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Original article  105

Psychosocial characteristic of female victims of domestic

violence
Khaled Abd El Moeza, Mona Elsyeda, Ismail Yousefb, Amany Waheed Eldeenc,
Wafa Ellithyb

Lecturer of Psychiatry, bProfessor of Psychiatry,

a
Professor of Community Medicine, Suez Canal
c
University, Ismailia, Egypt
Correspondence to Khaled Abd El Moez, MD,
Lecturer of Psychiatry, Faculty of Medicine,
Suez Canal University, Ismailia, Egypt
Tel: +00201060677901; fax: 0643398457
e-mail: naomsal2012@hotmail.com
Received 1 March 2014
Accepted 1 April 2014
Egyptian Journal of Psychiatry
2014, 35(2):105–113
Background
Domestic violence against women is prevalent in every country, cutting across boundaries of
culture, class, education, income, ethnicity, and age. Domestic violence against women results
in far-reaching physically and psychological consequences. Although the impact of physical
abuse may be more visible, psychological scarring is harder to define and report. Women
who remained in violent relationships were considered to have morbid characteristics, which
included the need to be hurt and punished.
Objective
This work was carried out to determine the psychosocial characteristics of women exposed
to domestic violence.
Materials and methods
The current study is a cross-sectional controlled study. In this study, psychological
characteristics, using the Minnesota multiphasic personality inventory scale (MMPI) personality
inventory scale, of 44 women (who presented to the Emergency Unit of Suez Canal University
Hospital) complaining of physical abuse of domestic origin were evaluated after taking their
consent, and were compared with 22 women with no history of domestic violence.
Results
The psychological assessment to 44 female victims of domestic violence according to the
MMPI personality inventory scale showed a significant difference between the study and the
control group in depressive traits, psychopath traits, and psychotic traits.
Conclusion
Our finding suggested that the study group showed more depressive, psychotic, and
psychopathic manifestations than the control group and more studies need to identify whether
this results were related to abuse or character logical traits in those women.

