Dependency. Core SS contains the central aspects of
Stockholm Syndrome including cognitive distortions and interpersonal
trauma of the victim. The cognitive distortion indicates rationalisation
and/or minimisation of the aggressor’s behaviour, self-blame, and
reporting acts of love and care in place of fear. Psychological Damage
managed the low self-esteem, depression/anxiety and other
interpersonal troubles. Love-Dependency was captured by the victim’s
firm belief that their survival is solely dependent on their partner’s
love and nurturance, intense idealization of the abusive partner, and
the strong belief that without their partner in their life, they have
nothing to look forward to and nothing to live for.
George (2015) investigated the role of SS and pathological
attachment in abusive relationships. The Stockholm Syndrome Scale
(SSS) was put through psychometric testing for confirmation of a
three-factor solution for the scale, the predictive qualities of the scales
were found to be linked to relationship violence. The study further
showed that this association between relationship violence and all
three components of SS are moderated by insecure attachment in male
partners and anxious attachment resulted in a stronger positive
correlation between Love-Dependence and relationship violence
among female partners.
The underlying causes of intimate partner violence are
ambiguous and often disputed due to varying sociocultural context in
which it is experienced. Especially, in the Pakistani context where
spousal violence has been reported to be understood as a religiously
and culturally integral part of marriage (Zakar et al., 2011). Over the
544 AHMAD, AZIZ, ANJUM, AND MIR
years, gender differences in both victims and abusers have also been
noted. Acts of violence committed by women in both urban and rural
Pakistani settings (Walayat, Hasan, & Ajmal, 2013) provides a unique
psychosocial perspective to IPV. Male dominant societies, poverty
and unemployment are also among the most widely quoted causes of
IPV (Jewkes, Levin, & Penn-Kekana, 2012). These undoubtedly result
in physical health consequences for the victim but apart from physical
health problems, numerous studies have shown a strong association
between IPV and its negative mental health consequences (e.g., Pico-
Alfonso, 2005).
The most highlighted mental health consequences of IPV are
namely, depression (e.g., Constantino, Sekula, Rabin, & Stone, 2000),
anxiety (e.g., Hathaway, Mucci, Silverman, Brooks, Mathews, &
Pavlos, 2000) and post-traumatic stress disorder (e.g., Woods, 2000).
Women are said to experience depression twice as much as men and
this difference has been explained with reference to more women
facing poverty, conflicting social roles, gender discrimination, adverse
life experiences, and violence at home (WHO, 2009).
Depression has been significantly related to IPV but causation
remains questionable. Some studies have shown that the perpetrator’s
abuse may or may not contribute to depression (e.g., WHO, 2009).
However, clear evidence documented stating that when IPV is
eliminated from the equation, the symptoms of depression reduce
(e.g., Kernic, Holt, & Stoner, 2003). Multiple studies have
documented that the implication of IPV is not only limited to
women’s reproductive and sexual health consequences, rather it
encompasses the victim’s entire well-being, the structure of the
victim’s household and family organization and the very fabric of
their community (e.g., Ellsberg, 2000). Stress as a major construct is
not significantly quoted in literature, and the current study aimed to
relatively fill this literature gap. Women are said to place great
emphasis on their personal relationships, especially with their
partners, which tends to cause them to avoid small or big conflict but
in the process, they tend to suppress their own feelings of anger. Men
on the other hand are more vocal with their feelings of hostility. This
type of inequality leads to a polarization of the relationship where the
victim unconsciously imposes upon themselves an act of self-silencing
which in turn leaves them feeling entrapped leading to Psychological
Distress (WHO, 2000).
