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PTSD, Anger, and Trauma-Informed Intimate Partner Violence Prevention

• Post-Traumatic Stress Disorders (T Geracioti and K Chard, Section Editors)
• Published: 09 August 2017
• Volume 4 , pages 262–270, ( 2017 )

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• Adam D. LaMotte MA 1 &
• Casey T. Taft Ph.D. 2  

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Opinion Statement

Despite a large and growing literature showing high rates of prior trauma exposure and posttraumatic stress disorder (PTSD) among those who engage in intimate partner violence (IPV), there has been a lack of trauma-informed interventions developed for this population. This review discusses the latest background research and clinical developments in the area of trauma-informed IPV intervention. We discuss how recent evidence points to the relevance of trauma-related social information processing biases and anger in the etiology of IPV perpetration, and a promising intervention that targets social information processing deficits in preventing and ending IPV. Future areas of research are needed to better explicate the mechanisms responsible for the success of these interventions, as well as replication of research findings across trauma-exposed populations and trauma types.

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Posttraumatic Stress Disorder, Intimate Partner Violence, and Trauma-Informed Intervention

Psychological Theories of Intimate Partner Violence

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • of importance •• of major importance.

Black MC, Basile KC, Briding MJ, Smith SG, Walters ML, Merrick MT et al. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2011.

Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359:1331–6. doi: 10.1016/S0140-6736(02)08336-8 .

Article   PubMed   Google Scholar  

Catalano S. Intimate partner violence: attributes of victimization, 1993–2011. Special Report (NCJ-243300). Washington, DC: US Department of Justice, Bureau of Justice Statistics; 2013.

Golding JM. Intimate partner violence as a risk factor for mental disorders: a meta-analysis. J Fam Violence. 1999;14:99–132. doi: 10.1023/A:102207941822 .

Article   Google Scholar  

Hoyt T, Wray AM, Wiggins KT, Gerstle M, Maclean PC. Personality profiles of intimate partner violence offenders with and without PTSD. J Offender Rehabil. 2012;51:239–56. doi: 10.1080/10509674.2011.650349 .

Maguire E, Macdonald A, Krill S, Holowka DW, Marx BP, Woodward H, et al. Examining trauma and posttraumatic stress disorder symptoms in court-mandated intimate partner violence perpetrators. Psychological Trauma: Theory, Research, Practice and Policy. 2015;7:473–8. doi: 10.1037/a0039253 .

Semiatin JN, Torres S, LaMotte AD, Portnoy GA, Murphy CM. Trauma exposure, PTSD symptoms, and presenting clinical problems among male perpetrators of intimate partner violence. Psychol Violence. 2017;7:91–100. doi: 10.1037/vio0000041 .

Birkley EL, Eckhardt CI, Dykstra RE. Posttraumatic stress disorder symptoms, intimate partner violence, and relationship functioning: a meta-analytic review. J Trauma Stress. 2016;29:397–405. doi: 10.1002/jts.22129 .

Taft CT, Watkins LE, Stafford J, Street AE, Monson CM. Posttraumatic stress disorder and intimate relationship problems: a meta-analysis. J Consult Clin Psych. 2011;79:22–33. doi: 10.1037/a0022196 .

McFall RM. A review and reformulation of the concept of social skills. Behav Assessment. 1982;4:1–33.

Holtzworth-Munroe A. Social skill deficits in martially violent men: interpreting the data using a social information processing model. Clinical Psychol Rev. 1992;12:605–18. doi: 10.1016/0272-7358(92)90134-T .

Crick NR, Dodge KA. A review and reformulation of social information-processing mechanisms in children’s social adjustment. Psychol Bull. 1994;115:74–101. doi: 10.1037/0033-2909.115.1.74 .

Lemerise EA, Arsenio WF. An integrated model of emotion processes and cognition in social information processing. Child Dev. 2000;71:107–18. doi: 10.1111/1467-8624.00124 .

Article   CAS   PubMed   Google Scholar  

• Taft CT, Weatherill RP, Scott JP, Thomas SA, Kang HK, Eckhardt CI. Social information processing in anger expression and partner violence in returning U.S. veterans. J Trauma Stress. 2015;28:314–21. doi: 10.1002/jts.22017 . Study of the connection between decoding deficits in social information processing, PTSD symptoms, and use of IPV

Davison GC, Robins C, Johnson MK. Articulated thoughts during simulated situations: a paradigm for studying cognition in emotion and behavior. Cognitive Ther Res. 1983;7:17–40. doi: 10.1007/BF01173421 .

• LaMotte AD, Taft CT, Weatherill RP, Eckhardt CI. Social skills deficits as a mediator between PTSD symptoms and intimate partner aggression in returning veterans. J Fam Psychol. 2017;31:105–10. doi: 10.1037/fam0000215 . Study of the connection between decision deficits in social information processing, PTSD symptoms, and use of IPV

Anglin K, Holtzworth-Munroe A. Comparing the responses of maritally violent and nonviolent spouses to problematic marital and nonmarital situations: are the skill deficits of physically aggressive husbands and wives global? J Fam Psychol. 1997;11:301–13. doi: 10.1037/0893-3200.11.3.301 .

Holtzworth-Munroe A, Anglin K. The competency of responses given by maritally violent versus nonviolent men to problematic marital situations. Violence Vict. 1991;6:257–69.

CAS   PubMed   Google Scholar  

Chemtob CM, Novaco RW, Hamada RS, Gross DM, Smith G. Anger regulation deficits in combat-related posttraumatic stress disorder. J Trauma Stress. 1997;10:17–36. doi: 10.1023/A:1024852228908 .

LaMotte AD, Taft CT, Weatherill RP, Scott JP, Eckhardt CI. Posttraumatic stress disorder symptoms, traumatic reminders, and partner aggressive tendencies among veterans. J Fam Violence. 2016;31:461–6. doi: 10.1007/s10896-015-9776-9 .

Germain CL, Kangas M, Taylor A, Forbes D. The role of trauma-related cognitive processes in the relationship between combat-PTSD symptom severity and anger expression and control. Aust J Psychol. 2016;68:73–81. doi: 10.1111/ajpy.12097 .

LaMotte AD, Taft CT, Weatherill RP. Mistrust of others as a mediator of the relationship between trauma exposure and use of partner aggression. Psychological Trauma: Theory, Research, Practice, and Policy. 2016;8:535–40. doi: 10.1037/tra0000157 .

• Novaco RW, Chemtob CM. Violence associated with combat-related posttraumatic stress disorder: the importance of anger. Psychological Trauma: Theory, Research, Practice, and Policy. 2015;7:485–92. doi: 10.1037/tra0000067 . Study that highlights the importance of anger in the connection between PTSD and use of IPV

Berthelot N, Hébert M, Godbout N, Goulet M, Bergeron S, Boucher S. Childhood maltreatment increases the risk of intimate partner violence via PTSD and anger personality traits in individuals consulting for sexual problems. J Aggress Maltreat Trauma. 2014;23:982–98. doi: 10.1080/10926771.2014.960631 .

Wilk JE, Quartana PJ, Clarke-Walper K, Kok BC, Riviere LA. Aggression in US soldiers post-deployment: associations with combat exposure and PTSD and the moderating role of trait anger. Aggressive Behav. 2015;41:556–65. doi: 10.1002/ab.21595 .

Massa AA, Eckhardt CI, Sprunger JG, Parrott DJ, Subramani OS. Trauma cognitions and partner aggression: anger, hostility, and rumination as intervening mechanisms. Psychol Violence 2017;Online First:1–8. Doi: 10.1037/vio0000127 .

Taft CT, Murphy CM, Creech SK. Trauma-informed treatment and prevention of intimate partner violence. Washington: American Psychological Association; 2016.

Book   Google Scholar  

•• Taft CT, Macdonald A, Creech SK, Monson CM, Murphy CM. A randomized controlled trial of the Strength at Home Men’s Program for partner violence in military veterans. J Clin Psychiatry. 2016;77:1168–75. doi: 10.4088/JCP.15m10020 . RCT of the efficacy of the Strength at Home Men’s Program in treating IPV use among veterans

Creech SK, Macdonald AM, Benzer JK, Poole G, Murphy CM, Taft CT. PTSD symptoms predict outcome in trauma-informed treatment of intimate partner aggression. J Consult Clin Psych. 2017; (in press).

•• Taft CT, Creech SK, Gallagher MW, Macdonald A, Murphy CM, Monson CM. Strength at Home Couples program to prevent military partner violence: a randomized controlled trial. J Consult Clin Psych. 2016;84:935–45. doi: 10.1037/ccp0000129 . RCT of the efficacy of the Strength at Home Couples Program in preventing IPV use among veterans and their partners

Hayes MA, Gallagher MW, Gilbert KS, Creech SK, DeCandia CJ, et al. Targeting relational aggression in veterans: the Strength at Home Friends and Family intervention. J Clin Psychiatry. 2015;76:e774–8. doi: 10.4088/JCP.14m09155 .

Eckhardt CI, Murphy CM, Whitaker DJ, Sprunger J, Dykstra R, Woodard K. The effectiveness of intervention programs for perpetrators and victims of intimate partner violence. Partner Abuse. 2013;4:196–231. doi: 10.1891/1946-6560.4.2.196 .

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LaMotte, A.D., Taft, C.T. PTSD, Anger, and Trauma-Informed Intimate Partner Violence Prevention. Curr Treat Options Psych 4 , 262–270 (2017). https://doi.org/10.1007/s40501-017-0121-1

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DOI : https://doi.org/10.1007/s40501-017-0121-1

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Complex PTSD in survivors of intimate partner violence: risk factors related to symptoms and diagnoses

Tept complejo en supervivientes de violencia de género: factores de riesgo relacionados con síntomas y diagnósticos, 亲密伴侣暴力幸存者的复杂性 ptsd: 与症状和诊断相关的风险因素, c. fernández -fillol.

a Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain

b Faculty of Psychology, Department of Personality, Assessment and Psychological Treatment, University of Granada, Granada, Spain

C. Pitsiakou

M. perez -garcia.

c Faculty of Education, Department of Developmental and Educational Psychology, University of Granada, Granada, Spain

N. Hidalgo- Ruzzante

Associated data.

Data and analyses are available on request due to the privacy and safety of research participants.

Background : In 2018, the World Health Organization proposed a new diagnosis entitled Complex Posttraumatic Stress Disorder (CPTSD) in the ICD-11. It is a diagnosis that encompasses the classic symptoms of PTSD, along with symptoms of disturbances in self-organization (DSO). Although this disorder has been studied in several countries and populations, research on the population of women survivors of intimate partner violence (IPV) is scarce.

Objectives : 1) To analyse the prevalence of CPTSD and PTSD according to ICD-11 criteria; 2) To analyse the associations between CPTSD symptomatology and severity of violence, level of fear, resilience and strategies of emotion regulation; 3) To analyse which risk factors (severity of violence, level of fear, resilience and strategies of emotion regulation) may differ between female survivors with CPTSD or PTSD.