Keywords:
domestic violence, psychological traits, social characteristics

Egypt J Psychiatr 35(2):105–113

© 2014 Egyptian Journal of Psychiatry
1110-1105

to suffer throughout their adult lives, abused, raped,

Introduction
Violence against women in the domestic sphere is
usually perpetrated by men who are, or who have been,
in positions of trust and intimacy and power such as
husbands, fathers, fathers-in-law, stepfathers, brothers,
uncles, sons, or other relatives. Domestic violence is,
in most cases, violence perpetrated by men against
women. Women can also be violent, but accounts for a
small percentage of domestic violence [United Nation
Children Fund (UNICEF), 2000].
Domestic violence against women is often a cycle of
abuse that manifests itself in many forms through
their lives. Even at the very beginning of her life, a girl
may be the target of sex-selective abortion or female
infanticide in a culture where a preference for sons is
prevalent. During childhood, violence against girls may
include enforced malnutrition, lack of access to medical
care and education, incest, female genital mutilation,
early marriage, and forced prostitution. Some go on
1110-1105 © 2014 Egyptian Journal of Psychiatry
and even murdered by intimate partners. Other crimes
of violence against women include forced pregnancy,
abortion or sterilization, and harmful traditional
practices such as killings in the name of honor. Elderly
women may also experience abuse [World Health
Organization (WHO), 2004].
A review of studies from 35 countries indicated
that between 10 and 52% of women reported being
physically abused by an intimate partner at some point
in their lives, and between 10 and 30% reported that
they had experienced sexual violence by an intimate
partner. Between 10 and 27% of women and girls
reported having been sexually abused, either as children
or as adults (WHO, 2007).
Culture ideologies – both in industrialized and in
developing countries – provide ‘legitimacy’ for violence
against women under certain circumstances. Religious
and historical traditions in the past have sanctioned
DOI: 10.4103/1110-1105.134197
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106  Egyptian Journal of Psychiatry
the chastizing and beating of wives. The physical
punishment of wives has been particularly sanctioned
under the notion of entitlement and ownership of
women. The concept of ownership, in turn, legitimizes
control over women’s sexuality. Women’s sexuality
is also tied to the concept of family honor in many
societies. Traditional norms in these societies allow the
killing of ‘errant’ daughters, sisters, and wives suspected
of defiling the honor of the family by indulging in
forbidden sex, or marrying and divorcing without the
consent of the family (UNICEF, 2000).
The prevailing belief has always been that only women
who “liked it and deserved it” were beaten. In a study
of battered wives as recently as twenty years ago, it
was suggested that beatings are solicited by women
who suffer from negative personality characteristics,
including masochism. “Good wives” were taught that
the way to avoid assaults. She must examine their
behavior and attempt to modify it to please men: to
be less provocative, less aggressive, and less frigid.
There was no suggestion that provocation might occur
from other than masochistic ones, that aggressiveness
might be an attempt to avoid further assault, and that
frigidity might be a very natural result of subjection
to severe physical and psychological pain (Bogard,
1988).
The burden of guilt for battering has fallen on women
and the violent behavior of men has been perpetuated.
The myth of the masochistic woman is a favorite of all
who try to understand the battered woman. No matter
how sympathetic people may be, they frequently
come to the conclusion that the reason an abused
woman remains in such a relationship is because she
is masochistic. Masochism in a woman is defined as
experiencing pleasure, often sexual pleasure, by being
beaten by the man she loves. Because this has been
such a prevailing stereotype, many abused women
begin to question whether they are indeed masochistic
(Bogard, 1988).
This myth is related to the masochism myth in that
it places the blame for the battering on a woman’s
negative personality characteristics. The survival
behaviors of abused women have often earned them
the misdiagnosis of ‘being crazy’. Unusual actions
which may help them to survive in the battering
relationship have been taken out of context by closure
their problems from medical and mental health
workers. Several of the women were reported being
hospitalized for schizophrenia, paranoia, and severe
depression (Walker, 1995).
The theory of learned helplessness in passive women
quickly becomes entwined with the commonly asked
question of why does she stay? The result was a picture
of masochistic and passive women who are to blame
completely for their situation (Bogard, 1988).
Criticisms have suggested that learned helplessness
cannot explain why so many women have been able
to get away from their violent partners. The concept
of learned helplessness also portrays women as
passive rather than as active individuals seeking help.
The theory of learned helplessness also ignores the
multiple dimensions involved in the process of escape,
including, for example, the potential for greater
violence if attempts to escape unsuccessful or violence
against other family members especially her children,
she may be emotional in love, hope to change and fear
to be alone, culture stigma, and /or has no residence.
(Gondolf, 1988).
In contrast to the learned helplessness model,
Gondolf (1988) has developed a model suggesting
that women are active survivors who try to escape
violent relationships, but are often limited by the
unavailability of resources. In other words, women
respond to abuse by attempting to seek help that
does not exist rather than taking the blame as
a victim; this model places blame on the social
structure (Gondolf, 1988).
Aim
This work was carried out to determine the psychosocial
characteristics of women exposed to domestic violence.
Materials and methods
This is an analytic cross-sectional study that was carried
out to study the psychosocial characteristics of women
exposed to domestic violence.
Inclusion criteria
All female participants ranging in age from 16
to 60 years, able to write and read, and presented
to the Emergency Unit of Suez Canal University
Hospital because of physical abuse of domestic
origin were included in this study after obtaining
their consent.
Selection of the control group
The control group was selected from among women who
were matched to the abused group for age, educational
level, marital status, occupation, and income, and had
apparently no history of domestic violence.
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Psychosocial characteristic of female El Moez et al.  107

Exclusion criteria
Patients and control women were eligible for the
study on exclusion of certain medical problems
(epilepsy, stroke, hypertension, diabetes mellitus, and
chronic liver cirrhosis), head injuries, and history
of psychotic disorder. Also, illiterate patients were
excluded because they would not be able to perform
the psychological test.
Sample size
The sample size included all female patients who
fulfilled the inclusion criteria, presented during the
period of the study (from April to December 2006),
and agreed to participate in this study.
In the study, psychological traits were evaluated using
the MMPI personality inventory scale for 44 women
who had experienced domestic violence and were
compared with 22 women with no history of domestic
violence.
Results
Table 1 shows statistically nonsignificant differences
between the abused group and the control group in
age, residence, education, marital status, occupation,
family size, and income. The mean age of the women
was 30.9 ± 9.2 and 35.5 ± 4.1 years in the abused group
and the control group, respectively.
Sporadic abuse was the most frequent (54%) (Table 2).
The most common causes of abuse were financial
(22.7%), followed by forced intercourse (15.9%)
(Table  2); 75% of women had not notified the
authorities, whereas 25% of abused victims had
physical sequels and 95% had psychological sequel
(Table 2).
There was a statistically significant difference between
the abused group and the control group in depressive
traits, psychopath, paranoid, psychoasthenia, and
psychotic traits (P < 0.00) (Table 3).

