Depression,Anxiety,and Posttraumatic Stress Disorder Following Intimate Partner Violence: The Role of Self-Criticism,Guilt,and Gender Beliefs

Abstract

Intimate partner violence (IPV) predicts anxiety, depression, and posttraumatic stress disorder (PTSD), yet the role of cognition in these pathways is poorly understood. This study explored whether self-criticism, guilt, and gender beliefs predicted psychological symptoms, using self-report data from 50 Colombian female IPV survivors with diverse socioeconomic statuses. Self-criticism and guilt were high and significantly associated with IPV. Self-criticism significantly predicted depression and PTSD, whilst only guilt predicted anxiety. Traditional gender role beliefs were associated with emotional abuse, but not with self-criticism, guilt, or symptoms. In conclusion, self-criticism and guilt are important treatment targets for female IPV survivors, regardless of gender beliefs.

Keywords

intimate partner violence self-criticism depression anxiety posttraumatic stress disorders Latin America

Introduction

Intimate partner violence (IPV) refers to violence occurring between intimate partners, including physical, emotional, economic, and sexual abuse, as well as controlling behaviors (World Health Organization, 2012). High rates of posttraumatic stress disorder (PTSD), depression, and anxiety are seen in IPV survivors, even in comparison to other trauma-exposed victims, leading to chronic distress and functional impairment (Lagdon et al., 2014; Lawrence et al., 2012). An improved understanding of the relationship between psychological disorders and IPV in clinical and nonclinical samples will enable better-designed and more effective treatments for these populations. The present study therefore explores how IPV frequency and subsequent psychological symptoms relate to several hypothesized risk factors: self-criticism, guilt, and beliefs about gender roles and gender violence, in a sample of female Colombian IPV survivors who were not seeking psychological support.

IPV is a type of interpersonal violence that may involve: (a) the use of physical force against one's partner (e.g., pushing and hitting); (b) behaviors to make a partner feel about himself or herself or to attack his or her self-esteem (e.g., insults and destroying partner's things); (c) forced sexual activity (e.g., unwanted touch and nonconsensual sex); (d) other behaviors that have the purpose of controlling one's partner such as intimidation, economic abuse, social isolation or using prerogatives based on one's gender (Stith et al., 2011). In Colombia, women report experiencing an alarmingly high prevalence of psychological (64%), physical (32%), and economic (31%) abuse from current or ex-partners, as reported on a National Health and Demographics Survey (Profamilia—Ministerio de Salud y Protección Social, 2015).

There is much less research about IPV in areas such as Latin America and this is important to work on given that pathways to IPV victimization in this social context may differ from those in other countries. For instance, the high prevalence of IPV in Latin America is explicable by the fact that much of this region presents with many relevant risk factors, such as women having low socioeconomic status or being a homemaker leading to economic dependency on abusers (Krahé et al., 2005; Mallory et al., 2016); and adverse early experiences such as child abuse or witnessing parental IPV, which may lead to desensitization to violence and interpersonal skills deficits (Valdez et al., 2013; Zaleski et al., 2009). In addition to these risk factors, Colombia has a history of sociopolitical violence that has extended over six decades. This context of political violence has been associated with increased risks for IPV and other forms of familial and community violence such as sexual assault (Instituto Colombiano de Bienestar Familiar & Organizacion Internacional para las Migraciones, 2013). Furthermore, the conflict in Colombia has led to significant levels of forced displacement, which has also contributed to increased rates of IPV, poverty, and limited access to health services (Instituto Colombiano de Bienestar Familiar & Organizacion Internacional para las Migraciones, 2013).

A limitation in the current literature on IPV is that studies are almost always conducted in high-income countries. A recent meta-analysis concluded that IPV perpetration is predicted by different risk factors depending on the country's income inequality (Spencer, Mendez, et al., 2019). Therefore, research is needed on the association between IPV victimization, psychological symptoms, and cognitions in lower-income economies.

It is also known that IPV rates vary cross-culturally, as do factors such as beliefs about gender roles which may contribute to processes such as guilt, self-criticism, and tolerance of IPV. For example, patriarchal beliefs are a strong predictor of IPV (Kim, 2017). Thus, research on IPV should also consider factors such as cultural beliefs about gender and violence. Patriarchal beliefs about gender and IPV are widespread in Colombia, across both sexes, and are associated with heightened couple violence (Cardona et al., 2015). Internationally, it is recognized that traditional gender role beliefs (e.g., that men ought to be the decision-makers and financial providers in a family) maintain IPV, for example, by leading men to believe they can sanction women who deviate from social norms and by leading women to be financially trapped (Cislaghi & Heise, 2018; Heise, 1998). Evidence indicates that gender role beliefs increase the risk for IPV perpetration (Reyes et al., 2016; Shen et al., 2012), but inconsistent evidence exists regarding whether traditional gender role beliefs predict IPV victimization, with some finding a relationship between the two (Foshee et al., 2004) and others not (Shen et al., 2012). This may reflect cultural differences in the prevalence of traditional gender roles. Based on these findings, the first hypothesis for the present study was that patriarchal beliefs about gender roles would be significantly associated with a reported frequency of IPV (H₁). IPV victimization has been associated with several mental health problems, including anxiety, depression, and PTSD (Spencer, Mallory, et al., 2019). Although IPV research has primarily focused on the psychological consequences of physical violence, studies have also found a significant association between psychological IPV and mental health problems (Al-Modallal, 2012). Therefore, we hypothesized that a higher frequency of different types of IPV would be significantly associated with greater symptoms of depression, anxiety, and PTSD (H₂).