Method : 162 women IPV survivors who completed a socio-demographic and violence-related interview, as well as questionnaires to assess PTSD and CPTSD, severity of violence, resilience and emotion regulation strategies.

Results : The results showed a higher prevalence of CPTSD (39.50%), compared to PTSD (17.90%). Moreover, a high level of fear was related to re-experiencing in the here and now, avoidance, current sense of threat and disturbances in relationships. Low levels of resilience and maladaptive emotion regulation strategies such as expressive suppression were related to affective dysregulation, negative self-concept and disturbances in relationships. Finally, the results showed that maladaptive emotion regulation strategies differentiated between meeting CPTSD and PTSD criteria in women survivors of IPV.

Conclusion : The findings of this study indicated that CPTSD was twice as prevalent as PTSD within the sample. Moreover, maladaptive emotion regulation strategy as expressive suppression was the main variable related to experiencing CPTSD, in contrast to PTSD. These findings may have important implications for the design of specific treatments aimed at women survivors of IPV, who also suffer CPTSD.

• This study provides information on CPTSD according to ICD-11 in women survivors of IPV.
• Results show a higher prevalence of women survivors that meet CPTSD, over PTSD criteria.
• Low level of resilience and expressive suppression are related to DSO symptoms.

Short abstract

Antecedentes: En 2018, la Organización Mundial de la Salud propuso en la CIE-11 un nuevo diagnóstico denominado trastorno de estrés postraumático complejo (TEPTC). Se trata de un diagnóstico que engloba los síntomas clásicos del TEPT y los síntomas de alteraciones de la auto-organización (AAO). Aunque este trastorno se ha estudiado en varios países y poblaciones, la investigación en la población de mujeres supervivientes de violencia de género (VG) es escasa.

Objetivos: 1) Analizar los porcentajes de TEPTC y TEPT según los criterios de CIE-11; 2) Analizar las asociaciones entre los síntomas de TEPTC con la gravedad de la violencia, nivel de miedo, resiliencia y estrategias de regulación emocional; 3) Analizar qué factores de riesgo (gravedad de la violencia, nivel de miedo, resiliencia y estrategias de regulación emocional) diferencian entre sufrir TEPTC o TEPT en mujeres supervivientes de VG.

Método: Las participantes fueron 162 mujeres supervivientes de VG que completaron una entrevista sociodemográfica y de violencia, así como cuestionarios para evaluar el TEPT y el TEPTC, gravedad de la violencia, resiliencia y estrategias de regulación emocional.

Resultados: Los resultados mostraron una mayor prevalencia de TEPTC (39,50%) que de TEPT (17,90%). Además, un alto nivel de miedo se relacionó con la reexperimentación en el aquí y ahora, evitación, sensación actual de amenaza y alteraciones en las relaciones. Bajos niveles de resiliencia y estrategias desadaptativas de regulación emocional como la supresión de la expresión, se relacionaron con los síntomas de desregulación afectiva, autoconcepto negativo y alteraciones en las relaciones. Por último, los resultados mostraron que las estrategias desadaptativas de regulación emocional diferenciaban entre cumplir los criterios de TEPTC y TEPT en mujeres supervivientes de VG.

Conclusión: Este estudio mostró que el TEPTC es dos veces más prevalente que el TEPT en la presente muestra de mujeres supervivientes de VG. Además, la estrategia desadaptativa de regulación emocional de supresión de la expresión fue la principal variable relacionada con presentar TEPTC en contraste con el TEPT. Estos hallazgos podrían tener importantes implicaciones para el diseño de tratamientos específicos dirigidos a las mujeres supervivientes de VG que sufren TEPTC.

背景: 2018 年, 世界卫生组织在 ICD-11（WHO，2018）提出了一个叫做复杂性创伤后应激障碍(CPTSD) 的新诊断。这是一种包括 PTSD 经典症状以及自组织障碍 (DSO) 症状的诊断。尽管已经在多个国家和人群中研究了这种疾病, 对亲密伴侣暴力 (IPV) 女性幸存者人群的研究很少。

目的: 1) 根据 ICD-11 标准分析 CPTSD 和 PTSD 的流行率; 2)分析 CPTSD 症状与暴力严重程度, 恐惧程度, 心理韧性和情绪调节策略之间的关联; 3) 分析哪些风险因素 (暴力的严重程度, 恐惧程度, 心理韧性和情绪调节策略) 可能在患有 CPTSD 或 PTSD 的女性幸存者之间有所不同。

方法: 162 名 IPV 女性幸存者完成了社会人口统计和暴力相关访谈, 以及评估 PTSD 和 CPTSD, 暴力严重程度, 心理韧性和情绪调节策略的问卷。

结果: 结果表明, CPTSD 的流行率 (39.50%) 比PTSD (17.90%) 更高。此外, 高水平的恐惧与此时此地的再体验, 回避, 当前的威胁感和关系困扰有关。低水平的心理韧性和适应不良的情绪调节策略 (如表达抑制) 与情感失调, 负性自我概念和人际关系障碍有关。最后, 结果表明 IPV 女性幸存者中适应不良的情绪调节策略在符合 CPTSD 和 PTSD 标准之间存在差异。

结论: 总之, 本研究结果表明, 此样本中CPTSD 是 PTSD 的两倍。此外, 与 PTSD 不同, 作为表达抑制的适应不良情绪调节策略是与经历 CPTSD 相关的主要变量。这些发现可能对设计针对患有 CPTSD 的 IPV 女性幸存者的特定治疗具有重要意义。

1. IPV definition and prevalence

Intimate partner violence (IPV) is a critical international public health problem. It refers to any behaviour within an intimate relationship that causes physical, psychological or sexual harm (World Health Organization [WHO], 2012 ) and is one of the main causes of death and disability among women worldwide (WHO, 2013 ).

One out of three women worldwide has suffered physical and/or sexual violence from an intimate partner, and in some regions this rate can reach 38% (WHO, 2013 ). In Spain, a large-sample survey about violence against women carried out every four years with women ages 16 and over, revelated that 32.4% of the Spanish female population had experienced IPV. Moreover, in a total of 9568 interviewed women survivors of IPV, 11% reported that they had suffered physical violence, 8.9% reported they had suffered sexual violence, 27% had suffered psychological control violence and 23.2% had suffered psychological emotional violence (Ministry of Health, Social Services and Equality, 2020 ).

1.1. PTSD and CPTSD in survivors of IPV

Experiencing interpersonal violence by a partner or ex-partner may increase the risk of onset of mental health disorders (Dillon, Hussain, Loxton, & Rahman, 2013 ; Sugg, 2015 ; Thurston & Miller, 2019 ). This is also the case with PTSD, which appears to be the most common mental health problem that female survivors of IPV may develop. According to Golding ( 1999 ), the PTSD prevalence may range from 31% to 84.4% within this population. Subsequent similar studies in different populations of female IPV victims and survivors confirmed similar rates of prevalence of PTSD (e.g. Kastello et al., 2016 ; Kelly, 2010 ; Nathanson, Shorey, Tirone, & Rhatigan, 2012 ; Nerøien & Schei, 2008 ; Pico-Alfonso et al., 2006 ).

The definition of PTSD includes symptoms of intrusion and re-experiencing, avoidance and a current sense of threat following a traumatic experience (American Psychiatric Association [APA], 2013 ). Interpersonal traumatic experiences are associated with an increased risk of PTSD (Kessler et al., 2017 ), leading the ICD-11 (World Health Organization’s International Classification of Diseases, ICD-11, 2018 ) to propose a distinction between PTSD and Complex Posttraumatic Stress Disorder (CPTSD). Therefore, according to ICD-11, some people could develop PTSD or CPTSD after suffering traumatic events. In addition to the aforementioned PTSD symptoms of re-experiencing, avoidance and current sense of threat, CPTSD contains a set of symptoms called disturbances in self-organization (DSO), which in turn are comprised of affective dysregulation, negative self-concept and disturbances in relationships (Brewin et al., 2017 ).

Up to now, the studies about CPTSD have been carried out with adult clinical samples (Cloitre et al., 2018 ; Hyland et al., 2017 ; Karatzias et al., 2016 ; Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018 ; Simon, Roberts, Lewis, van Gelderen, & Bisson, 2019 ; Stadtmann, Maercker, Binder, & Schnepp, 2018 ; van Dijke, Hopman, & Ford, 2018 ), non-clinical community-based samples (Karatzias, Hyland, Ben-Ezra, & Shevlin, 2018a ; Murphy, Elklit, Dokkedahl, & Shevlin, 2018 ), child and adolescent victims of maltreatment (Bertó et al., 2017 ), trafficked children (Ottisova, Smith, & Oram, 2018 ), former child soldiers (Murphy et al., 2018 ), women’s clinical samples (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014 ; Hyland, Shevlin, Fyvie, & Karatzias, 2018 ), male perpetrators of IPV (Gilbar, Hyland, Cloitre, & Dekel, 2018 ), refugees (Vallières et al., 2018 ) and war prisoners (Zerach, Shevlin, Cloitre, & Solomon, 2019 ). In addition, some of these studies compared PTSD and CPTSD prevalences in the same populations (Cloitre et al., 2014 , 2018 ; Gilbar et al., 2018 ; Hyland et al., 2017 ; 2018 ; Karatzias et al., 2016 ; Murphy et al., 2018 ; Simon et al., 2019 ; Vallières et al., 2018 ; Zerach et al., 2019 ). Despite the fact that IPV is a type of interpersonal violence that is difficult to escape for its particular bond between the survivors and perpetrators, and despite its possible consequences, such as low self-esteem and deconstruction of identity (Hyland et al., 2018 ; Matheson et al., 2015 ; Pill, Day, & Mildred, 2017 ), research on CPTSD in women survivors of IPV is scarce. So far there is only one study that has studied the presence of CPTSD in this population (Dokkedahl, Kristensen, Murphy, & Elklit, 2021 ), which found a prevalence of PTSD = 56.5% and CPTSD = 21.1% in a Danish sample recruited in four shelters. Therefore, the present study aims to explore the prevalence of PTSD and CPTSD, as well as the variables that could increase the risk of the onset of this disorder and its symptomatology among women survivors of IPV who attend women’s information centres but who are not currently living in shelters.

1.2. Risk factors related to PTSD and CPTSD after suffering IPV

An important factor that may facilitate the onset or aggravation of PTSD symptoms is the severity of the violence experienced (Lagdon, Armour, & Stringer, 2014 ). In a study carried out by Ferrari et al. ( 2016 ), three-quarters of the female participants who had experienced high levels of recent violence showed PTSD scores above the clinical threshold. This is consistent with the argument that the risk of PTSD is higher than of any of the other mental health issues experienced by IPV survivors (Howarth & Feder, 2013 ). Furthermore, the amount of time passed since the event may also influence the current manifestation of the PTSD symptoms (Badour, Resnick, & Kilpatrick, 2017 ). In terms of remission, it should be noted that treatment could be a factor influencing symptom remission. However, most remission studies do not include populations that have received a specific PTSD treatment. On the other hand, it has been observed that the average time to remission of PTSD symptoms is longer in people who have experienced interpersonal trauma, in comparison to those who have experienced a non-interpersonal trauma (Chapman et al., 2012 ; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995 ).