Anna Freud’s (1936/1937) concept of identification with the
abuser, or with a dominant authority figure in one’s life is a defence
mechanism for avoiding anxiety and punishment. This relates with the
concept of SS when the abused victim of IPV identifies with their
INTIMATE PARTNER VIOLENCE AND PSYCHOLOGICAL DISTRESS 545
perpetrator in an effort to avoid confronting their helplessness in the
situation. Thus, their response in the form of SS becomes a coping
strategy to survive IPV (Dutton & Painter, 1993). The longer an
abusive relationship stretches with the abuser’s repeated acts of
violence, the victim more heavily begins to rely on their partner not
just for basic needs which are under the abuser’s control but for
simple comforts in life. The repeated abuse not only makes the victim
weak and fearful but also instils in the victim the idea of helplessness
that their partner is the central force of the relationship. The
polarization of the relationship with the intermittent nature of abuse,
the victim begins to rationalize the experienced abuse, this gives the
perpetrator basis to dominate even further. The interactional
techniques the aggressor uses in order to gain further control, such as
negotiations, assertiveness, and problem-solving enhance the abuser’s
chances of being the central pole of the relationship, and the small acts
of kindness by the perpetrator, genuine or not, further still cement the
polarization and the dynamics of the relationship (Dutton & Painter,
1993; Graham et al.,1995).
This toxic amalgamation of acts of compassion interlaced with
abusive episodes gives way to doubts and convinces the victim to hold
onto the relationship. This results in reinforcing the tormentor and
fuelling the cycle to continue (Crane, 1997). The underlying
mechanism of SS states that the more friendly the abused feels
towards the perpetrator, the less the negativity they would experience.
Auerback et al. (1994) are to date the only ones to have studied SS in
a controlled and empirically replicated setting. The main problem was
the morality of inflicting terror on the participants, even though, their
consent was taken. In their study Auerback et al. (1994) staged a
hostage situation, which resulted in symptoms of SS exhibited by the
participants. The researchers noted that SS in the participants resulted
because of an interplay of domination, that is, the aggressors’ control
over their hostages, and a strong affiliation, that is, the victims’
idolization and identification with the aggressors. This presented the
conclusion that SS is an unconscious effort for survival, a form of
self-delusion through trying to find mutual ground with the abuser.
This form of coping is quite similar to avoidance coping which has
been shown to relate with Psychological Distress (e.g., Holahan,
2005). Although, SS as a form survivor’s avoidance coping has been
linked to Psychological Distress among the general population (e.g.,
Blalock & Joiner, 2000) and clinical samples (e.g., Sherbourne, Hays,
& Wells, 1995). The underlying mechanism through which this
relationship exists leading to Psychological Distress is still unclear.
Yet, the stress arousing component of avoidance coping exhibits a
546 AHMAD, AZIZ, ANJUM, AND MIR
central path through which coping strategies are linked to emotional
and Psychological Distress. This form of coping strategy is also
related to SS because survivors who show the symptoms of SS often
delude their own thinking by not only minimizing the abuse they
experienced but also completely refusing to acknowledge it (Graham
et al., 1995).
The aim of the present study was to understand the relationship of
IPV and Psychological Distress mediated by SS among intimate
Pakistani partners. It is intriguing to study the reason behind why
victims choose to stay with their abusive partners; multiple theories
have been presented over the years to explain terror or traumatic
bonding in relation to recidivism, but there is a dearth of empirical
data available for the Pakistani population. The present study tried to
provide empirical grounds for SS keeping in mind that most victims
do not recognize that they have experienced abuse (Graham et al.,
1995). The cases and their circumstantial scenarios are extreme and
traumatic which has resulted in the difficulty of studying this
phenomenon in a large number of people with any control. Since there
seems to be no simple research based explanation for why victims
remain with their abusive partners. However, the current study,
propagated to understand SS as a mediating mechanism for IPV and
psychological distress. Using the modified version of Graham’s
(1995) scale, SSS, by George (2015), which has also not been used in
a non-western population to date, the present study aimed to explain
that SS may describe why victims choose to remain in abusive
relationships (see Figure 1).
Figure 1. The proposed mediated role of Stockholm Syndrome.
Regarding the basic relationship between the constructs, the
following effects were proposed:
1. Intimate partner violence positively relates to all three
components of psychological distress and Stockholm
syndrome.
INTIMATE PARTNER VIOLENCE AND PSYCHOLOGICAL DISTRESS 547
2. All three components of Stockholm syndrome negatively
relate to all three components of Psychological Distress.