Whilst prevention of IPV requires population-level strategies, treatment programs are vitally important to help survivors to cope with the psychological sequelae of abuse. For the greatest efficacy, these should target the processes that influence the onset and maintenance of psychological disorders. Some mechanisms hypothesized to be important are self-criticism and guilt (Kubany & Ralston, 2008). Self-criticism refers to self-judgment, self-comparison, and negative self-labeling, and can take the form of self-hatred (associated with a desire to self-harm) or self-inadequacy (focusing on one's mistakes and perceived inadequacies; Gilbert et al., 2004). Guilt refers to judging our actions as unacceptable (Gilbert, 2014).

IPV survivors report high levels of IPV-related guilt and self-blame, especially following chronic abuse (Karakurt et al., 2014; Kubany et al., 1996). These may stem from beliefs of being a bad partner, or (after leaving the relationship) self-judgment for not having left sooner (Kubany & Ralston, 2008). Previous research has postulated that specific environmental events (e.g., trauma associated with IPV) may be damaging to the individual's self-definition, as they activate mechanisms such as self-criticism. Even though IPV is a relational issue, it affects individuals’ self-definition by generating perceptions of incompetence, failure to fulfill standards, or disempowerment (Sharhabani-Arzy et al., 2005). Guilt may be reinforced by gender stereotypes, since identification with traditional female gender schemas (which value helping, being gentle, and getting along with others over independence) is associated with an elevated proneness to guilt (Benetti-McQuoid & Bursik, 2005). Similarly, recent research found childhood sexual abuse and physical neglect to be positively correlated with generalized guilt, whilst emotional abuse was positively related to generalized shame (Sekowski et al., 2020). Based on these findings, we hypothesized that experiences of IPV would be significantly associated with self-criticism and guilt-related cognitions (H₃).

Self-judgment and guilt are theorized to maintain trauma symptoms by motivating individuals to suppress trauma memories rather than process them (Lee et al., 2001). Indeed, self-criticism has been linked to elevated PTSD and depression symptoms in IPV survivors. Self-criticism distinguished between women survivors of IPV with and without PTSD symptoms (Sharhabani-Arzy et al., 2005). Also, self-criticism regarding IPV is significantly associated with depression and moderates the relationship between physical violence and psychological symptoms (O'Neill & Kerig, 2000).

Whilst shame has been established to moderate the impact of trauma on psychological symptoms (Shorey et al., 2011), the role of the related concept of guilt in psychological functioning is less certain due to conflicting findings. Of two studies with IPV survivors, one found guilt affect and guilt-related cognitions to correlate with higher rates of PTSD in IPV survivors (Beck et al., 2011); whilst another found that shame alone, and not guilt, is associated with PTSD (Street & Arias, 2001). Thus, further replications are warranted. This study’s final hypothesis was that self-criticism and guilt would predict psychological symptoms (H₄).

A limitation of current research on the association between cognitions and psychological symptoms in IPV survivors is that most studies are based on clinical samples of women (e.g., women seeking therapy for IPV-related trauma or women living in shelters), who have left the violent relationship and may have received psychoeducation regarding IPV. Consequently, they may have already reduced guilt or self-criticism and changed beliefs about gender violence (e.g., Beck et al., 2011; Karakurt et al., 2014). Only a few studies (e.g., Ellsberg et al., 2000; O'Neill & Kerig, 2000) have focused on samples of IPV female victims who are not seeking psychological support reporting IPV. The present study was based on a sample of Colombian women who had experienced IPV currently or previously: some were receiving legal advice at a non-governmental organization (NGO) but none were seeking or receiving psychological support. This enables us to explore psychological processes in women with moderate-to-severe levels of psychological symptoms, who have limited access and experience with psychological services, and who may live with or are in contact with their violent partner. Such characteristics are typical of women in lower-income countries, so they may offer a clearer picture of functioning in such populations.

In sum, the present study had two main aims. Firstly, to describe the frequency of IPV, the intensity of psychological sequelae (depression, anxiety, and PTSD), and possible associated variables (self-criticism, guilt, and beliefs about gender roles) of women in Colombia who have or are experiencing IPV. Secondly, to increase understanding of the role of self-criticism, trauma-related guilt, and patriarchal beliefs in the relationship between IPV and symptoms of anxiety, depression, and PTSD, by exploring the relationships summarized in Figure 1. Specifically, we tested the following four hypotheses:

Figure 1.

hypothesized relationships between trauma, beliefs, self-criticism, guilt and symptomatology.