Several studies have shown a positive association between the level of fear experienced and subsequent appearance of PTSD symptoms (Hebenstreit, Maguen, Koo, & DePrince, 2015 ), as well as with the number of symptoms presented (Amstadter, Nugent, & Koenen, 2009 ; Mahan & Ressler, 2012 ; Milad et al., 2008 ). However, fear has not been linked yet to the DSO symptoms of CPTSD, since PTSD is conceptualized as a fear-based disorder, whereas CPTSD is conceptualized as a broader clinical disorder that is defined by the impact of trauma on emotion regulation, identity, and the interpersonal domain (Hyland et al., 2017 ).

A variable that has been shown to be a protective factor in risky situations and post- trauma is resilience (Horn & Feder, 2018 ). According to Connor and Davidson ( 2003 ), resilience embodies the personal qualities that enable one to thrive in the face of adversity (measure tenacity, pressure and control, adaptability and support, control and purpose, and spirituality). Therefore, resilience could be understood as a measure of a successful stress-coping ability. In line with this, other authors reported that active coping strategies were negatively related to the development of PTSD symptoms, as opposed to negative coping (Thompson, Fiorillo, Rothbaum, Ressler, & Michopoulos, 2018 ). In women survivors of IPV, possessing fewer effective coping strategies was related to a greater number of PTSD symptoms (Sullivan, Weiss, Price, Pugh, & Hansen, 2018 ).

Finally, emotion regulation strategies is another important variable in IPV related to affect, cognition and behaviour and it is defined as an attempt, whether implicit or explicit, to modify one’s emotional response (Werner & Gross, 2010 ). It has been shown that greater emotion regulation difficulties and maladaptive strategies were related to greater severity of PTSD (Chang, Kaczkurkin, McLean, & Foa, 2018 ; Moore, Zoellner, & Mollenholt, 2008 ; Short, Boffa, Clancy, & Schmidt, 2018 ; Weiss et al., 2012 ). Likewise, higher levels of emotion dysregulation difficulties were related to more severe PTSD symptoms in IPV survivors (Lilly & Lim, 2012 ). In the case of emotion regulation strategies and CPTSD, there is only one study that indicates that emotion regulation maladaptive strategies were significantly related to receiving a CPTSD diagnosis. That maladaptive strategy was expressive suppression, which is understood as efforts to conceal, inhibit or reduce emotional expression (Karatzias et al., 2018b ). Nevertheless, these results should be considered with caution in relation to CPTSD, due to the lack of CPTSD measures and the cross-sectional designs of the previous studies.

In summary, even though factors such as severity of violence, level of fear, resilience and emotion regulation strategies have been shown to be related to PTSD and in the case of emotion regulation to CPTSD too, these factors have not been studied in relation to CPTSD within women survivors of IPV. The current study attempts to fill the gap in research since it is crucial to explore the presence of CPTSD in this population and to also look into whether the aforementioned PTSD factors could be related to CPTSD symptoms.

1.3. Objectives and hypotheses

The first objective was to analyse the prevalence of women survivors of IPV who met the criteria for PTSD or CPTSD. It was hypothesized that the frequency of CPTSD would be higher than PTSD due to the characteristics of the violence suffered by these women. This was based on the fact that IPV is a repeated trauma that involves a difficulty in escaping the situation and the violence is perpetrated by someone within the context of an intimate relationship. This high CPTSD prevalence was also observed on other populations of survivors and victims of interpersonal violence (Cloitre et al., 2014 , 2018 ; Hyland et al., 2017 , 2018 ; Karatzias et al., 2016 ; Murphy et al., 2018 ; Simon et al., 2019 ; Vallières et al., 2018 ). However, Dokkedahl et al. ( 2021 ) found the opposite. We therefore consider it is important to analyse the prevalence of both diagnoses according to ICD-11 criteria in the present sample of women survivors.

The second objective was to analyse whether the severity of violence, the level of fear, resilience and emotion regulation strategies were related to CPTSD symptomatology. Based on previous literature, we hypothesized that women who suffer more severe violence, show a higher level of fear, show dysfunctional emotion regulation strategies and a low level of resilience, would present a higher level of CPTSD symptoms.

Finally, we analysed which risk factors may be the deciding ones between presenting with CPTSD and presenting with PTSD after suffering IPV. Although there are no previous studies on this topic, we hypothesized that maladaptive emotion regulation strategies could be considered risk factors that would be associated with CPTSD symptoms.

2.1. Participants and procedures

Participants were 162 women who had suffered IPV from their ex-partners at some point in their lives. They were recruited in associations and women’s centres from 30 localities in six different regions of Spain (Andalucía, Asturias, Castilla la Mancha, Castilla y León, Extremadura and Comunidad Valenciana). All of them were over 18 years old ( M = 41.42 years old; SD  = 11.55; age range: 20–75), survivors of IPV (psychological, physical and/or sexual) perpetrated by ex-partners, none of them were still in the relationship or lived with the perpetrator and all spoke and wrote fluent Spanish ( M = 46.11 months from the end of the relationship until the assessment; SD  = 61.54). The exclusion criteria were: not having suffered IPV by their partner/ex-partner, being under 18 years old and not being able to read, understand and write in Spanish.

The sample was composed entirely of women residents in Spain (including native Spanish from other nationalities such as Venezuela ( N = 1), Morocco ( N = 3), Russia ( N = 1) and Ecuador ( N = 1). Data on the nationalities of the non-Spanish women were not provided by all centres. They had a M  = 14.30 of academic years of studies ( SD  = 5.25) and 83.33% shared children with their violent ex partners. Table 1 shows other socio-demographic and violence-related information.

Socio-demographic and violence data

The study was approved by the Ethics Committee of the University of Granada (933/CEIH/2019. Ethics Committee on Human Research, CEIH) and the data were collected after agreeing on a collaboration with the centres and associations where women attended. Contact with the women’s centres and associations was made by telephone and email. Firstly, information about the study was given and collaboration was proposed. The centres dependent on regional or local governments needed permission from the authorities in order to be able to proceed with the assessments. In the case of non-governmental associations, permission was given by the associations themselves.

From the different centres that were contacted, the professionals informed us of their acceptance to participate in the study and they referred the women to us for evaluation. The professionals of the women’s centres made the first contact and the women who agreed to know about the study were informed in detail by members of our research team. Our team directly requested the women’s permission to participate by means of informed consent, previously approved by the ethics committee. Participants were invited to collaborate in the study on a voluntary and anonymous basis and they had the right to withdraw from the study at any time. Of the total number of women, only one was unable to take part in the assessment despite her willingness to do so, due to severe symptoms of disorientation and memory loss. The evaluation consisted of completing a brief interview and self-reporting questionnaires and participants were assessed by at least one psychologist during all evaluations. The data collection period was from November 2019 to January 2021. They did not receive incentives or payments for their participation. Confidentiality was kept and guaranteed according to the Spanish legislation on personal data protection (Organic Law 15/13 December 1999).

2.2. Measures

2.2.1. socio-demographic and violence interview.

The research team developed a self-reported structured interview in which they collected socio-demographic data (date of birth, information about children, total years of school attendance, level of education, current education); yes/no questions about the violent relationship (types of violence suffered, duration of the violence, number of violent relationships); previous trauma and its type, current relationship status with the perpetrator (i.e. Are you still in the relationship?; Are you currently living together?); contact with perpetrator due to common issues (legal issues, parenting, custody) (i.e. text messages, conversations with the aggressor and what they may involve or indirect messages through the children); ongoing legal proceedings (i.e. Are you currently in any kind of legal proceedings with your partner/ex-partner?; Does he currently have a restraining order?; Has your partner/ex-partner been or is currently in prison?); or whether they have contact with the perpetrator because they have legal issues in regards to shared children (i.e. Do you and your partner/former partner have children in common?; Are your children under 18 years old?; and a description about the type of custody and whether they see ex-partners at legal meeting points).

2.2.2. Fear

The level of current fear they feel towards the perpetrators was assessed with a Likert scale developed where they reported the level of fear that they felt in the moment of the assessment in one of the six levels of fear proposed, ranging from ‘no fear at all’ to ‘the most intense possible fear’: no fear (0), very slight fear (1), mild fear (2), moderate fear (3), intense fear (4), very intense fear (5) and the most intense possible fear (6).

2.2.3. ICD-11 CPTSD and PTSD

The International Trauma Questionnaire (ITQ) (Cloitre et al., 2018 ) was used to measure PTSD and CPTSD. This is a brief measure of CPTSD (free access) developed at an international level according to ICD-11 (WHO) criteria. The ITQ Spanish adapted version was used (Fernández-Fillol, Hidalgo-Ruzzante, Pérez-García, & Daugherty, 2020 ; International Test Commission [ITC], 2018 ). It includes 18 items (9 PTSD symptoms and 9 DSO items) and six items related to functional impairment of PTSD symptoms and functional impairment of DSO symptoms. PTSD diagnosis requires the endorsement of one of two symptoms (scores more than 2) from each PTSD cluster, plus endorsement of functional impairment associated with these symptoms. Diagnosis of CPTSD requires the endorsement of one of two symptoms from each of the six PTSD and DSO clusters, plus endorsement of functional impairment associated with these symptoms. According to the ICD-11 taxonomic structure, ITQ only allows one diagnosis of PTSD or CPTSD, but not both. The internal reliability for both scales is satisfactory, with Cronbach’s α ≥ 0.79 in a community sample (Cloitre et al., 2018 ).

2.2.4. Severity of IPV

The Composite Abuse Scale (Revised)-Short Form (CASR-SF) (Ford-Gilboe et al., 2016 ) was used for this variable. This is a 15-item self-report measure that assesses the severity and intensity of intimate partner violence in the past 12 months. It includes measures for psychological, physical and sexual violence. CASR-SF assesses the frequency of each type of violence on a scale of 0–5 with a range of 0–75 (higher total score means a higher severity of violence). The original CASR-SF has an internal consistency of 0.942 (Ford-Gilboe et al., 2016 ) and was translated into Spanish for the sample of this study following the International Test Commission Guidelines for Translating and Adapting Tests Second Edition (ITC, 2018 ). Since many women had suffered violence for years but not in the last year, we also used this measure for a period prior to the last 12 months, in order to know the type of violence and its frequency.