Table 1 Sociodemographic characteristics of the studied groups

Variables N (%) P
Victims (n = 44) Control (n = 22)
Mean age ± SD (range) 30.9 ± 9.2 (18–51) 35.5 ± 4.1 (19–52) NS
Residence (urban/rural) (%) 30/14 (68.2/31.8) 18/4 (81.8/18.2) NS
Educational level
Basic education 8 (36.4) 8 (36.4) NS
Intermediate education 8 (36.4) 8 (36.4)
High education 6 (27.2) 6 (27.2)
Marital status
Married 29 (65.9) 18 (81.8) NS
Divorced 7 (15.9) 1 (4.5)
Single 8 (18.2) 3 (13.6)
Occupation
House wife 11 (25.0) 2 (9.1) NS
Manual worker 9 (20.5) 5 (22.7)
Clerical 16 (36.4) 10 (45.5)
Free business 2 (4.5) 2 (9.1)
Student 6 (13.6) 3 (13.6)
Family members
3–5 28 (63.6) 7 (31.8) NS
6–8 16 (36.4) 15 (68.2)
Mean ± SD (range) 4.8±1.5 (3–8) 3.7 ± 2.4 (3–7) NS
Family percapita (LE/month)
<100 20 (45.5) 8 (36.4) NS
100 to <200 13 (29.5) 8 (36.4)
200 to <400 7 (15.9) 4 (18.1)
≥400 4 (9.1) 2 (9.1)
Mean ± SD (range) 112.8 ± 56.5 (30–250) 110.0 ± 60.3 (50–210) NS
Source of income
Husband 13 (29.5) 8 (36.4) NS
Wife 9 (20.5) 4 (18.2)
Husband and wife 13 (29.5) 6 (27.3)
Father 5 (11.4) 3 (13.6)
Brothers and/or father 4 (9.1) 1 (4.5)
NS, P > 0.05.
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108  Egyptian Journal of Psychiatry

Table 2 Details of abuse in the studied victims (n = 44) There was a nonstatistically significant difference
Details of abuse N (%) between the abused group and the control group
Frequency of abuse in hysterical, manic, and avoidant traits, and
Sometimes (sporadic) 24 (54.5)
hypochondriasis (P > 0.05) (Table 3).
Daily 11 (25.0)
Weekly 9 (20.5)
Cause of abuse
Financial (money) causes 10 (22.7)
Sexual causes (forced to have sexual 7 (15.9)
Discussion
intercourse) Frequency of abuse
Objection of the clothes worn, going out, 5 (11.4) The present study shows that all abused women reported
and/or coming back late repetition of abuse. More than half of them were abused
Marital argument 5 (11.4) sporadically, a quarter were abused daily, and a fifth were
Forced to marriage or objection to marriage 4 (9.1) abused weekly. These results were in agreement with
of a loved one
another study carried out on a sample of 100 females
Jealousy 3 (6.8)
Quarrel with the husband’s family 3 (6.8)
between 14 and 65 years of age from Manshiet Nasser,
Hitting kids 2 (4.5) which indicated that all the women reported repetition of
Husband nervousness and/or drug abuse 2 (4.5) abuse, whereas 30% of the women questioned admitted
Wish to marry another woman or the presence 2 (4.5) to being subjected to domestic violence on a daily basis,
of another wife 34% on a weekly basis, 15% on a monthly basis, and
Insistence on divorce 1 (2.3) 21% occasionally (Committee on the Elimination of
Type of abuse
Discrimination against Women, 2001).
Physical and verbal 23 (52.3)
Physical, verbal, and sexual 10 (22.7)
Physical and sexual 5 (11.4) Causes of abusing
Physical, verbal, and control money 3 (6.8)
The present study shows that the commonest causes
Mixed 3 (6.8)
Notification of authorities 11 (25.0)
for abusing were financial causes (22.7%) following
Reasons for not notifying the authorities (n = 33)
by forcing wives to sexual intercourse (15.9%) then
For the benefit of the children (fear of losing 11 (33.4) marital argument (11%), disobedience (11%), forced
them/abuse) to married against her will (9.1%) then jealousy (6%).
Family’s honor 6 (18.2) Other included kids hitting (4.5%), drug abused of
Wish to continue 6 (18.2) husbands (4.5%) and presence other women (4.5%)
Fear of assailant (more abuse) 5 (15.1) lastly insist to divorce (2.3%).
Fear for assailant 5 (15.1)
Response of victims other than notification of
authorities (n = 44)
These results were different than Manshiet Nasser’s
Leave home 10 (22.7)
study where the main reason for domestic violence
Notify relatives 9 (20.5) (75%) of these women, was sexual (women are beaten,
Angry inside home 8 (18.2) raped or abused for refusing to have sex with their
Crying 6 (13.6) husbands) followed by financial causes (65%) then
Abuse causes physical sequels 21 (47.7) visiting family without husband permission (32%),
Abuse causes psychological sequels 42 (95.5) housework (25%), religion (8%), jealousy (6%) and
Consultation with a psychiatrist after abuse 21 (47.7) disobedience (5%) (Committee on the Elimination of
Discrimination against Women, 2001).