H₁.

Patriarchal beliefs about gender roles predict greater IPV frequency, as well as trauma-related guilt and self-criticism.

H₂.

IPV frequency predicts greater depression, anxiety, and PTSD symptoms.

H₃.

IPV frequency predicts greater self-criticism and trauma-related guilt

H₄.

Self-criticism and trauma-related guilt predict greater anxiety, depression, and PTSD symptoms.

Methods

Participants

Participants were 50 female survivors of current/past IPV, recruited from three sources in Bogotá, Colombia: a program offering high school education for low-income women on a flexible schedule to adapt to work and childcare commitments (n = 19), a program supporting women in poverty with income via crafting (n = 9) and an NGO that offers legal and practical assistance to women who have or are experiencing gender violence from all socioeconomic backgrounds (n = 22). Three additional women were initially recruited (two from the crafting program and one more from the gender violence NGO) but their data were excluded because one reported no gender violence, and two completed less than four measures, in addition to the demographics (this cut-off was selected because it would allow the individual to be included in at least some of the planned analyses).

Data on demographics, clinical history, and descriptive data of all questionnaires are reported in Table 1.

Table 1.

Demographics and Descriptive Data of the Sample (n = 50).

Age (years)	Mean (SD)	39.32 (12.44)
	Range	18–62
Employment status	Homemaker	11 (22%)
	Employed or self-employed full-time	11 (22%)
	Student	9 (18%)
	Unemployed	9 (1%)
	Informal work	7 (14%)
	Employed part-time	3 (6%)
Education level attained	Secondary school incomplete	22 (11%)
	Secondary school complete	8 (16)
	Postschool technical qualification	4 (8%)
	Undergraduate degree, ongoing	10 (20%)
	Undergraduate degree or above	6 (12%)
Sexual orientation	Heterosexual	46 (92%)
	Bisexual	1 (2%)
	Did not specify	3 (6%)
Women with children	Children any age	43 (86%)
Women with children	Children under 12 years	15 (30%)
Current relationship status	Single	26 (52%)
	Live-in partner	12 (24%)
	Married	6 (12%)
	In a relationship, not living together	5 (10%)
	Did not specify	1 (2%)
Childhood violent experiences	Physical abuse	3 (6%)
	Sexual abuse	8 (16%)
	Witnessed violence	13 (26%)
Experience of intimate partner violence (IPV)	In current relationship	14 (28%)
	In a previous relationship	33 (66%)
	Did not specify	3 (6%)
Use of psychological services	Current	10 (20%)
Use of psychological services	Previously	19 (38%)
IPV protection order	Currently	13 (26%)
IPV protection order	Previously	11 (22%)

Women largely were working class, with a mean monthly income (for those who reported any income) of $1,354,543 Colombian pesos (US$395), compared to a national minimum wage of USD$267. Only 20 (39%) reported growing up in a home with both biological parents.

Recruitment was intentionally conducted from various sources to achieve a sample that was representative of Colombian women, since we observed that few women with lower education levels accessed the gender-based violence (GBV) charity. Although the size of the three subsamples did not permit statistical comparison, observation indicated that education level was lower in crafting and education (three had a technical qualification, the rest had at most finished high school) than the GBV charity (two had a postgraduate degree, 15 had ongoing or completed undergraduate degrees, whilst 5 reported a technical qualification or completion of high school). Unsurprisingly, the group mean frequency of abuse was higher in the GBV charity for each type of abuse (21.0–32.7), compared to crafting (14.9–22.9) and education (14.4–21.2), although all groups showed considerable variation between individuals. Using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item Scale (GAD-7) cut-offs described in measures, the number of women meeting clinical caseness for depression was 14 (64%) for charity, 3 (33%) for crafting, and 14 (74%) for education. For anxiety, this was 12 (55%) for charity, 3 (33%) for crafting, and 11 of 19 (58%) for education. Finally, the crafting group had a higher mean age (47.2 years) than the education program (38.7 years) and charity (36.5 years). This study was part of a larger project evaluating the outcomes of group therapy for female survivors of violence. All participants attended this initial evaluation session as a condition of receiving free group therapy.

Measures

Demographic Information. This questionnaire explored the following variables: age, nationality, educational level, relationship status, occupation, income, religion, family structure, use of mental health services, and substance use. Participants reported frequency of childhood trauma (sexual abuse, physical abuse other acute traumas, and witnessing others’ trauma), from 0 (never) to 4 (over 10 times).