2.2.5. Resilience

The Connor-Davidson Resilience Scale (CD-RISC) (Connor & Davidson, 2003 ) was used to assess resilience. This measure has different subscales (tenacity, pressure control, adaptability and support, control and purpose, and spirituality) and the sum total of these subscales constitutes the resilience construct. It contains 25 items, each scored on a 5-point scale (0–4), with higher scores reflecting greater resilience (0–100). In terms of internal consistency, Cronbach’s α for the full scale is 0.89 and item-total correlations range from 0.30 to 0.70 (Connor & Davidson, 2003 ). Similar results are obtained in the Spanish version, Cronbach’s α for the full scale is 0.86 and the mean of the correlations between each item and the total scale was 0.42 (SD = 0.13) (León, González-Gómez, Robles-Ortega, Padilla, & Peralta-Ramirez, 2019 ).

2.2.6. Emotion regulation

The Emotion Regulation Questionnaire (ERQ) (Gross & John, 2003 ) was used to evaluate the participants’ emotion regulation. This is a 10-item scale designed to measure the tendency of respondents to regulate their emotions in two ways: cognitive reappraisal as an adaptive strategy and expressive suppression as maladaptive strategy. The response to each item is given on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). A higher total score on the cognitive reappraisal subscale means a greater use of adaptive emotion regulation strategies (range 0–42) and a higher total score on the expressive suppression subscale means a greater use of maladaptive emotion regulation strategies (range 0–28). The reliability of the subscales in the validated Spanish version is similar and as adequate as the original version, with Cronbach’s α = 0.75 for emotional suppression and 0.79 for cognitive reappraisal strategies (Cabello, Salguero, Fernández-Berrocal, & Gross, 2013 ).

2.3. Data analysis

Data were analysed using the Statistical Package for the Social Sciences, version 26.0 (SPSS; IBM Corp., 2019). For the first objective, we used a frequency analysis to find out the prevalence of women who met the CPTSD or PTSD diagnosis. Through this analysis, the percentage of women who met each of the CPTSD symptoms could also be explored.

For the purpose of analysing which risk factors (severity of violence in two periods, level of fear, resilience and two strategies of emotion regulation as Independent Variables (IV)) were related with the presence of each one of the CPTSD symptoms (re-experiencing, avoidance, current sense of threat, affective dysregulation, negative self-concept and disturbances in relationships) as dependent variables (DV), we carried out six logistic regression analyses. For each logistic regression model, the method of entering all variables together as independent variables (IV) was used. Statistical significance of contribution of each IV was obtained using t tests. The presence of the symptom was coded as 1 and the absence of the symptom as 0. We used this same analysis to analyse which risk factors were related to the fulfilment of diagnostic criteria for PTSD to become CPTSD as it has previously been reported in other studies (Karatzias et al., 2018b ).

3.1. Prevalence rates and descriptive statistics

ITQ follows the structure of ICD-11, which allows the diagnosis of CPTSD or PTSD, but not both at the same time. 57.40% ( N = 93) of women survivors of IPV met the diagnostic criteria for either CPTSD or PTSD. Specifically, 39.50% ( N = 64) met the diagnostic criteria for CPTSD and 17.90% (N  = 29) met the criteria for PTSD. Descriptive data and frequencies for each CPTSD symptom are presented in Table 2 .

Descriptive data and frequencies according to CPTSD symptomatology

ITQ P1 = Re-experiencing in the here and now item 1; ITQ P2 = Re-experiencing in the here and now item 2; ITQ P3 = Avoidance item 1; ITQ P4 = Avoidance item 2; ITQ P5 = Current sense of threat item 1; ITQ P6 = Current sense of threat item 2; ITQ C1 = Affective dysregulation item 1; ITQ C2 = Affective dysregulation item 2; ITQ C3 = Negative self-concept item 1; ITQ C4 = Negative self-concept item 2; ITQ C5 = Disturbances in relationships item 1; ITQ C6 = Disturbances in relationships item 2.

3.2. Association between severity of violence, fear, resilience and emotion regulation with manifestation of CPTSD symptoms after suffering IPV

Descriptive data for the totals of each measure used are detailed in Table 3 and the results of the logistic regression analysis for each of the CPTSD symptoms (dependent variables) are shown in Table 4 . A higher level of fear was related to the presence of symptoms such as ‘re-experiencing’ (R 2  = 0.14, OR = 1.33, 95%CI: 1.08–1.63), ‘avoidance’ (R 2  = 0.09, OR = 1.43, 95%CI: 1.10–1.87), ‘current sense of threat’ (R 2  = 0.24, OR = 1.68, 95%CI: 1.29–2.19) and ‘disturbances in relationships’ (R 2  = 0.15, OR = 1.27, 95%CI: 1.03–1.57). On the other hand, lower levels of resilience were related to the presence of symptoms such as ‘affective dysregulation’ (R 2  = 0.14, OR = 0.93, 95%CI: 0.89–0.97), ‘negative self-concept’ (R 2  = 0.23, OR = 0.93, 95%CI: 0.90–0.96) and ‘disturbances in relationships’ (R 2  = 0.15, OR = 0.96, 95%CI: 0.93–0.99). Finally, a higher level of expressive suppression was related to ‘affective dysregulation’ (R 2  = 0.14, OR = 1.08, 95%CI: 1.00–1.17), ‘negative self-concept’ (R 2  = 0.23, OR = 1.07, 95%CI: 1.01–1.14) and ‘disturbances in relationships’ (R 2  = 0.15, OR = 1.07, 95%CI: 1.01–1.14).

Descriptive data for each measure

Risk factors related to the presence of CPTSD symptoms

CASR-A = Severity of violence in the last year; CASR-B = Severity of violence over a year ago; ERQ-CR = Cognitive reappraisal strategies; ERQ-SE = Expressive suppression strategies.

3.3. Risk factors associated with the development of PTSD or CPTSD after IPV

The results of a final logistic regression showed that high expressive suppression scores were related to a CPTSD diagnosis, compared to a PTSD diagnosis in women survivors of IPV (β = 0.14, SE  = .048, Wald  = 8.64, p = .003, R 2  = 0.14, OR = 1.15, 95%CI: 1.04–1.26).

4. Discussion

To the authors´ knowledge, there is only one previous study that has analysed the presence of CPTSD in women survivors of IPV and this is the first study to analyse the different risk factors related to its symptomatology. Although CPTSD has been addressed in other victims and survivors that have experienced continuous interpersonal violence (Kessler et al., 2017 ), the studies of this disorder in this population are scarce. Moreover, it is important to emphasize that women survivors of IPV usually seek care in victim and survivor`s services to cope with issues associated with emotion regulation, self-esteem and interpersonal relationships (Lilly & Lim, 2012 ; Matheson et al., 2015 ; St. Vil, Carter, & Johnson, 2018 ), which are all related to CPTSD symptomatology.

The main results of this study showed that the prevalence of CPTSD was twice (39.50%) the prevalence of PTSD (17.90%). Moreover, results indicated that high levels of fear were related to re-experiencing, avoidance, current sense of threat and relationship disturbances. Low resilience and high expressive suppression were related to affective dysregulation, negative self-concept and disturbances in relationships. Finally, a high tendency towards the maladaptive emotion regulation strategy of suppressing expression made the difference between PTSD and CPTSD in women survivors of IPV.

In line with previous studies of PTSD, our results indicated that more than half of the women survivors of IPV developed a disorder related to posttraumatic stress (Golding, 1999 ; Kastello et al., 2016 ; Kelly, 2010 ; Nathanson et al., 2012 ; Nerøien & Schei, 2008 ; Pico-Alfonso et al., 2006 ). However, in our sample, CPTSD was the most common type of traumatic stress disorder. Thus, this possible sequela which occurs in a very considerable prevalence, could be currently under-diagnosed within the population and therefore, not receiving targeted treatment. In respect to the only previous study showing the prevalence of PTSD and CPTSD in women survivors (Dokkedahl et al., 2021 ), the results obtained in the present study show opposite prevalences. One possible reason for this difference may be that although the ITQ test was used in both studies, the versions of the test were not the same. For example, there were differences in the number of items, the name and number of symptoms, as well as the diagnostic criteria for the two disorders. In the study of Dokkedahl et al. ( 2021 ), they used a prior version of the ITQ to the publication of the WHO ICD-11 criteria (Cloitre et al., 2015 in Dokkedahl et al., 2021 ). To the contrary, the present study used a more updated version of the ITQ, which follows ICD-11 criteria established by the WHO, that was psychometrically and internationally supported (Cloitre et al., 2018 ). The diagnostic criteria used in the present study, as described in the methods section above, are different from the previous version and this may be the reason for the difference in the results in terms of prevalence. Despite this possible explanation, it is important to further explore the prevalence of both diagnoses in order to clarify the extent to which they occur in the population of women survivors of IPV.

Additionally, we explored how each of the symptoms that makes up CPTSD was presented in this population. To analyse their presence after experiencing IPV, we studied the factors related to the six CPTSD symptoms. We found that high levels of fear of the perpetrator were especially important in presenting symptoms of re-experiencing, avoidance, current sense of threat and alterations in social relationships. The present results are consistent with the aforementioned three PTSD symptoms, and with PTSD being understood as a fear-based disorder according to the ICD-11 (Hyland et al., 2017 ). The associations of these factors with the three PTSD symptoms could be explained by the proximity of the perpetrator, considered as the source of violence (Hecker, Ainamani, Hermenau, Haefele, & Elbert, 2017 ). This would explain the tendency to avoid anything related to the perpetrators, while also experiencing fear or a current sense of threat when continuing to be in contact due to judicial matters or because of a lack of a restraining order that would provide a sense of safety. In the present study, fear was also related to disturbances in relationships, a DSO symptom. This could be explained by the fact that fear can be very present after IPV and interfere with establishing or maintaining new relationships, for a fear of repetition of the abuse (Flasch, Murray, & Crowe, 2015 ; St. Vil et al., 2018 ).

Furthermore, a low level of resilience was found to be a factor related to the occurrence of all three DSO symptoms. These findings are in line with other studies that analysed interpersonal violence survivor populations. Such studies concluded that resilience was related to dysregulation, self-esteem and social relationships after trauma (Gao et al., 2019 ; Poole, Dobson, & Pusch, 2017 ). Low scores on resilience that involve non-use of adaptive coping strategies (tenacity, pressure and control, adaptability and support, control and purpose, and spirituality) (Connor & Davidson, 2003 ) could be explained by the helplessness experienced after suffering deliberate repeated interpersonal violence from men who were their partners.

Another variable that may underpin each DSO symptoms and made the most difference between meeting PTSD and meeting CPTSD criteria, was the maladaptive emotion regulation strategy of expressive suppression. Matheson et al. ( 2015 ) found that expressive suppression in IPV survivors may be explained by the devastation of self-esteem and identity. Therefore, survivors may feel a lack of self-importance and may tend to suppress emotional expression, which is a maladaptive strategy. Likewise, this could explain why expressive suppression was a variable related to the occurrence of disturbances in social responses and relationships (Tackman & Srivastava, 2016 ). This result may be attributed to women survivors of IPV having difficulties in regulating positive emotions (Weiss, Dixon‐Gordon, Peasant, & Sullivan, 2018 ) and it could also be related to the fact that survivors may prefer not to express or to avoid judgements, may reserve their intimacy, or they may feel vulnerable and seek to protect themselves from others (Cloitre, Cohen, Ortigo, Jackson, & Koenen, 2020 ).