Table 3 Mean MMPI scores of the studied groups The difference between two studies may due to
Variables Mean ± SD P difference in time as in our study financial causes was
Victims Control the first cause then refuse sexual relationship while
(n = 22) (n = 44) the reverse is true in other study as more financial
Hypochondriasis 60.9 ± 9.1 59 ± 2.4 NS difficulties present nowadays in most Egyptian families
Depressive 82.3 ± 11.3 58 ± 3.2 <0.0001**
to obtain basic life needs comparing with their financial
Hysterical 60.8 ± 10.1 59 ± 2.8 NS
difficulty since 7 years ago.
Psychopathic 67.6 ± 9.6 56 ± 4.7 <0.0001**
Male to female 50.6 ± 9.2 51 ± 1.9 NS
These results different from that of Tayseer et al; (2003)
Paranoia 64.6 ± 8.9 48 ± 6.8 <0.0001**
Psychoasthenia 69.4 ± 9.1 50 ± 4.3 <0.0001**
who studied domestic violence against women among
Psychotic 63.3 ± 3.9 50 ± 5.8 <0.0001** rural families in Suez Governorate which revealed
Manic 60.1 ± 5.8 59 ± 5.2 NS the commonest causes of violence against women was
Avoidant 59.1 ± 7.0 58 ± 7.6 NS disobedience followed by outside home problems,
NS, P > 0.05; Significant, P < 0.05; **Highly significant, P < 0.00. refusing female intercourse, and finally the presence of
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addict husbands. This difference between studies may
be because of differences in the setting as the sample
in the Tayseer study included rural families; thus, the
most common reason for abuse was disobedience, and
community norms allow punishment of women who
do not obey their husbands.
Types of abuse
The present study shows that there was more than
one type of abuse. Physical and verbal abuse was the
most common (52%), followed by physical, verbal,
and sexual abuse (22.7%), physical and sexual abuse
(11.4%), physical and verbal abuse, and control
over wives’ money (6.8%), and all forms of abuse
(6.8%). These results are supported by Heise et al.
(1999), who found that physical violence in intimate
relationships is almost always accompanied by
psychological abuse and, in one-third to half of the
cases, by sexual abuse.
The UNICEF (2000) also reported that physical
violence is usually accompanied by psychological abuse
and in many cases by sexual assault.
A WHO (2004) multicountry study showed that
in the majority of the countries studied, there was a
considerable overlap between physical and sexual
violence by intimate partners.
Notification of authorities
In the present study, of 44 abused women, 75% did not
notify authorities, whereas 25% notified authorities.
The percentage of women who did not notify
authorities is less than that in the Manshiet Nasser
study, which reported that 87% did not notify
authorities and only 13% went to the police (although
all of them subsequently withdrew the charges)
not really wanting to cause any harm to abusers
(Committee on the Elimination of Discrimination
against Women, 2001).
This result in consistent with a WHO (2004)
multicountry study that found that between 55 and
95% of women who had been physically abused by
their partners had never sought help from formal
services or from individuals in a position of authority
(e.g. village leaders). Women were more likely to have
sought help or left home if they had experienced severe
physical violence.
Despite cultural differences, the percentage of women
who did not notify authorities in the present study
is not very different from that reported by Scottish
Executive (2003), where nearly 60% of intimate
Psychosocial characteristic of female El Moez et al.  109
partner violence was not reported. This can be
explained by the WHO (2004), which reported that
domestic violence is considered a family matter and
women sometimes view a certain amount of physical
abuse as justified under certain conditions. Cultural,
ethnic, or religious backgrounds may influence a
woman’s response to abuse and her awareness of
viable options.
Reasons for not notifying authorities
The current work highlights the main causes for
not reporting abuse to the authorities. Women did
not report violent incidents to the authority, which
represents a major problem in the community. The
most common cause of un-notification authorities
benefit of kids (fear from take them or abuse them)
(33.4%) then family’s fame (18.2%), wish to continues
in marital relation (18.2%) then fear from assailants
(more abuse) (15.1%) and keep for assailant (in love)
(15.1%). Another study carried out on a sample of 100
women from Manshiet Nasser showed that (87%) of
the women did not report violence to the police because
of embarrassment (65%), for the children’s sake (32%),
fear for their husbands, or fear of their husbands (19%)
(Committee on the Elimination of Discrimination
against Women, 2001).
This was similar to the Gondolf ’s (1988) study, which
reported that fear of more abuse, emotional causes