Checklist of Controlling Behaviors (CCB; Lehmann et al., 2012). This self-report measure consists of 84 items divided into 10 subscales. In the present study, to avoid respondent fatigue only the physical, sexual, emotional, and economic abuse subscales were used. Participants rated each item on a 5-point Likert scale based on frequency, from 1 (never) to 5 (very frequently). Participants were asked to respond in terms of the peak IPV experienced across their lifetime. The original validation study revealed good internal consistency for the four subscales used here (α = .88–.92; Lehmann et al., 2012). Internal consistency in the present study was high for physical (α = .923), sexual (α = .849), emotional (α = .925), and economic (α = .918).

The PHQ-9 (Kroenke et al., 2001). The PHQ-9 is a measure of depressive symptoms. Caseness is defined as a score of ≥10. Scores are interpreted as 0–4 none, 5–9 mild, 10–14 moderate, 15–19 moderately severe, and 20–27 severe depression. It has a sensitivity for major depression of 88% and a specificity of 88% (Kroenke et al., 2010). Internal consistency in the present study was high (α = .895).

The GAD-7 (Spitzer et al., 2006). The GAD-7 is a measure of general anxiety symptoms. Caseness is defined as a score of ≥8. Cut points of 5, 10, and 15 are typically interpreted as representing mild, moderate, and severe levels of anxiety. It has a sensitivity of 89% and a specificity of 82% for generalized anxiety disorder (Spitzer et al., 2006) and is moderately good at screening for panic disorder, social anxiety disorder, and PTSD (Kroenke et al., 2010). Internal consistency in the present study was high (α = .917).

Impact of Event Scale-Revised (IES-R; Weiss & Marmar, 1997). This is a 15-item self-report questionnaire that evaluates the frequency of intrusive and avoidant symptoms of PTSD (Gargurevich et al., 2009). Participants rate the frequency of these symptoms on a 5-point Likert scale. The validation of the Spanish version of the questionnaire (Baguena et al., 2001) showed good internal consistency (α = .95). Internal consistency in the present study was high (α = .945). The total score can be interpreted as follows: 0–8 (subclinical), 9–25 (mild), 26–43 (moderate), and 44+ (severe PTSD), with 33+ representing the cut-off for a probable diagnosis of PTSD (Creamer et al., 2002).

Forms of Self-Criticism/Attacking and Self-Reassuring Scale (FSCRS; Gilbert et al., 2004). This self-report scale consists of 22 items rated on a 5-point Likert scale, which make up three components: self-inadequacy, self-hatred, and self-reassurance (ability to reassure oneself during difficulties). For this study, we used the self-inadequacy and self-hatred subscales only. The original validation study found high internal consistency for all subscales (α = .86–.90). Factor analysis studies concluded that a three-factor model best fits the data; although self-hatred and self-inadequacy correlate highly, between r = .68 and .80 (Gilbert et al., 2004; Richter et al., 2009). Internal consistency in the present study was high for self-inadequacy (α = .929) and self-hatred (α = .875).

Trauma-Related Guilt Inventory (TRGI; Kubany et al., 1996). The TRGI is a self-report measure of 32 items divided into three scales: Global Guilt (emotional distress and feelings of guilt), which we henceforth refer to as ‘Guilt affect’ to distinguish it from other subscales, Guilt Cognitions (covering hindsight bias/responsibility, wrongdoing, and insufficient justification), and Distress, which was not used in the present study. The Distress subscale was not used to avoid response fatigue in participants, given that some of them had limited literacy, and our main variable of interest was guilt. Furthermore, the IES-R measured the impact of the traumatic event. Participants rate items on a 5-point Likert Scale from 0 (totally untrue/never) to 4 (totally true/always). Confirmatory factor analysis of the Spanish version revealed a good fit of the three-factor model, consistent with the original measure, and high internal consistency (Pereda et al., 2011). Internal consistency in the present study was also high for guilt affect (α = .902) and guilt cognitions (α = .919).

Inventory of Beliefs About Wife Beating (IBWB; Saunders et al., 1987). The IBWB is a self-report measure made up of 36 items for which respondents rate agreement on a 7-point Likert scale. To avoid participant fatigue, the present study used only 6 items with the highest factor loading from the 19-item “Wife Beating is Justified” subscale. The original validation found acceptable to good reliability for this subscale (α = .73–.86). In contrast, internal consistency in the present study was very poor (α = .205), likely because all items were extremely positively skewed, reflecting low permissiveness (Sheng & Sheng, 2012).

Patriarchal Beliefs Scale (PBS; Yoon et al., 2015). This 35-item self-report measure assesses beliefs “about the foundational social system of gender hierarchy that underlies particular experiences or manifestations of gender inequality” (Yoon et al., 2015, p. 265) and contains three subscales according to the level of a social system (macrolevel, mesolevel, and microlevel). Items are answered on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree), with a higher score reflecting greater endorsement of patriarchal beliefs. In the original study, the reliability found for this subscale was satisfactory (α = .96) and the confirmatory factor analysis revealed a good fit for the three-factor model (Yoon et al., 2015). For this study, only the Gendered Domestic Roles subscale, which encompassed beliefs about gender roles in the family (man as breadwinner and decision maker/woman as caretaker and housework), was used. Internal consistency in the present study was excellent (α = .955).