Considering these results, a double pattern may emerge. On one hand, risk factors related to the circumstances of the violence and/or to specific events in time (e.g. fear of being assaulted again by the abuser) may be more related to classic PTSD symptoms such as re-experiencing, avoidance and arousal. On the other hand, risk factors related to the psychological resources of survivors such as resilience and emotion regulation strategies would be related to DSO but not to classic PTSD symptoms. Future studies should further explore this hypothesis.

Finally, it is essential to identify the factors that make the difference between receiving a PTSD or CPTSD diagnosis. The present results indicate that expressive suppression is the variable that most contributes to the difference between both diagnoses. It should be noted that this result is congruent with the fact that the variable related to all symptoms of DSO may be also related to the frequency of the most common CPTSD symptoms in this study: avoidance and affective dysregulation. Hence, it could be considered that high avoidance may be related to the suppressive component and in turn, these maladaptive emotion strategies may be implicated in all emotional problems related to DSO symptoms.

5. Limitations and future directions

The sample size is the main limitation of this study. For this reason, it is necessary to continue these assessments and replicate this study to obtain information from a larger sample of women survivors of IPV. This would allow to study the prevalence of both diagnoses after suffering IPV and to investigate in depth the risk factors that are related to symptoms and diagnoses, with the aim of improving targeted treatments in this population. For example, this could include adapting specific treatments that have been effective in other interpersonal trauma populations presenting with DSO symptoms, to CPTSD symptoms. For instance, the STAIR-MPE treatment (Cloitre et al., 2020 ). It would also be necessary to study the present findings in other interpersonal violence survivor populations, as the characteristics of the sample in this study are very specific and the results cannot be generalized to other populations. Another limitation of this study could be that it is a cross-sectional design and, therefore, cause-effect relationships cannot be established. Other limitations may include the absence of specific diagnostic interviews for CPTSD that do not currently exist in Spanish, the use of retrospective reports and the inability to access the census of women victims and survivors and all nationalities in each of the 30 centres. Finally, there may be some conceptual overlap in measures referring in some way to emotion regulation and future studies should explore this. These limitations have to be taken into account in order to improve future studies.

6. Conclusion

This study shows that CPTSD is a mental health issue that a high percentage of the women survivors of IPV of this sample are suffering from. These results may reflect what could be happening within this population. IPV survivors may be suffering from symptoms that have so far not been assessed and, therefore, not properly treated. This disorder may disrupt their lives in numerous ways, while factors such as fear of the perpetrator, low levels of resilience and, in particular, a tendency to suppress the expression of emotions may increase the risk of them developing symptoms of CPTSD. The results of this study highlight the need for multidisciplinary action focused on increasing women’s protection to reduce fear of perpetrators, as well as the need for specific interventions in CPTSD. This could include treatments focused on emotion regulation through the improvement of adaptive strategies, while reducing maladaptive strategies.

Acknowledgments

This article forms part of the first author’s doctoral thesis. The present research group thanks the professionals from women’s centres and associations for their participation in our study. Many thanks to Julia C. Daugherty for her contribution to the improvement of the manuscript. Special mention and thanks to all women who shared their experiences with us in a disinterested way and with the common aim of understanding their reality in order to improve the assistance to other women.

This study has been supported by the Agencia Estatal de Investigación (Gobierno de España) in the framework of the research project reference PID2019.110041GB/AEI/10.13039/ 770 501100011033 and by Consejería de Economía y Conocimiento (Junta de Andalucía) with this research project code B-CTS493-UGR18.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