3. The positive relationship between intimate partner violence
and the Stress component of psychological distress to be
negatively affected via the subscales Core Stockholm
Syndrome, Psychological Damage, and Love-Dependence.
4. The positive relationship between intimate partner violence
and the Anxiety component of psychological distress to be
mediated by the subscales Core Stockholm Syndrome,
Psychological Damage, and Love-Dependence.
5. The positive relationship between intimate partner violence
and the Depression component of psychological distress to be
negatively affected via the subscales Core Stockholm
Syndrome, Psychological Damage, and Love-Dependence.
Method
Participants
Individuals in married and dating relationships were approached
through purposive convenient sampling. A total of 212 individuals
(men = 123, women = 89) were reached with an age range of 20 years
to 68 years (M = 35.69, SD = 11.37). No specification in regards to
on-going or prior psychological treatment was made, the researcher
also did not include individuals from shelter homes or who had been
previously through medical or at official levels identified as
“battered”. The only condition the researcher imposed was that the
participants must be in an ongoing relationship to satisfy the
requirement of Stockholm Syndrome (married individuals = 131,
dating individuals = 81), as SS is said to be more prevalent during an
ongoing relationship and not after it (Demarest, 2009). All the
participants were from the cities of Islamabad and Rawalpindi,
Pakistan.
Instruments
The Following instruments were used in the study:
Hurt Insult Threaten Scream (HITS). Hurt Insult Threaten
Scream (HITS; Sherin, Sinacore, Li, Zitter, & Shakil, 1998) is a short
IPV screening too. It has four items, measured on a five-point scale.
The responses range from Never (1) to Frequently (5). The scores
range from four to 20 and a score above the cut-off point of 10
548 AHMAD, AZIZ, ANJUM, AND MIR
indicates high levels of IPV. Its simple statements, good internal
validity, reliability (α = .80), and concurrent consistency with Conflict
Tactics Scale (CTS; Straus, 1979) as reported by the authors has made
HITS a common tool across the globe.
Depression Anxiety Stress Scale (DASS). Depression Anxiety
Stress Scale (Lovibond & Lovibond, 1995) is a 42-item scale widely
used for measuring negative emotional states of depression, anxiety
and stress. The current study made use of its shorter version, namely,
DASS-21, which has a set of 21 items following the same subscales
(i.e., Depression, Anxiety & Stress) and measures on a four-point
Likert scale. Each subscale has seven items and the scores are
calculated separately for each subscale. The Cronbach alpha for the
subscales as reported by the developers are, Depression, α = .88,
Anxiety, α = .82, and Stress, α = .90.
Stockholm Syndrome Scale (SSS). The Stockholm Syndrome
Scale (SSS; Graham et al., 1995) is a 49-item scale to identify the
existence of SS. The items are equally divided in three subscales; Core
SS, Psychological Damage, and Love-Dependence. The current study
used the modified version of the original scale (George, 2015). The
modified version has 24 items, eight items for each subscale of SS.
The responses range from Never (1) to Always (7). The score range for
each subscale is 8 to 56, with high scores indicating high levels of
Core SS symptoms, Psychological Damage, and Love-Dependency,
respectively. SSS is measured on a 7-point Likert Scale with two
items of Psychological Damage reversed scored. The Cronbach alphas
for the subscales as reported by the authors are, Core Stockholm
Syndrome, α = .94, Psychological Damage, α = .89, and Love-
Dependence, α = .74.
Procedure
Participants were presented with an information sheet about the
study, which gave a thorough explanation about the aims of the study,
the level of possible personal discomfort, sensitivity, and the
approximate time it would take to the finish the questionnaire booklet.
Ethical protocol was maintained: participants were assured of the
confidentiality and anonymity of their information, and their right to
withdraw at any stage of the research. The battery of tests was
presented to the participants with the information of the primary
researcher as well as self-help websites, and contact information of
counsellors, psychologist and social workers in case of possible
distress. The primary researcher was available for all the participants
INTIMATE PARTNER VIOLENCE AND PSYCHOLOGICAL DISTRESS 549
who wished for a debriefing session about the study as well as those
who needed a moment of catharsis.