Procedure

Participants completed an informed consent form, followed by the questionnaires in the following order: demographic questionnaire, PHQ-9, GAD-7, IES-R, FSCRS, IBWB, PBS, CCB, and TRGI. For the CCB, participants were instructed to respond regarding the most recent relationship in which they experienced IPV. If participants had limited literacy, a research assistant read the questions and response options to them in an individual assessment session.

Research assistants proofread questionnaires to ensure that participants responded to all questionnaire items. However, on some occasions, time limitations meant that the set of measures had to be administered over two sessions (always within a maximum of one week). If participants did not return for the second assessment session, the final measures of the questionnaire pack were not administered, resulting in missing data. Additionally, when more than 15% of items had no response, the measure was excluded from analyses. Table 2 indicates the amount of missing data per variable, following the exclusion of incomplete measures.

Table 2.

Pearson Correlations Between Variables.

Variables	1	2	3	4	5	6	7	8	9	10	11	12	13	14
M SD	22.66 10.33	27.69 10.88	17.24 7.98	18.44 9.65	11.78 7.23	9.98 6.58	47.09 21.0	7.53 6.15	18.54 9.84	26.081 4.98	6.45 4.92	37.221 .2	43.60 25.23	8.98 3.6
N	41	41	41	41	47	47	47	47	47	47	40	40	40	48
1. Physical abuse (CCB)
2. Emotional abuse (CCB)	.452**
3. Sexual abuse (CCB)	.316*	.659**
4. Economic abuse (CCB)	.377*	.792**	.556**
5. Depression (PHQ-9)	−.108	.093	.211	.30
6. Anxiety (GAD-7)	−.21	.13	.25	.29	.73**
7. PTSD (IES-R)	.08	.24	.44**	.29	.58**	.58**
8. Self-hatred (FSCRS)	.01	.38*	.41*	.32*	.40**	.42**	.42**
9. Self-inadequacy (FSCRS)	.096	.34*	.32*	.25	.54**	.43**	.49**	.74**
10. Total self-criticism	.07	.38*	.38*	.30	.52**	.46**	.50**	.90**	.96**
11. Guilt affect (TRGI)	−.12	.14	.39**	−.07	.47**	.47**	.40**	.49**	.59**	.59**
12. Guilt cognitions (TRGI)	.02	.16	.42*	−.06	.38*	.47**	.35*	.49**	.52**	.78**	.54**
13. Total Guilt	−.00	.16	.43*	−.06	.41**	.48**	.37*	.51**	.55**	.57**	.85**	.99**
14. Gendered domestic roles (PBS)	.01	.37*	.06	.13	.11	−.04	.01	.16	.03	.04	.14	.04	−.26

Note. CCB = Checklist of Controlling Behaviors; PHQ-9 = Patient Health Questionnaire 9-item; GAD-7 = Generalized Anxiety Disorder 7-item Scale; IES-R = Impact of Event Scale-Revised; PTSD = posttraumatic stress disorder; FSCRS = Forms of Self-Criticism/Attacking and Self-Reassuring Scale; TRGI = Trauma-Related Guilt Inventory; PBS = Patriarchal Beliefs Scale. *p < .05 **p < .01.

Data Analysis

Data analysis was conducted using SPSS v26. All analyses were conducted using the pairwise exclusion of missing values. All variables were normally distributed except for gender role beliefs, gender violence beliefs, self-hatred, IPV sexual abuse, and IPV economic abuse (all positively skewed, indicating low endorsement of patriarchal beliefs, low permissiveness of violence, self-hatred, and abuse). Transformations produced little improvement so correlations were run on untransformed variables. Since the gender violence beliefs scale demonstrated poor internal consistency (α = .205) and low variability between participants, it was excluded from analyses.

Multiple regression analyses were conducted to evaluate the contribution of cognitions to symptoms. No significant signs of multicollinearity were found and both predictors were entered simultaneously in the analyses.

Results

Means, standard deviations, N for each measure, and correlations between measures are presented in Table 2. Means of CCB subscales indicated that on average women experienced emotional and physical abuse occasionally, whereas they experienced sexual and economic abuse rarely. Means of symptom measures indicated that on average, women were experiencing severe PTSD, moderate depression, and mild-to-moderate anxiety. The reported peak frequency of abuse was significantly lower in those experiencing current IPV compared to women who had left abusive relationships (p ≤ .024). No significant differences in physical abuse, self-criticism, guilt, or symptoms emerged between the two groups (p ≥ .196).

Correlation Analysis

H₁: Patriarchal Beliefs and IPV. Patriarchal beliefs about gender domestic roles were positively correlated with the frequency of IPV emotional abuse, but no other types of IPV abuse (see Table 2). Beliefs about violence did not correlate with self-criticism and guilt.