• American Psychiatric Association . (2013). DSM-5. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. [ Google Scholar ]
• Amstadter, A. B., Nugent, N. R., & Koenen, K. C. (2009). Genetics of PTSD: Fear conditioning as a model for future research . Psychiatric Annals , 39 ( 6 ), 358–12. doi: 10.3928/00485713-20090526-01 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Badour, C. L., Resnick, H. S., & Kilpatrick, D. G. (2017). Associations between specific negative emotions and DSM-5 PTSD among a national sample of interpersonal trauma survivors . Journal of Interpersonal Violence , 32 ( 11 ), 1620–1641. doi: 10.1177/0886260515589930 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bertó, C., Ferrín, M., Barberá, M., Livianos, L., Rojo, L., & García-Blanco, A. (2017). Abnormal emotional processing in maltreated children diagnosed of complex posttraumatic stress disorder . Child Abuse & Neglect , 73 , 42–50. doi: 10.1016/j.chiabu.2017.09.020 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., … Reed, G. M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD . Clinical Psychology Review , 58 , 1–15. doi: 10.1016/j.cpr.2017.09.001 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cabello, R., Salguero, J. M., Fernández-Berrocal, P., & Gross, J. J. (2013). A Spanish adaptation of the emotion regulation questionnaire . European Journal of Psychological Assessment , 29 ( 4 ), 234. doi: 10.1027/1015-5759/a000150 [ CrossRef ] [ Google Scholar ]
• Chang, C., Kaczkurkin, A. N., McLean, C. P., & Foa, E. B. (2018). Emotion regulation is associated with PTSD and depression among female adolescent survivors of childhood sexual abuse . Psychological Trauma: Theory, Research, Practice, and Policy , 10 ( 3 ), 319. doi: 10.1037/tra0000306 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chapman, C., Mills, K., Slade, T., McFarlane, A. C., Bryant, R. A., Creamer, M., … Teesson, M. (2012). Remission from post-traumatic stress disorder in the general population . Psychological Medicine , 42 ( 8 ), 1695–1703. doi: 10.1017/S0033291711002856 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cloitre, M., Cohen, L. R., Ortigo, K. M., Jackson, C., & Koenen, K. C. (2020). Treating survivors of childhood abuse and interpersonal trauma: STAIR narrative therapy . New York: Guilford Publications. [ Google Scholar ]
• Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis . European Journal of Psychotraumatology , 5 ( 1 ), 25097. doi: 10.3402/ejpt.v5.25097 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cloitre, M., Roberts, N. P., Bisson, J. I., & Brewin, C. R. (2015). The ICD-11 trauma questionnaire. Self-report community version 1.0 . Unpublished manuscript. [ Google Scholar ]
• Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., … Hyland, P. (2018). The international trauma questionnaire: Development of a self‐report measure of ICD‐11 PTSD and complex PTSD . Acta Psychiatrica Scandinavica , 138 ( 6 ), 536–546. doi: 10.1111/acps.12956 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC) . Depression and Anxiety , 18 ( 2 ), 76–82. doi: 10.1002/da.10113 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dillon, G., Hussain, R., Loxton, D., & Rahman, S. (2013). Mental and physical health and intimate partner violence against women: A review of the literature . International Journal of Family Medicine , 2013 , 1–15. doi: 10.1155/2013/313909 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dokkedahl, S., Kristensen, T. R., Murphy, S., & Elklit, A. (2021). The complex trauma of psychological violence: Cross-sectional findings from a Cohort of four Danish Women Shelters . European Journal of Psychotraumatology , 12 ( 1 ), 1863580. doi: 10.1080/20008198.2020.1863580 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fernández-Fillol, C., Hidalgo-Ruzzante, N., Pérez-García, M., & Daugherty, J. C. (2020). Translation and Adaptation of the Spanish Version of the International Trauma Questionnaire (ITQ) following ITC Guidelines for Translating and Adapting Tests . doi: 10.31234/osf.io/gps7k [ CrossRef ]
• Ferrari, G., Agnew-Davies, R., Bailey, J., Howard, L., Howarth, E., Peters, T. J., … Feder, G. S. (2016). Domestic violence and mental health: A cross-sectional survey of women seeking help from domestic violence support services . Global Health Action , 9 ( 1 ), 29890. doi: 10.3402/gha.v9.29890 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Flasch, P., Murray, C. E., & Crowe, A. (2015). Overcoming abuse: A phenomenological investigation of the journey to recovery from past intimate partner violence . Journal of Interpersonal Violence , 32 ( 22 ), 3373–3401. doi: 10.1177/0886260515599161 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ford-Gilboe, M., Wathen, C. N., Varcoe, C., MacMillan, H. L., Scott-Storey, K., Mantler, T., … Perrin, N. (2016). Development of a brief measure of intimate partner violence experiences: The Composite Abuse Scale (Revised)—Short Form (CASR-SF) . BMJ Open , 6 ( 12 ), e012824. doi: 10.1136/bmjopen-2016-012824 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gao, F., Yao, Y., Yao, C., Xiong, Y., Ma, H., & Liu, H. (2019). The mediating role of resilience and self-esteem between negative life events and positive social adjustment among left-behind adolescents in China: A cross-sectional study . BMC Psychiatry , 19 ( 1 ), 1–10. doi: 10.3389/fpsyt.2020.560556 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gilbar, O., Hyland, P., Cloitre, M., & Dekel, R. (2018). ICD-11 complex PTSD among Israeli male perpetrators of intimate partner violence: Construct validity and risk factors . Journal of Anxiety Disorders , 54 , 49–56. doi: 10.1016/j.janxdis.2018.01.004 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis . Journal of Family Violence , 14 ( 2 ), 99–132. doi: 10.1023/A:1022079418229 [ CrossRef ] [ Google Scholar ]
• Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being . Journal of Personality and Social Psychology , 85 ( 2 ), 348. doi: 10.1037/0022-3514.85.2.348 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hebenstreit, C. L., Maguen, S., Koo, K. H., & DePrince, A. P. (2015). Latent profiles of PTSD symptoms in women exposed to intimate partner violence . Journal of Affective Disorders , 180 , 122–128. doi: 10.1016/j.jad.2015.03.047 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hecker, T., Ainamani, H. E., Hermenau, K., Haefele, E., & Elbert, T. (2017). Exploring the potential distinction between continuous traumatic stress and posttraumatic stress in an east African refugee sample . Clinical Psychological Science , 5 ( 6 ), 964–973. doi: 10.1177/2167702617717023 [ CrossRef ] [ Google Scholar ]
• Horn, S. R., & Feder, A. (2018). Understanding resilience and preventing and treating PTSD . Harvard Review of Psychiatry , 26 ( 3 ), 158–174. doi: 10.1097/HRP.0000000000000194 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Howarth, E., & Feder, G. (2013). Prevalence and physical health impact of domestic violence. In Howarth E., Feder G., Howarth L., Agnew-Davies R., and Feder G. (Eds.), Domestic violence and mental health (pp. 1–17). London: Royal College of Psychiatric Publications. [ Google Scholar ]
• Hyland, P., Shevlin, M., Brewin, C. R., Cloitre, M., Downes, A. J., Jumbe, S., … Roberts, N. P. (2017). Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the international trauma questionnaire . Acta Psychiatrica Scandinavica , 1363 , 313–322. doi: 10.1111/acps.12771 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hyland, P., Shevlin, M., Fyvie, C., & Karatzias, T. (2018). Posttraumatic stress disorder and complex posttraumatic stress disorder in DSM-5 and ICD-11: Clinical and behavioral correlates . Journal of Traumatic Stress , 31 ( 2 ), 174–180. doi: 10.1002/jts.22272 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• International Test Commission, ITC . (2018). ITC Guidelines for Translating and Adapting Tests (Second Edition) . International Journal of Testing , 18 ( 2 ), 101–134. doi: 10.1080/15305058.2017.1398166 [ CrossRef ] [ Google Scholar ]
• Karatzias, T., Hyland, P., Ben-Ezra, M., & Shevlin, M. (2018a). Hyperactivation and hypoactivation affective dysregulation symptoms are integral in complex posttraumatic stress disorder: Results form a nonclinical Israeli sample . International Journal of Methods in Psychiatry Research , 27 , e1745. doi: 10.1002/mpr.1745 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., … Cloitre, M. (2016). An initial psychometric assessment of an ICD-11 based measure of PTSD and complex PTSD (ICD-TQ): Evidence of construct validity . Journal of Anxiety Disorders , 44 , 73–79. doi: 10.1016/j.janxdis.2016.10.009 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Karatzias, T., Shevlin, M., Hyland, P., Brewin, C. R., Cloitre, M., Bradley, A., … Roberts, N. P. (2018b). The role of negative cognitions, emotion regulation strategies, and attachment style in complex post‐traumatic stress disorder: Implications for new and existing therapies . British Journal of Clinical Psychology , 57 ( 2 ), 177–185. doi: 10.1111/bjc.12172 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kastello, J. C., Jacobsen, K. H., Gaffney, K. F., Kodadek, M. P., Sharps, P. W., & Bullock, L. C. (2016). Predictors of depression symptoms among low-income women exposed to perinatal intimate partner violence (IPV) . Community Mental Health Journal , 52 ( 6 ), 683–690. doi: 10.1007/s10597-015-9977-y [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kazlauskas, E., Gegieckaite, G., Hyland, P., Zelviene, P., & Cloitre, M. (2018). The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services . European Journal of Psychotraumatology , 9 ( 1 ), 1414559. doi: 10.1080/20008198.2017.1414559 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kelly, U. A. (2010). Symptoms of PTSD and major depression in Latinas who have experienced intimate partner violence . Issues in Mental Health Nursing , 31 ( 2 ), 119–127. doi: 10.3109/01612840903312020 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., … Koenen, K. C. (2017). Trauma and PTSD in the WHO world mental health surveys . European Journal of Psychotraumatology , 8 ( 5 ), 1353383. doi: 10.1080/20008198.2017.1353383 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey . Archives of General Psychiatry , 52 , 1048–1060. doi: 10.1001/archpsyc.1995.03950240066012 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lagdon, S., Armour, C., & Stringer, M. (2014). Adult experience of mental health outcomes as a result of intimate partner violence victimisation: A systematic review . European Journal of Psychotraumatology , 5 ( 1 ), 24794. doi: 10.3402/ejpt.v5.24794 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• León, M. Á. G., González-Gómez, A., Robles-Ortega, H., Padilla, J. L., & Peralta-Ramirez, I. (2019). Propiedades psicométricas de la Escala de Resiliencia de Connor y Davidson (CD-RISC) en población española . Anales de Psicología/Annals of Psychology , 35 ( 1 ), 33–40. doi: 10.6018/analesps.35.1.31411 [ CrossRef ] [ Google Scholar ]
• Lilly, M. M., & Lim, B. H. (2012). Shared pathogeneses of posttrauma pathologies: Attachment, emotion regulation, and cognitions . Journal of Clinical Psychology , 69 , 737–748. doi: 10.1002/jclp.21934 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mahan, A. L., & Ressler, K. J. (2012). Fear conditioning, synaptic plasticity and the amygdala: Implications for posttraumatic stress disorder . Trends in Neuroscience , 35 , 24–35. doi: 10.1016/j.tins.2011.06.007 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Matheson, F. I., Daoud, N., Hamilton-Wright, S., Borenstein, H., Pedersen, C., & O’Campo, P. (2015). Where did she go? The transformation of self-esteem, self-identity, and mental well-being among women who have experienced intimate partner violence . Women’s Health Issues , 25 ( 5 ), 561–569. doi: 10.1016/j.whi.2015.04.006 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Milad, M. R., Orr, S. P., Lasko, N. B., Chang, Y., Rauch, S. L., & Pitman, R. K. (2008). Presence and acquired origin of reduced recall for fear extinction in PTSD: Results of a twin study . Journal of Psychiatric Research , 42 , 515–520. doi: 10.1016/j.jpsychires.2008.01.017 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ministry of Health, Social Services and Equality (Ministerio de Sanidad, Servicios Sociales e Igualdad) . (2020). Macroencuesta de violencia contra la mujer 2019 . Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad, Centro de Publicaciones. [ Google Scholar ]
• Moore, S. A., Zoellner, L. A., & Mollenholt, N. (2008). Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behaviour Research and Therapy , 46 ( 9 ), 993–1000. doi: 10.1016/j.brat.2008.05.001 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Murphy, S., Elklit, A., Dokkedahl, S., & Shevlin, M. (2018). Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11 . European Journal of Psychotraumatology , 9 ( 1 ), 1457393. doi: 10.1080/20008198.2018.1457393 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nathanson, A. M., Shorey, R. C., Tirone, V., & Rhatigan, D. L. (2012). The prevalence of mental health disorders in a community sample of female victims of intimate partner violence . Partner Abuse , 3 ( 1 ), 59–75. doi: 10.1891/1946-6560.3.1.59 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nerøien, A. I., & Schei, B. (2008). Partner violence and health: Results from the first national study on violence against women in Norway . Scandinavian Journal of Public Health , 36 ( 2 ), 161–168. doi: 10.1177/1403494807085188 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ottisova, L., Smith, P., & Oram, S. (2018). Psychological consequences of human trafficking: Complex posttraumatic stress disorder in trafficked children . Behavioral Medicine , 44 ( 3 ), 234–241. doi: 10.1080/08964289.2018.1432555 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pico-Alfonso, M. A., Garcia-Linares, M. I., Celda-Navarro, N., Blasco-Ros, C., Echeburúa, E., & Martinez, M. (2006). The impact of physical, psychological, and sexual intimate male partner violence on women’s mental health: Depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide . Journal of Women’s Health , 15 ( 5 ), 599–611. doi: 10.1089/jwh.2006.15.599 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pill, N., Day, A., & Mildred, H. (2017). Trauma responses to intimate partner violence: A review of current knowledge . Aggression and Violent Behavior , 34 , 178–184. doi: 10.1016/j.avb.2017.01.014 [ CrossRef ] [ Google Scholar ]
• Poole, J. C., Dobson, K. S., & Pusch, D. (2017). Anxiety among adults with a history of childhood adversity: Psychological resilience moderates the indirect effect of emotion dysregulation . Journal of Affective Disorders , 217 , 144–152. doi: 10.1016/j.jad.2017.03.047 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Short, N. A., Boffa, J. W., Clancy, K., & Schmidt, N. B. (2018). Effects of emotion regulation strategy use in response to stressors on PTSD symptoms: An ecological momentary assessment study . Journal of Affective Disorders , 230 , 77–83. doi: 10.1016/j.jad.2017.12.063 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Simon, N., Roberts, N. P., Lewis, C. E., van Gelderen, M. J., & Bisson, J. I. (2019). Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for treatment . European Journal of Psychotraumatology , 10 ( 1 ), 1573129. doi: 10.1080/20008198.2019.1573129 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• St. Vil, N. M., Carter, T., & Johnson, S. (2018). Betrayal trauma and barriers to forming new intimate relationships among survivors of intimate partner violence . Journal of Interpersonal Violence , 0886260518779596. doi: 10.1177/0886260518779596 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stadtmann, M. P., Maercker, A., Binder, J., & Schnepp, W. (2018). Why do I have to suffer? Symptom management, views and experiences of persons with a CPTSD: A grounded theory approach . BMC Psychiatry , 18 , 392. doi: 10.1186/s12888-018-1971-9 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sugg, N. (2015). Intimate partner violence: Prevalence, health consequences, and intervention . Medical Clinics , 99 ( 3 ), 629–649. doi: 10.1016/j.mcna.2015.01.012 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sullivan, T. P., Weiss, N. H., Price, C., Pugh, N., & Hansen, N. B. (2018). Strategies for coping with individual PTSD symptoms: Experiences of African American victims of intimate partner violence . Psychological Trauma: Theory, Research, Practice, and Policy , 10 ( 3 ), 336. doi: 10.1037/tra0000283 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tackman, A. M., & Srivastava, S. (2016). Social responses to expressive suppression: The role of personality judgments . Journal of Personality and Social Psychology , 110 ( 4 ), 574. doi: 10.1037/pspp0000053 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Thompson, N. J., Fiorillo, D., Rothbaum, B. O., Ressler, K. J., & Michopoulos, V. (2018). Coping strategies as mediators in relation to resilience and posttraumatic stress disorder . Journal of Affective Disorders , 225 , 153–159. doi: 10.1016/j.jad.2017.08.049 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Thurston, R. C., & Miller, E. (2019). Association of interpersonal violence with women’s health . JAMA Internal Medicine , 179 ( 1 ), 87–89. doi: 10.1001/jamainternmed.2018.5242 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vallières, F., Ceannt, R., Daccache, F., Abou Daher, R., Sleiman, J., Gilmore, B., … Hyland, P. (2018). ICD-11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: The factor structure and the clinical utility of the international trauma questionnaire . Acta Psychiatrica Scandinavica , 138 , 547–557. doi: 10.1111/acps.12973 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• van Dijke, A., Hopman, J. A. B., & Ford, J. D. (2018). Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder . European Journal of Psychotraumatology , 9 , 1400878. doi: 10.1080/20008198.2017.1400878 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Weiss, N. H., Dixon‐Gordon, K. L., Peasant, C., & Sullivan, T. P. (2018). An examination of the role of difficulties regulating positive emotions in posttraumatic stress disorder . Journal of Traumatic Stress , 31 ( 5 ), 775–780. doi: 10.1080/16506073.2011.621970 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Weiss, N. H., Tull, M. T., Davis, L. T., Dehon, E. E., Fulton, J. J., & Gratz, K. L. (2012). Examining the association between emotion regulation difficulties and probable posttraumatic stress disorder within a sample of African Americans . Cognitive Behaviour Therapy , 41 , 5–14. doi: 10.1080/16506073.2011.621970 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Werner, K., & Gross, J. J. (2010). Emotion regulation and psychopathology: A conceptual framework. In Kring A. M., and Sloan D. M. (Eds.), Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment (pp. 13–37). New York: The Guilford Press. [ Google Scholar ]
• World Health Organization, WHO . (2012). Understanding and and addressing violence against women . Geneva: WHO Press. [ Google Scholar ]
• World Health Organization, WHO . (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence . Geneva: WHO Press. [ Google Scholar ]
• World Health Organization . (2018). International statistical classification of diseases and related health problems (11th Rev. ed.). Geneva: WHO. [ Google Scholar ]
• Zerach, G., Shevlin, M., Cloitre, M., & Solomon, Z. (2019). Complex posttraumatic stress disorder (CPTSD) following captivity: A 24-year longitudinal study . European Journal of Psychotraumatology , 10 ( 1 ), 1616488. doi: 10.1080/20008198.2019.1616488 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

• Open access
• Published: 23 November 2021

Depression and post-traumatic stress disorder in females exposed to intimate partner violence

• Youmna Sabri 1  

Middle East Current Psychiatry volume  28 , Article number:  85 ( 2021 ) Cite this article

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United Nations considered intimate partner violence (IPV) as a serious problem affecting 35% of females all over the world requesting action to face this problem. There is strong evidence that the effect of violence against women has short-term and long-term negative outcomes on women physical health such as pain, wounds, fractures or even death in addition to serious psychiatric disorders for example anxiety, depression, and post-traumatic stress disorder (PTSD).