Results
The present study aimed to explore the relationship between IPV
and Psychological Distress (Stress, Anxiety, and Depression) via the
mediating role of SS. The proposed mediating role of SS was
measured through a Multiple Mediation Model analysis. The tabulated
results are as follows:
Table 1
Descriptive Statistics and Correlations of Study Variables (N = 212)
Measure
1
2
3
4
6
7
1.HITS
(.90)
.05
.14*
.14*
.64**
.38**
2.Stress
(.78)
.70**
.70**
.26**
-.07
3.Anxiety
(.80)
.76**
.36**
.12
4.Depression
(.87)
.43**
.20
5.Core SS
.76**
.53**
6.PD
(.79)
.52**
7.LD
(.90)
M
8.72
8.02
6.08
6.41
30.39
35.24
SD
4.49
4.38
4.54
5.36
9.42
12.37
Range
4-20
0-19
0-20
0-21
8-50
8-56
Skewness
.68
.10
.57
.74
-.02
-.48
Kurtosis
-.75
-.67
-.11
.13
-1.10
-.64
Note. HITS = Hurts Insult Threaten Scream; Stress, Core SS = Core Stockholm
Syndrome, PD = Psychological Damage, LD = Love-Dependence. Alpha reliability
coefficients are given in diagonals.
*p < .05. **p < .01.
While HITS positively and significantly correlated with all the
subscales of SS; Core SS, PD, and LD, it does not significantly
correlate with one subscale of Psychological Distress; Stress (Table
1). Where it is significantly correlated with Anxiety and Depression.
Similarly, the subscales of Psychological Distress correlates positively
with both HITS and SS. Two out of three subscales of SS (Core SS
and PD) correlate positively with both HITS and Psychological
Distress, while LD correlates significantly and positively with HITS
but not with Psychological Distress.
550 AHMAD, AZIZ, ANJUM, AND MIR
Table 2
Indirect Effects of Intimate Partner Violence on Psychological
Distress via Proposed Mediators (N = 212)
Normal theory
test
Bias-
corrected
and
accelerated
CIs
Mediator
Bootstrap
effect
Normal
effect
SE
Z
p
LL
UL
Mediated effect on Stress
Total effect
.23
_
_
_
_
.09
.36
Core SS
.03
.04
.07
.58
.56
-.07
.18
PD
.27
.33
.08
3.92
.00
.15
.43
LD
-.08
-.10
.04
-
2.73
.01
-.15
-.04
Mediated effect on Anxiety
Total effect
.28
_
_
_
_
.16
.40
Core SS
-.01
-.02
.07
-.22
.82
-.13
.11
PD
.31
.39
.09
4.41
.00
.17
.44
LD
-.02
-.02
.03
-.68
.49
-.07
.03
Mediated effect on Depression
Total effect
.36
_
_
_
_
.25
.47
Core SS
-.02
-.02
.08
-.28
.78
-.14
.11
PD
.43
.64
.11
6.04
.00
.29
.57
LD
-.06
-.09
.04
-
2.18
.03
-.13
-.01
Note. Core SS = Core Stockholm Syndrome; PD = Psychological Damage; LD =
Love-Dependence.
As shown in Table 2, the three components of Psychological
Distress through the analysis are not mediated by the Core SS
component of SS. Hence, the direct effect of IPV on Stress is not
affected. Whereas, Psychological Damage is an effective indicator of a
significant indirect effect (with p < .001) on all three components of
Psychological Distress. The Love-Dependence component of SS has
no effect on Anxiety (p = .49) but is significantly affecting the Stress
(p = .01) and Depression (p = .03) components.
Mediation analyses were conducted using the bootstrapping
method (5000 samples) with bias corrected confidence estimates
(Preacher & Hayes, 2008).