(being in love, hope to change, and fear of being alone),
cultural stigma, fear for children (will take children,
better with both the parents), and economic reasons (no
place to stay and lack of economic resources) were the
most common causes for not reporting to authorities
and continuation in a violence relationship.
The widespread acceptability of circumstances where
wife beating is justified highlights the extent to which,
in many countries, women appear to make distinctions
in terms of the circumstances under which wife
beating may or may not be ‘acceptable’. In all countries,
considerably more women accept wife-beating in the
case of actual or suspected female infidelity, or for
‘disobeying’ a husband or a partner. Qualitative research
suggests that individuals make complex judgments
about the acceptability of violence by considering who
does what to whom, and for what reason (Heise and
Garcia-Moreno, 2002).
Responses of victims other than notification of
authorities
In the present study, the common responses of abused
women were temporarily leaving their homes (22.7%),
followed by notifying relatives (20.5%), angry inside
home (18.2%), and crying (13.6%). These results
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110  Egyptian Journal of Psychiatry
differed from the Manshiet Nasser study, which showed
that most of the abused women suffered in silence
(53%) and attempted suicide (9%), and only 6% of
these women demanded a divorce. The other common
responses to violence were calling their neighbors,
attempting to leave their homes at least once, and
seeking help from family members (either their own
or their spouse’s) (Committee on the Elimination of
Discrimination against Women, 2001).
The WHO (2004) multicountry study found that
women who had been physically abused by their
partner were under circumstances ranging from not
completing the housework adequately, refusal to have
sex, disobeying her husband, or being unfaithful.
The study also showed that between 19 and 51% of
them ever left home for at least one night. The study
also found that when women who had not sought
help from any of the services mentioned were asked
why this was the case, the most common responses
were either that the women considered the violence
normal or not serious or because they feared the
consequences, either for their own safety, or that they
would lose their children, or that they would bring
shame to their families. In Ethiopia province, 53%
of these women reported that fear kept them from
seeking help. Other reasons included beliefs about
the inadequacy of the likely response, in particular,
that they would not be believed or that it would not
help (WHO, 2004).
Rubenstein (1999) reported that abused women
tend to remain in abusive relationships for a number
of reasons: women tend to be the peacekeepers in
relationships (the ones responsible for making the
marriage work), adverse economic consequences, it is
more dangerous to leave than to stay, prior threats by
batterer to abscond with children, lost self-esteem and
lack psychological adaptation to separate from batterer.
Psychological traits of studied groups according to
MMPI
A comparison between the mean scores of the abused
group and the mean scores of the control group showed
an increase in scores in scale 2 (depression), which is
similar to the result of Campbell (2002), who found
that intimate partner violence is associated with high
rates of depression. Coid et al. (2003) also supported
this finding; they reported a statistical association
between domestic violence and depression.
These results also in agreement with Golding (1999),
who found that the association between domestic
violence and depression reflects a causal link. Campbell
(1997) also reported that abused women were found
to have more depressive symptoms than other women.
A comparison between the mean scores of the abused
group and the mean scores of the control group
showed an increase in the scores of scale 6 (paranoid),
scale 8 (schizophrenia), and scale 4 (psychopath),
consistent with the Patrici’s (1997) study, which
found a statistically significant difference between the
mean scores of abused women and the mean scores
of control women in the control group for paranoia,
schizophrenia, and psychopathic traits.
Davidson (1991) also found a significant difference
between the abused group and the control group in
their study in terms of paranoia, schizophrenia, and
psychopathic traits.
There was an increase in scores on scale 6 (paranoia).
Paranoia is a disturbed thought process characterized
by excessive anxiety or fear, often to the point of
irrationality and delusion. Paranoid thinking typically
includes persecutory beliefs of a perceived threat
(Wikipedia, 2006).
From this point of view, the fearfulness and suspicion
of others might be viewed as a logical outcome of