The study aims to evaluate the prevalence of different subtypes of (IPV) in a group sample of married females.

Also, the current study will examine the relation of intimate partner violence with subsequent depression and post-traumatic stress disorder disorders among those females.

This study highlights subtypes of intimate partner violence among the studied females according to the Composite Abuse Scale (CAS); the highest prevalence type of violence is harassment (72.2%) followed by physical violence (57.8%), severe combined violence (54.4%), emotional violence (53.3%), and finally the last one is sexual abuse (7.8%). Post-traumatic stress disorder distribution among studied females; the highest prevalence ( n = 37, 41.1%) had mild PTSD, followed by 23 (25.6%) who were normal, and then n = 20 (22.2%) who had severe PTSD, while the least prevalence ( n = 10, 11.1%) had moderate PTSD.

In concern to depressive disorder distribution among studied females, the highest prevalence ( n = 33, 36.7%) were normal, followed by 29 (32.2%) who had moderate depression, and then n = 12 (1.3%) who had severe depression, n = 9 (10.0%) who had mild depression, while the least prevalence ( n = 7, 7.8%) had very severe depressive symptoms.

Conclusions

This study found that the prevalence of intimate partner violence among the studied females is high. In addition, the presence of a strong relationship between all subtypes of intimate partner violence and the diagnosis of PTSD and depressive disorder among studied females. Potential implications; these results can be applied clinically as females are exposed to the burden of IPV and should be helped empowered in various ways such as providing psychiatric counselling for those females.

United Nations considered intimate partner violence (IPV) as a serious problem affecting 35% of females all over the world requesting an action to face this problem [ 1 ].

The World Health Organization in its 2010 report defines IPV as behavior within an intimate relation resulting in physical, sexual, or psychological harm such as acts of physical aggression, sexual coercion, psychological abuse, and controlling behaviors [ 2 ].

Females are more exposed to fatal injuries by violence, whatever their nationality, education, or socioeconomic level [ 3 ].

IPV is uncommon to occur only one time. It is usually characterized by its recurrent occurrence. Despite that, 39% of IPV is kept secret not documented in a legal form [ 4 ].

A recent study [ 5 ] reported that in the USA, 22.3% of women were exposed to physical (IPV), 15.8% to sexual violence, and 84% to psychological harm.

In multi-countries study [ 6 ], it was found that the prevalence of violence against females is between 15 and 71% with the least occurrence reported in Japan and the highest prevalence\ was reported in Bangladesh and Ethiopia.

The impact of violence against women has short- and long-term negative outcomes on women physical health such as pain, wounds, fractures, or even death in addition to serious psychiatric disorders, for example anxiety, depression, and post-traumatic stress disorder (PTSD) [ 7 ].

As the act and the outcome of intimate partner violence are more common to be hidden; this leads to a significant underestimation of the actual frequency and impact of this act [ 8 ].

Getting more accurate information about the prevalence and the impact of IPV in society will provide a real chance to improve women mental health and wellbeing.

This study aims to evaluate the prevalence of different subtypes of intimate partner violence in a group sample of married females.

This study is a cross-sectional study which was done at the Psychiatry Department, Faculty of Medicine, Mansoura University Hospitals (MUH).

The study took place during the period from November 2020 to April 2021 (6-month period), convenience sample of 100 female employees working at the Mansoura University Hospitals (MUH) were asked to join this study due to limited time and cost of the study. The aim of the study was explained to them and they were given the choice to participate or not, they were told that all of their answers would be confidential and written consent will be taken from them.

n = 3 refused to join the study (not interested, personal issues), and n = 7 were excluded according to exclusion criteria.

Finally, the sample size was ninety ( n = 90) participants who joined this study.

Inclusion criteria

No past or family history of depression before marriage.

Exclusion criteria

Age < 25 years or > 45 years

Presence of past or family history of depression before marriage.

Major depressive episodes and post-traumatic stress disorder were assessed clinically in the examined sample with Structured Clinical Interview for DSM-IV (SCID).

Data collection instrument

The composite abuse scale (cas).

This scale is a self-report scale to assess violence in intimate relationships.

The Composite Abuse Scale [ 9 , 10 ], consists of 30 items, measures five types of abuse: (1) severe combined abuse, (2) sexual abuse, (3) emotional abuse, (4) physical abuse, and (5) harassment.

Each item was rated on a 6-point response scale: never (0), only once (1), several times (2), once a month (3), once a week (4), and daily (5). The cutoff score is severe combined abuse (≥ 1), physical abuse (≥ 1), emotional abuse (≥ 3), and harassment (≥ 2).

Harassment is a form of vexatious behavior that involves repeated hostile and unwanted words, behavior, or actions that are painful, hurtful, annoying, humiliating, or insulting. While verbal abuse is a type of psychological/mental abuse that involves the use of oral language, gestured language, and written language directed to a victim [ 11 ].

Arabic version was prepared by translation and back translation in the Department of Psychiatry, Faculty of Medicine, Mansoura University.

The Hamilton Depression Rating Scale (HDRS)

It is a questionnaire [ 12 ] designed for adults, and Arabic version [ 13 ] is used to rate the severity of depression by assessing their mood , feelings of guilt, suicide ideation, insomnia , agitation or retardation, anxiety , weight loss , and somatic symptoms. The time is about 20 min. A score of 0–7 = normal, 8–13 = mild depression, 14–18 = moderate depression, 19–22 = severe depression, ≥ 23 = very severe depression.

Post-Traumatic Stress Diagnostic Scale (PDS)

The Post-Traumatic Stress Diagnostic Scale (PDS)-Arabic version [ 14 , 15 ] provides a brief but reliable self-report measure of post-traumatic stress disorder (PTSD) for use in both clinical and research settings. The scale is used to detect the presence of PTSD in persons who were exposed to a traumatic event and to assess symptom severity and functioning. The test is self-administered; the time is within 10–15 min and requires a reading age of 13 years. Questions related to the frequency of re-experience distressing and intrusive thoughts, post-traumatic avoidance, and hyper arousal. The PDS has 49 items. The cut-offs for symptom severity rating are 0 no rating, 1–10 mild, 11–20 moderate, 21–35 moderate to severe, and ≥ 36 severe Table 1 .

Socio demographic data of the studied females: n = 90 females mean ± SD is 34.02 ± 4.85, n = 69, 76.7% are urban, n = 21, 23.3% are rural. Level of education: 16.6% intermediate, 83.3% high. Years of marriage; 46.6%, < 10 years; 53.3%, > 10 years

No. of children: 20%, < 2 children; 65.5%, 2–4children; 14.4%, > 4 children. Husband education: 21.1% intermediate, 78.8% high

Husband employment: 5.5% doctor, 12.2% engineer, 52.2% employee, 20% teacher, and 10% others

Table 2 highlights types of intimate partner violence among the studied females according to the Composite Abuse Scale (CAS); the highest prevalence of the type of violence is harassment (72.2%) followed by physical violence (57.8%), and then severe combined violence (54.4%) then emotional violence (53.3%), and finally the last one is sexual abuse (7.8%).

Table 3 studied post-traumatic stress disorder distribution among studied females; the highest prevalence ( n = 37, 41.1%) had mild PTSD, followed by 23 (25.6%) who were normal, and then n = 20 (22.2%) who had severe PTSD, while the least prevalence ( n = 10, 11.1%) had moderate PTSD.

In concern to depressive disorder distribution among studied females, the highest prevalence ( n = 33, 36.7%) were normal, followed by 29 (32.2%) who had moderate depression, and then n = 12 (1.3%) who had severe depression, n = 9 (10.0%) had mild depression, while the least prevalence ( n = 7, 7.8%) had very severe depressive symptoms.

Table 4 revealed the presence of a significant positive relationship ( P < 0.001) between sexual, emotional, physical violence, and diagnosis of PTSD among studied females.

Table 5 examined a univariate analysis of post-traumatic disorders and types of violence among studied females reporting the presence of a significant positive relationship ( P < 0.001) between severe combined, emotional, physical violence, and diagnosis of PTSD among studied females.

Figure 1 illustrates a statistically significant positive correlation between sexual violence and post-traumatic stress disorder ( r = 0.393).

Scatter diagram showing a correlation between sexual violence and post-traumatic stress disorder

Figure 2 illustrates a statistically significant positive correlation between emotional violence and post-traumatic stress disorder ( r = 0.554).

Scatter diagram showing a correlation between emotional violence and post-traumatic stress disorder

Figure 3 illustrates a statistically significant positive correlation between physical violence and post-traumatic stress disorder ( r = 0. 649).

Scatter diagram showing a correlation between physical violence and post-traumatic stress disorder

Figure 4 illustrates a statistically significant positive correlation between harassment and post-traumatic stress disorder ( r = 0.589).

Scatter diagram showing a correlation between harassment and post-traumatic stress disorder

Table 6 examined the relationship between depressive disorder and types of violence among studied females showing that the presence of a significant positive relationship ( P < 0.001) between all types of intimate partner violence and diagnosis and severity of depressive disorder among studied females.

Table 7 assessed univariate analysis of depressive disorders and types of violence among studied females revealing the presence of a significant positive relationship ( P < 0.001) between severe combined, emotional, physical violence, harassment, and diagnosis of depressive disorder among studied females.

Figure 5 illustrates a statistically significant positive correlation between harassment and depressive disorder ( r = 0.637).

Scatter diagram showing a correlation between harassment and depressive disorder

Figure 6 illustrates a statistically significant positive correlation between physical violence and depressive disorder ( r = 0.6 50).