INTIMATE PARTNER VIOLENCE AND PSYCHOLOGICAL DISTRESS 551
Discussion
The underlying question of the present study was to understand a
possible reason as to why individuals in abusive relationships choose
to stay with their tormentors. Thus, understanding SS as a coping
mechanism formed the basis to measure potential cognitive distortions
i.e., a dissonance in the thinking patterns, and the justifications an
abuse victim associates to IPV (Dutton & Painter, 1993). The assaults
the aggressor makes on the victim’s self-concept, progression in life,
the blocks that the abuser adds between the victim and the outside
world, the effects of the physical, psychological and/or sexual
violence, as well as the intermittent acts between violence and
kindness result in unpredictability of the relationship. Thus, the victim
not only finds it difficult to the leave the relation, fails to recognise the
abuser and rescuer as the same individual but also entirely depends on
the perpetrator for their survival (Graham et al., 1995; Sullivan &
Lasley, 2010).
The present study aimed to explore the relationship of IPV and
Psychological Distress, incorporating SS as a mediator for this
relationship. Based on the theoretical grounds that individuals who
choose to stay in abusive relationships do not report experiencing
Psychological Distress because it is overcome by the distortions and
disorganised attachment caused by SS (e.g., Dutton & Painter, 1993;
Graham et al., 1995).
Consistent with previous literature (e.g., Demarest, 2009; George,
2015), the current study found positive and significant correlations
between IPV and Anxiety and Depression as well as all three
components of SS. However, IPV did not significantly correlate with
Stress. In addition, all three subscales of Psychological Distress did
not correlate with Love-Dependence. Hence, the findings only
partially supported the first and second hypotheses, which stated that
IPV would positively relate to all components of both Psychological
Distress as well as SS, and that SS would negatively relate to
Psychological Distress, respectively.
To study the role of SS as a mediator in the interaction of IPV
and Psychological Distress, certain directional paths were proposed.
To the best of the researcher’s knowledge, the proposed paths of
mediation via SS have not been reported in any previous study. The
multiple mediation analysis (Preacher & Hayes, 2008) showed a
significant indirect effect of IPV on Psychological Distress via SS.
The predicted path of IPV’s association with Stress was mediated by
two components of SS i.e., Psychological Damage and Love-
Dependence. The direct effects were both positive and significant.
552 AHMAD, AZIZ, ANJUM, AND MIR
This result coincides with the definition of Psychological Damage (by
Graham et al., 1995) that an individual experiencing low self-esteem
and a loss of sense of self would not experience stress since SS occurs
at an unconscious level while stress is when the individual perceives
the discrepancy in the environment and actively acts to modify the
situation. On the other hand, Core SS did not mediate any of the
subscales of Psychological Distress, although, the Love-Dependence
component mediated both Stress and Depression but not Anxiety.
According to Graham et al. (1995), SS may cause unconscious
cognitive disturbances, which in turn would result in anxiety among
the victims. The results on the other hand, only partially supported this
notion as Core SS and Love-Dependence did not mediate Anxiety. In
an abusive relationship, there are moments when the abuser shows an
act of kindness, thus, leaving the victim feeling unsure if the
relationship could ever be violent or abuse free. This sense of hope
causes the victim to become more dependent on the abuser and the
distortion in their thinking pattern results in the form of Core SS. The
minimising and/or rationalising of the abuse also occurs out of the
need for social desirability and the feeling of responsibility to commit
and invest more in the relation (Brockner, Rubin, & Lang, 1981; Staw,
1976). This coincides with the notion that the destructiveness of an
abusive relationship is manifested through internalizing the abuse
(McCarthy, 1990). In the current study, two out of three components
of SS (Core SS and Psychological Damage) overall showed a positive
and significant effect on Psychological Distress.
IPV is generally predicted to be mildly severe in a general
community sample (e.g., George, 2015), and in the current study, it
highly correlates with all three components of SS. Previous researches
state, that the Core SS component moderately predicts IPV (e.g.,
Demarest, 2009), this study also showed this consistency but with a
novel result for a positive and significant predictive association with
Psychological Damage.