abuse by one with whom an individual had an intimate
relationship. Intimate relationships are supposed to be
based on trust and abuse in an intimate relationship
would destroy that trust (Erickson, 2004).
There was increase in the scores on scale 8 (schizophrenia).
This can be explained by understanding what scale 8
measures. It measures confusion in thought processes
and feelings of being overwhelmed. It is not necessary
to be schizophrenic to receive an elevated score on
scale 8. Abuse by an intimate partner could certainly
cause confusion in thought processes and feelings of
being overwhelmed (Erickson, 2004).
Increases in scores on scale 4 (psychopath) are more
difficult to interpret. As the text on MMPI indicates,
scale 4 was developed to measure the personality
characteristics of an amoral and asocial subgroup with
psychopathic personality disorders. If the evaluator
does not examine more deeply the possible reasons
for an elevation on scale 4, he/she might infer that
the individual has serious character logical traits such
as impulsiveness, poor interpersonal judgment, and
reduced sense of responsibility and morals. They tend to
sacrifice long-term goals for short-term desires. Social
relations are typically shallow and strong loyalties are
rarely developed (Morrell and Rubin, 2001).
Dukworth and Anderson (1995) viewed fighting as
a cardinal feature of increase scores on scale 4. They
suggested that the individual may be in conflict with
his or her parents, friends, spouse, society, or school and
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that it is essential to examine the context in which the
individual is being assessed. Another important issue
in terms of an increase in the scores on scales 4, 6, and
8 is whether this elevation character logical or reactive.
Abused women, however, on the basis of the
results of the MMPI, appear to have various
psychopathologies, including but not limited to
paranoia, histrionic personality, psychopathic traits,
and even schizophrenia. The evaluator may conclude
that the women’s apparent psychopathology is a
personality disorder and therefore character logical
(a ‘trait’). Personality disorders are viewed by many
psychologists as highly treatment resistant and
therefore curable (Rosewater, 1988).
Lundy and Jay (2002) shows that an ‘alternative
conceptualization’ is that a woman’s psychological
presentation is a reaction to the abuse she has suffered
(a reactive ‘state’). If the increase in scores on MMPI
of abused women is reactive, one would expect that
their MMPIs before abuse would be relatively ‘normal’,
their MMPIs during the abusive relationship would be
increased, and that their MMPIs would decrease after
the abuse ended. In addition, it might be expected that
the severity of the abuse suffered by the woman or the
length of time she was abused might correlate with
increases in the scores of MMPI.
As yet, no such longitudinal study has been reported.
Therefore, we do not know with any degree of certainty
whether abused women, before they suffered abuse,
were ‘normal’ or showed certain psychological problems
(and, if so, what the problems are). However, research
on MMPI scores of abused women strongly suggests
that they are usually ‘normal’ before abuse (Erickson,
2004).
An important study in this field compared the MMPI
scores of 12 currently abused women, 12 formerly
abused women, and 12 never abused women. It was
found that the increases in MMPI on scales 2, 4, and 8
were lower for formerly abused women (similar to the
control group) than for currently abused women. It was
found that the scores decreased when the women were
no longer being abused, indicating that the increase in
scores on MMPI clinical scale 2, 4, 6, and 8 could be
considered a reaction to the abusive relationship than
as character logical (Dolores, 1986).
Rosewater (1988) also administered the MMPI to
three groups. Group one included 50 women in a
currently abusive relationship, group two included 29
women from an intervention program, and group three
included 27 women who had never been abused as
a control group. They found an increase in scores on
Psychosocial characteristic of female El Moez et al.  111
scales 4, 6, and 8 for group one. The formerly abused
women had lower increases in the scores than the
currently abused women. In other words, the formerly
abused women appeared to be recovering from the
effects of abuse. Rosewater pointed to the MMPI
scores of a battered women might lead to a mental
health evaluator to misdiagnosis the women as severely
mentally ill even psychotic or psychopath while they
were actually suffering from the effect of abuse, their
elevation of scale 4 consider as angry, their elevation
of scale 6 consider fear and their elevation of scale 8
measure confusion. Rosewater believed the condition