H₂: Permissive Beliefs and IPV. This hypothesis could not be tested due to the low reliability of the measure of beliefs about gender violence.

H₃: IPV and Psychological Symptoms. It was hypothesized that IPV frequency would be associated with psychological symptoms, and that guilt and self-criticism would be mediators.

Sexual IPV correlated with guilt affect, guilt cognitions, and both forms of self-criticism (p = .012–.05, see Table 2). Emotional IPV correlated with self-criticism (p = .020–.039) but not with guilt. Economic IPV correlated with self-hatred (p = .05) only.

The three symptom subscales were not significantly correlated with any type of IPV, apart from sexual IPV with PTSD (see Table 2).

All three symptom measures were significantly and positively correlated with all measures of guilt and self-criticism (p = .002–.027, see Table 2).

As shown in Table 2, all correlations had an N of 40 to 48. Considerations of the sample size are given in the discussion. As can be seen in Table 2, medium-sized correlations (e.g., r = .25 or .29) were not significant, therefore there is a risk of false negatives in this study. We therefore recommend that readers consider the r-values, not p-values alone. A power analysis indicated that to find a significant effect with an r of .25, a sample of 95 would be required, which should be considered in future studies. Nonetheless, the fact that many significant correlations were identified in this study demonstrates the strong relationships between many of the variables tested.

Regression Analysis

To evaluate the unique contribution of each guilt and self-criticism subscale to symptoms, regression models were tested with PTSD, depression, and anxiety symptoms as the dependent variables. Although models were statistically significant (anxiety: F = 3.3, p < .05; depression: F = 3.77, p < .05; PTSD: F = 3.17, p < .05), none of the four predictors had a statistically significant effect in any of the models. Next, three regression models were evaluated with symptom measures as dependent variables and two predictors, total guilt (combined guilt affect and guilt cognitions) and total self-criticism (combined self-hatred and self-inadequacy). Results are presented in Table 3. All three models were statistically significant and explained 26%–28% of symptom variance. For both PTSD and depression, only total self-criticism made a unique and significant contribution, whilst for anxiety, only total guilt had a unique significant effect. A sensitivity power calculation conducted with GPower (REF) using alpha = .05, beta = 0.8 and N = 40 and two predictors indicated that a small effect size of f = 0.156 would be needed to find a significant effect, As shown in Table 3, our F-values were 6.46 to 7.22.

Table 3.

Regression Models.

	Dependent variable: PTSD (n = 40)		Model summary
Model 1	B	T	R²	F	p
Total self-criticism	0.46*	2.71	0.28	7.22	.002
Total guilt	0.11	0.66
	Dependent variable: Depression (n = 40)		Model summary
Model 2	B	T	R²	F	p
Total self-criticism	0.39*	2.30	0.27	6.85	.003
Total guilt	0.18	1.08
	Dependent variable: Anxiety (n = 40)		Model summary
Model 3	B	T	R²	F	p
Total self-criticism	0.19	1.11	0.26	6.46	.004
Total guilt	0.38*	2.19

Note. PTSD = posttraumatic stress disorder. *p < .05; **p < .01

Discussion

The present study aimed to explore rates of guilt, self-criticism, and symptoms in a sample of female IPV survivors in Colombia, as well as the relationships between these variables and IPV frequency. The sample was not actively seeking psychological help but was approached via education/work programs or a helpline offering predominantly legal support.

Description of Sample

Although 72% of the sample were no longer in an abusive relationship, mean levels of symptoms indicated moderate-to-severe levels of depression, anxiety, and PTSD, reflecting other studies cross-culturally (e.g., Lagdon et al., 2014) and the long-term effects of IPV on women found in recent metanalyses (Spencer, Mallory, et al., 2019). This confirms the importance of providing psychological support for this highly vulnerable population, as well as implementing prevention programs.

In the present sample, TRGI means for guilt cognitions (M = 1.77) and “global guilt” or guilt affect (M = 1.61) were higher than in a sample of US college women (1.22 and 1.17, respectively) and similar to those in a sample of US women receiving counseling for IPV (M = 1.65 and 1.92, respectively; Kubany et al., 1996). Beck et al. (2011) reported somewhat higher means for guilt cognitions (M = 2.00) and guilt affect (M = 1.83) in a community sample of female IPV survivors. However, it should be noted that their sample, unlike ours, was actively seeking help and therefore may have been in a peak of distress. Similarly, FSCRS means in the present sample for self-inadequacy (M = 18.54) and self-hatred (M = 7.53) were considerably higher than in a sample of 94 Colombian healthcare workers (M = 10.33 and 2.78, respectively; Naismith et al., 2021). These findings indicate that, as expected, self-criticism and guilt are indeed elevated in this population and may be important treatment targets.