Implications
The current study provides empirical data to better understand
and add to the aforementioned gap in non-western literature related to
SS. SS may be an ineffective coping strategy (Demarest, 2009) but it
serves as a substantial explanation for why victims choose to stay in
abusive relationships. Thus, providing a platform to further explore
the buffering nature of SS which minimizes the psychological effects
of IPV. The study provides insight into the cognitive distortions
among the victims of IPV providing important structural directions to
be taken under consideration for therapies like Cognitive Behavioural
INTIMATE PARTNER VIOLENCE AND PSYCHOLOGICAL DISTRESS 553
Therapy that aim to rehabilitate and modify such faulty thinking
patterns. As exemplified in previous studies that developing a
treatment plan for Psychological Distress through medication and/or
with both medication and psychotherapy without taking into account
the extent and exposure a victim has had to violence can undermine
the effectiveness of the entire treatment strategy (for example,
Wathen, Jamieson, MacMillan, & MacMaster, 2007).
The study also successfully checked the reliability of the
Stockholm Syndrome Scale, which has not been used on a non-
western sample before. The nurses and lower staff who communicate
more regularly with the patients could also be trained for screening of
IPV as well as understanding the signs of SS which may need further
exploration since victims of abuse who exhibit SS cognitions are not
aware of their own condition (Graham et al., 1995). The public could
be made aware of the taboo to extend a collaborative effort to
overcome the growing issues of abusive relationships. Thus, the
variety, volume and predictive nature of the presented corpus could be
used to assist counsellors and clinicians to respond with more
accuracy and clarity to the victims and at-risk individuals facing such
personal and intimately damaging issues.
Limitations and Suggestions
Due to the cross sectional research design used in the current
study, causal association between the constructs may be limited to
being inferred but may not be confirmed. This also impacts the
generalizability and predictive values of the result. The use of self-
report measures result in high social desirability, hence, the research
design may also have been effected by the subjectivity of the
participants. As the sample was gathered through purposive
convenient sampling, it fell short of representing the general
population.
Future may target going for a bigger sample size in terms of the
numbers of participants as well as gathering the sample from multiple
cities across the country for better generalizability. Translating and
adapting the scales used in the current study to make the instruments
more indigenous to Pakistan for further enhancing their reliability and
validity. Further studies may add the demographics of religious beliefs
and socioeconomic statuses, as well as make use of an exploratory
study to understand how duration of an abusive relationship interact
with SS. Furthermore, a cross-cultural study could be conducted to
examine the difference between collectivistic and individualistic
societies, exploring how these societal values affect the type and
554 AHMAD, AZIZ, ANJUM, AND MIR
perception of abuse in terms of SS. Another recommendation is to
study IPV among stigmatized minorities, for example, hijras, in terms
of SS. Further studies need to be conducted to understand abuse in
terms of Love-Dependence in the victim, as the current study does not
show consistent results as compared to previous research. A
longitudinal study could explain the reasons behind this discrepancy
as well as giving further insight into SS as a coping response
mechanism to IPV.
Conclusion
The growing problems of Psychological Distress across the globe
is an inescapable and devastating phenomenon and effects all genders
and societies without discrimination. It results in a variety of settings
in the form of Stress, Anxiety and Depression. IPV is one way to
explain this phenomenon but research shows a discrepancy in that IPV
does not always result in Psychological Distress. The current study
chose a form of coping strategy called SS to explain this relationship.
The analyses revealed that, although, IPV results in Psychological
Distress, the interplay of SS in this relationship acts as a buffer in
reducing the effects of distress. While, the Core SS component of SS
did not mediate any of the three components of Psychological
Distress, Psychological Damage fully mediated the relationship, and
Love-Dependence partially mediated the direct effect of IPV on
Psychological Distress. As the study indicates, the causes and their
relationship with this social phenomenon are extensively intricate and,
thus, require an equally complex therapeutic and societal management
strategy. The associations found between IPV, Psychological Distress,
and SS in the present study, demonstrate some of the façades of this
social issue which may provide the incentive for further exploration.
The current study has added to the literature of the understudied
phenomenon in a non-western setting with empirical support but a
sizeable amount of additional investigations will be required to
understand the baseline reasons of relationship abuse to effectively
address the issues.
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Revision received 8th October, 2018
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