Scatter diagram showing correlation between physical violence and depressive disorder

Figure 7 illustrates a statistically significant positive correlation between emotional violence and depressive disorder ( r = 0.607).

Scatter diagram showing correlation between emotional violence and depressive disorder

Figure 8 illustrates a statistically significant positive correlation between sexual violence and depressive disorder ( r = 0.310).

Scatter diagram showing correlation between sexual violence and depressive disorder

Table 8 studied the correlation between PTSD, depressive disorder and types of intimate partner violence among studied females showing that the presence of a significant positive relationship ( P < 0.001) between all types of intimate partner violence and diagnosis of PTSD and depressive disorder among studied females.

Statistical analysis and data interpretation

Data were fed to the computer and analyzed using IBM SPSS Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Qualitative data were described using numbers and percentages. Quantitative data were described using mean, the standard deviation for parametric data after testing normality using Kolmogorov-Smirnov test. The significance of the obtained results was judged at the (0.05) level.

Data analysis

Qualitative data.

Chi-square test for comparison of two or more groups

Monte Carlo test as correction for chi-square test when more than 25% of cells have count less than 5 in tables (> 2 × 2).

Spearman’s correlation

Spearman's rank-order correlation is used to determine the strength and direction of a linear relationship between two non-normally distributed continuous variables and/or ordinal variables.

This study aimed to evaluate the prevalence of different subtypes of intimate partner violence in a group sample of married females.

Also, the current study examined the relation of intimate partner violence with subsequent depression and post-traumatic stress disorder disorders among those females, it highlights subtypes of intimate partner violence among the studied females according to the Composite Abuse Scale (CAS); the highest prevalence of the type of violence is harassment (72.2%) followed by physical violence (57.8%), severe combined violence (54.4%), emotional violence (53.3%), and finally the last one is sexual abuse (7.8%).

A similar study [ 5 ] found that psychological violence (45%), then physical (40%), and finally sexual (38%).

The same findings were confirmed by other studies [ 16 , 17 , 18 ].

But, it can be easily noticed that sexual violence is the least type of violence; may be due to cultural, social, and religious considerations. Maybe the prevalence is higher if the sample was taken from the gynecology and obstetrics outpatient clinic.

A higher prevalence of intimate partner violence was found in another study [ 19 , 20 ] maybe because the females in the sample of this study were educated, all from urban areas. Uneducated or from rural areas perhaps different results were obtained.

The current research studied post-traumatic stress disorder distribution among studied females; the highest prevalence ( n = 37, 41.1%) had mild PTSD, followed by 23 (25.6%) who were normal, and then n = 20 (22.2%) had severe PTSD, while the least prevalence ( n = 10, 11.1%) had moderate PTSD.

In concern to depressive disorder distribution among studied females; the highest prevalence ( n = 33, 36.7%) were normal, followed by 29 (32.2%) who had moderate depression, n = 12 (1.3%) who had severe depression, and n = 9 (10.0%) had mild depression, while the least prevalence ( n = 7, 7.8%) had very severe depressive symptoms.

A recent study reported that psychological abuse is more related to PTSD which may be explained by psychological abuse is attacking the female self-concept [ 21 ].

Another study agreed with our results about the relation between IPV and major depression disorder suggesting that depression may occur as a result of the IPV experience [ 22 ]. A univariate analysis of post-traumatic disorders and types of violence among studied females reporting the presence of a significant positive relationship ( P < 0.001) between severe combined, emotional, physical violence, and diagnosis of PTSD among studied females was examined.

Assessed univariate analysis of depressive disorders and types of violence among studied females revealing the presence of a significant positive relationship ( P < 0.001) between severe combined, emotional, physical violence, harassment, and diagnosis of depressive disorder among studied females.

Not surprisingly, the examined females reported symptoms of depression and PTSD appeared as a prevalent concern in the current study. Several studies [ 23 , 24 ] confirmed these findings.

Finally, these results should not be considered as magnifying the negative effect of IPV on females but should be regarded as females are exposed to the burden of IPV and should be helped empowered in various ways such as providing psychiatric counselling for those females. Therapeutic interventions either psychotherapy or pharmacotherapy especially group therapy promise in helping victims of IPV to overcome this painful experience.

Before we conclude, we would like to discuss the limitations of this study; the first limitation is the small sample size. Future research should be applied to a larger sample. Another limitation is the presence of important factors which may affect this issue such as education, no of children, age, occupation, and cigarette smoking of the intimate partner.

This study found that the prevalence of intimate partner violence among the studied group of females is high. In addition, the presence of a strong relationship between all types of intimate partner violence and the diagnosis of PTSD and depressive disorder among studied females.

Potential implications: these results can be applied clinically. These results should not be considered as magnifying the negative effect of IPV on females but should be regarded as females are exposed to the burden of IPV and should be helped empowered in various ways such as providing psychiatric counselling for those females. Therapeutic interventions either psychotherapy or pharmacotherapy especially group therapy promise in helping victims of IPV to overcome this painful experience.

Availability of data and materials

Data are available with the request from the corresponding author.

Abbreviations

• Intimate partner violence
• Post-traumatic stress disorder

Composite Abuse Scale

The Hamilton Depression Rating Scale

Post-Traumatic Stress Diagnostic Scale

UNODC. 2018. UN Joint Global Programme calls for coordinated, multi-sectoral responses to gender-based violence. Also available on[URL: https://www.unodc.org/unodc/en/frontpage/2018/May/un-jointglobal- programme-calls-for-coordinated—multi-sectoral-responses-to-gender-based-violence.html ]

World Health Organization (2010) Preventing intimate partner and sexual violence against women: taking action and generating Evidence 11. World Health Organization, Geneva

Google Scholar  

Barnett, OW., Miller-Perrin, CL., Perrin RD. (2011) Family violence across the lifespan: an introduction. Thousand Oaks, CA. Sage, WHO (2005) Addressing violence against women and achieving the Millennium Development Goals. WHO/FCH/GWH/05.

Follingstad DR, Rogers J (2014) The nature and prevalence of partner psychological abuse in a national sample of adults. Violence and Victims 29:3–23 https://doi.org/10.1891/0886-6708.09-160

Article   Google Scholar  

Agumasie S., Belachew T., Abdulahi, M. (2013) What factors are associated with recent intimate partner violence? multi-country study on women’s health and domestic violence. BMC Public Health (11):1471–2458.

Wakefield S. (2017) Transformative and feminist leadership for women’s rights. Boston, Oxfam.Retrieved from https://www. oxfamamerica. org/explore

Bacchus LJ, Ranganathan M, Watts C, Devries K (2018) Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies. BMJ Open 8(7)e019995

Hegarty K, Bush R, Sheehan M (2005) The Composite Abuse Scale: further development and assessment of reliability and validity of a multidimensional partner abuse measure in clinical settings. Violence Victims 20(5):529–547

Hegarty K, Sheehan M, Schonfeld C (1999) A multidimensional definition of partner abuse: development and preliminary validation of the Composite Abuse Scale. J Fam Violence 14(4):399

Patricia E (2010). Verbally abusive relationship, the : how to recognize it and how to respond. Adams Media Corporation. ISBN 978-1-4405-0463-1. OCLC 903230510.

Hamilton M (1980) Rating depressive patients. J Clin Psychiatry. (41): 21-24 PMID 7440521. 

Fatim L (1994) Hamilton Depression Rating Scale. Alanglo library, Egypt

Foa EB. (1995) Posttraumatic Stress Diagnostic Scale Manual. National Computer Systems Inc, Epub (2008) Aug 20. Pmid: 18718671; Pmcid: Pmc2683387.

Norris AE, Aroian KJ (2008) Assessing reliability and validity of the Arabic language version of the Post-Traumatic Diagnostic Scale (PDS) symptom items. Psychiatry Res. 160(3):327–334. https://doi.org/10.1016/j.psychres.2007.09.005

Article   PubMed   PubMed Central   Google Scholar  

Abeya S, Afework Mesganaw F, Yalewalemayehu W (2011) Intimate partner violence against women in Western Ethiopia: prevalence, patterns, and associated factors. BMC Public Health 11:913

Ali R, Radwan R (2017) Magnitude and determinants of domestic violence against ever-married women in Sohag, Egypt. Int J Med Sci Public Health 6:1285–1291

Andualem H, Tsehaw A, Negash M, Negash S (2015) Prevalence and Consequences of Domestic Violence among Married Women in Sheybench Town, Bench Maji Zone, Southwest Ethiopia. Department of Public Health. J Biol Agricult Healthcare 5(13):168-75.

Bosiljka D, Jansen HA, Otasevic S (2010) Factors associated with intimate partner violence against women in Serbia: a cross-sectional study. J Epidemiol Community Health 64:728–735

Chima H, Carol U, Linus IA, Florence UC (2015) Factors associated with intimate partner violence among wives of military and civilian men in Abuja Nigeria. Sociol Mind 5:61–73. https://doi.org/10.4236/sm.2015.52007

Beck JG, McNiff J, Clapp JD, Olsen SA et al (2011) Exploring negative emotion in women experiencing intimate partner violence: shame, guilt, and PTSD. Behavior therapy 42(4):740–750

Valdez CE, Lim BH, Lilly MM (2013) “It’s going to make the whole tower crooked”: victimization trajectories in IPV. J Fam Violence 28(2):131–140

Devries KM, Mak JY, Bacchus LJ, Child JC et al (2013) Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med 10:e1001439

Shamblaw AL, Cardy RE, Prost E, Harkness KL (2019) Abuse as a risk factor for prenatal depressive symptoms: a meta-analysis. Arch Women's Ment. Health 22:199–213

Chmielowska M, Fuhr DC (2017) Intimate partner violence and mental ill-health among global populations of Indigenous women: a systematic review. Soc. Psychiatry Psychiatry Epidemiology 52:689–704

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Youmna Sabri

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Y.S: prepared the study design, conducted the psychiatric assessment, collected and interpreted the data, and wrote and revised the manuscript. The author read the final draft and agreed about its contents.

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Sabri, Y. Depression and post-traumatic stress disorder in females exposed to intimate partner violence. Middle East Curr Psychiatry 28 , 85 (2021). https://doi.org/10.1186/s43045-021-00157-x

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DOI : https://doi.org/10.1186/s43045-021-00157-x

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Intimate partner violence and post-traumatic stress disorder symptoms in women: what we know and need to know

Affiliation.

• 1 The University of Akron, College of Nursing, Akron, OH, USA. [email protected]
• PMID: 15722493
• DOI: 10.1177/0886260504267882

This article presents a review of knowledge regarding post-traumatic stress disorder (PTSD) in women experiencing intimate partner violence. Knowledge related to the prevalence and predictors of PTSD in battered women, the association between PTSD and physical health, and the emerging science regarding PTSD and physiological and immune parameters is addressed. Primary recommendations for future research includes the need for longitudinal and intervention research that incorporates a range of psychosocial and physiologic health outcomes.

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