Most participants reported low permissiveness about IPV. This may reflect the fact that many had left the violent relationship some time ago and though still suffering considerable psychological sequelae, this population may differ from women who remain with violent partners. Furthermore, most of our sample did not endorse patriarchal beliefs about gender roles, based on the Gendered Domestic Roles subscale of the patriarchal beliefs scale (M = 2.82, SD = 1.89, on a scale of 1–7 where ≥5 represents endorsement). Nonetheless, the endorsement was higher than found in other samples (e.g., M = 1.92, SD = 1.21 for 423 adult females residing in the U.S.; Yoon et al., 2015, study 3).

Impact of Gender Role and Gender Violence Beliefs (H₁ and H₂)

Patriarchal beliefs about gender domestic roles were correlated with the frequency of emotional IPV, but not other IPV types. Whilst only correlational in nature, these results are partly consistent with theories stating that women with traditional role beliefs are more vulnerable to IPV victimization (Heise, 1998). It is not clear why only emotional abuse correlated with gender beliefs in our sample, although it should be acknowledged that comparing IPV frequency rather than presence or absence may influence results: for example, Shen et al. (2012) found that gender role beliefs predicted the presence, but not frequency, of physical IPV perpetration. Although prevention programs often target traditional role beliefs as a possible risk factor for IPV victimization, inconsistent evidence exists regarding their role, as noted previously (Foshee et al., 2004; Shen et al., 2012). Other studies in Colombia have found that patriarchal beliefs about gender roles were prevalent among women who had experienced IPV (Arrieta & Vergara, 2019; Cardona et al., 2015). Future research should further explore differences in the associations between different types of IPV and beliefs about gender roles and violence. In relation to the present study, it may be that mass media messages and social programs against physical IPV have made physical and sexual violence more visible and may have influenced women's views on the unacceptability of such forms of IPV—even women with more traditional role beliefs—while beliefs about emotional IPV may have not been targeted.

Contrary to our predictions, patriarchal beliefs did not correlate with self-criticism, guilt, or guilt cognitions. This suggests that women may be equally vulnerable to guilt and self-criticism about abuse, regardless of how they view their role in the relationship.

Unfortunately, hypotheses regarding beliefs about the permissiveness of IPV could not be tested due to the variable's low reliability and variance in this sample.

The Role of Self-Criticism and Guilt

Emotional, sexual, and economic IPV (but not physical IPV) were correlated with self-criticism. Sexual IPV was also associated with both guilt measures. These findings are consistent with existing literature that documents the presence of guilt and shame among survivors of traumatic events such as interpersonal violence, sexual trauma, and combat (Beck et al., 2011; Norman et al., 2014). Survivors of IPV and other forms of family violence often express self-blame for not having left their abuser and often conclude that they must have done something to deserve it. The present study extends these findings by indicating that they replicate in a Latin American (Colombian) sample and that these symptoms are high in survivors of both current and past IPV. This attests to the lasting impact of trauma, particularly IPV, on self-criticism and guilt.

Sexual IPV was significantly associated with PTSD symptoms, indicating that PTSD symptomatology was more severe in the context of more frequent sexual IPV. Contrary to hypotheses, physical and emotional IPV were not significantly correlated with symptoms. These results prevented us from exploring whether self-criticism and guilt mediated the relationship between IPV and symptomatology. These nonsignificant results could be caused by a ceiling effect, since IPV was a study inclusion criterion, and most participants in the present study reported at least some physical and emotional IPV. Previous studies highlighting the link between depression, anxiety, and other symptoms and psychological or physical IPV have typically involved designs comparing survivors to nonsurvivors (e.g., Al-Modallal, 2012; Vilariño et al., 2018), whereas our study explored the relationship between trauma frequency and symptoms within a trauma survivor population. Alternatively, it may be that measuring IPV frequency but not IPV severity limited the predictive power of this variable. Previous research has shown that presence, frequency, and severity can all be useful indices of IPV, but the strength of the association between IPV and psychological symptoms may be increased if more than one of such indices is used (Kan & Feinberg, 2010). Furthermore, IPV in many of our participants (66%) was historical, so other traumas or protective factors may have influenced this relationship over time. Indeed, a considerable number of participants reported additional traumas such as childhood sexual abuse (8%) or witnessing violence in childhood (26%), and due to their socioeconomic status, participants may have also been experiencing current stressors (e.g., financial strain and unstable housing). Studies in larger samples have shown that economic abuse is a common experience among IPV victims (approximately 93% of victims) that has a unique effect on symptoms of depression after controlling for other forms of abuse and demographic variables such as race (Stylianou, 2018). Lastly, the nonsignificant relationships between IPV and symptoms are also compatible with cognitive models of depression and anxiety stating that the interpretation of an event, rather than the event itself, determines symptoms (Beck & Beck, 2020).