of abused women could be most accurately described
as post-traumatic stress disorder (PTSD).
What used to be called ‘battered woman syndrome’ is
now more often known as PTSD (Erickson, 2004).
Some experts suggest, however, that the effects of
interpersonal violence (rape and abuse of children
and intimate partners) are perhaps broader than
the diagnostic criteria of PTSD and lead to a more
serious form of PTSD than traumas that are not
interpersonal in nature. This more serious form of
PTSD is sometimes called ‘complex’ PTSD or disorder
of extreme stress not otherwise specified (DESNOS)
(Luxenberg, 2001).
A crucial factor in terms of PTSD is that it is now
understood that any previously healthy individual
exposed to a trauma can develop PTSD (DSM-IV-R).
Another important study compared abused women
diagnosed with PTSD with abused women who did
not fulfill the criteria for PTSD. The study found that,
first, many of the non-PTSD participants reported
symptoms indicative of PTSD, but were not diagnosed
with PTSD because they failed to fulfill all the criteria
for PTSD. Second, the non-PTSD participants had
scores on MMPI elevation that were above the cut-off
point on scales 4 and 6. They also had increased scores
on scales 7 and 8 that approached the cut-off point. The
MMPI scores of the PTSD participants were higher
than those of the non-PTSD participants. Although
there was no statistically significant difference
between the PTSD group and the non-PTSD group,
it is noteworthy that 10% of the participants in the
PTSD group reported ‘extreme and permanent
injuries’, whereas only 3% of participants in the non-
PTSD group reported such injuries. This study lends
support to the reactive state theory. By definition,
PTSD is a sequel (post) of trauma. The fact that
such an overwhelming percentage of abused women
are diagnosed with PTSD indicates that they have
suffered severe trauma. The trauma that they reported
is domestic violence. Also, the PTSD group exposed
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112  Egyptian Journal of Psychiatry
to more severe trauma showed higher increases in the
scores on MMPI scales (Morrell and Rubin, 2004).
Clinical interpretation of a profile of a survivor of
domestic violence should recognize that, on average,
they will have significant levels of emotional turmoil,
major difficulties in trusting others, suspiciousness,
and paranoia. This level of stress is not unreasonable
because many survivors of domestic violence live with
their perpetrators everyday or at least have contact with
them periodically. This continuing interaction with the
perpetrators leads to constant emotional turmoil, fear,
paranoia, and distrust (Lundy and Jay, 2002).
Although the current study attempted to identify
the characteristics of women exposed to domestic
violence, we aimed to determine whether increased
MMPI scores of abused women on clinical scales
represent character logical traits or a reactive ‘state’.
Research to date seems to lend more support to the
reactive state theory. When groups are tested while
domestic violence is ongoing or has just ended, abused
women typically show increases in scores of MMPI/
MMPI-2 on several clinical scales. However, MMPI/
MMPI-2 tends to normalize after the abuse ends and
with time. In addition, the severity of abuse appears
to be correlated with the increased scores of MMPI/
MMPI-2, suggesting that the increase is caused by the
abuse.
Recommendation
More studies should be carried out in community
samples to determine whether residence, education,
occupation, family size, and family income may be risk
factors in domestic violence against women.
More studies should be carried out using MMPI
psychological assessments comparing women in
an abusive relationship and after recovery from the
abusive relationship to determine whether the increase
in depressive traits, psychopathic traits, and psychotic
traits (paranoid and schizophrenic) is a reaction to the
abusive situation or character logical traits of abused
women.
More studies should be carried out to assess the other
aspect of abuse, that is, personality traits of perpetrators.
Resources and training programs should be provided for
physicians in primary care, emergency, and psychiatric
clinics including policies and protocols on domestic
violence, and clinical guides on effective assessment,
intervention, documentation, and referral.
Marital counseling clinics and psychotherapy programs
should be set up for abused women.
This problem should also be tackled through health
education programs including targeting of religious
men, and through mass media and human right
organizations to increase awareness of the problems
of domestic violence and its impact on the family and
society.
Acknowledgements
Conflicts of interest
There are no conflicts of interest.
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