Self-criticism, guilt affect, and guilt-related cognitions were significantly correlated with all symptom measures. For PTSD and depression, self-criticism was a significant predictor even after controlling for guilt, whereas guilt did not predict these symptom measures after controlling for self-criticism. For anxiety, the reverse was true: guilt remained a significant predictor even after controlling for self-criticism, but not vice versa. Whilst conclusions about causation cannot be drawn from such a design, these findings are compatible with theoretical models suggesting that self-criticism and guilt are important factors in the maintenance of these difficulties, as well as with empirical studies from the US and Europe indicating the importance of these cognitions for predicting symptoms in IPV survivors (Beck et al., 2011; Crapolicchio et al., 2020; Street & Arias, 2001). A vicious circle is known to exist between self-criticism and depressed mood, with both phenomena maintaining one another (Teasdale & Cox, 2001). Self-criticism is also thought to maintain PTSD because it creates a sense that one has been devalued by the trauma, resulting in an ongoing sense of current threat which is key to PTSD (Ehlers & Clark, 2000).

Whilst some researchers have suggested that shame is more maladaptive than guilt, due to it involving a negative judgment of the whole self rather than solely one’s actions, recent evidence suggests that guilt can be as maladaptive as shame when it becomes generalized (unrelated to a specific situation) or involves exaggerated feelings of responsibility (Cândea & Szentagotai-Tătar, 2018). Although we did not measure shame in this study, this theory is compatible with current findings which found guilt to be a significant predictor for anxiety even after controlling for self-criticism. The relationship between anxiety and guilt is hypothesized to occur because individuals engage in worry to alleviate guilt and shame, unintentionally creating heightened anxiety (Schoenleber et al., 2014).

Clinical Implications

These findings indicate that guilt and self-criticism may be important treatment targets in IPV survivors, either with interventions that directly target guilt and self-criticism (Kubany et al., 2004), or those such as compassion-based interventions that offer an “antidote” to self-criticism and guilt (Gilbert, 2010). Kubany et al. (2004) reported a significant reduction of PTSD and depression symptoms in women survivors of IPV after a treatment intervention that focused on reducing guilt-related and shame cognitions. Although not in a sample of IPV survivors, another study found that a reduction in trauma-related guilt following psychotherapy corresponded with a reduction in PTSD symptoms (Pugh et al., 2015). Whilst little evidence exists outside of high-income countries, a pilot study of group compassion-based therapy for Colombian female survivors of IPV that targeted guilt and self-criticism showed a significant reduction in PTSD and depression symptoms (Naismith et al., 2020).

The fact that IPV frequency was not significantly correlated with symptoms may reflect overall high symptomatology and trauma in this population but also suggests, as noted above, that women may be experiencing many other stressors that contribute to symptoms. This implies that any intervention for IPV survivors in low-income countries/populations should recognize that other stressors may be the primary cause of symptoms. Whilst targeting social factors may be beyond the scope of interventions, it is important for facilitators to acknowledge their impact. Additionally, transdiagnostic processes such as self-criticism, guilt, and experiential avoidance may influence the impact of these stressors and therefore interventions should support participants to generalize the strategies to different domains of life. One recent study found that high self-efficacy buffered the relationship between self-criticism and PTSD in IPV survivors, perhaps because a sense of achievement and control can help clients counter self-criticism with self-acceptance (Crapolicchio et al., 2020). This may be an important element to consider when developing interventions.

Study Limitations and Future Research

Recruitment was challenging due to the time limitations of potential participants, who were often single working mothers. A larger sample would have permitted exploration of mediation and moderation pathways.

Participants were recruited from three separate sources (education, craft group, and gender violence charity), which showed some differences in terms of demographics and symptom levels, although this could not be tested statistically due to subgroup sizes. However, this recruitment process ensured that our sample was more representative of the wider group of Colombian IPV survivors. Combining individuals with past and current IPV does make it more challenging to draw conclusions regarding the immediate impact of IPV on psychological functioning, yet this population is also important to study since IPV is known to have long-term effects and thus the majority of those requiring help may have past, not current, IPV. Also, in future studies, several indices of IPV (e.g., frequency and severity) should be included to evaluate their association with symptoms and cognitions. The time period of victimization needs to also be considered, as the chronicity of the abuse may increase the risk of psychological symptoms. Lastly, other cognitions (such as belief in a just world; Lerner, 1980), which have previously been associated with stress and low well-being may also predict symptoms in this population (Lucas et al., 2008).

Conclusions

The present study extends the literature on self-criticism and guilt in IPV survivors by exploring these relationships in a low-income Latin American population. Findings underscore the importance of developing interventions for survivors of IPV that specifically target self-criticism and guilt. Guilt and self-criticism appear to be just as prevalent regardless of traditional role beliefs, indicating that all populations could benefit equally from these interventions.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article

ORCID iD

Iona Naismith

Author Biographies

Iona Naismith obtained a Doctorate in Clinical Psychology from University College London and an undergraduate in psychology from the University of Oxford. She is an Associate Professor at the University of the Andes, Colombia, who specializes in the role of self-criticism and self-compassion in mental health. Her clinical work has involved supporting survivors of IPV both in Colombia and the UK.

Karen Ripoll-Núñez has a Doctorate in Human Development and Family Studies from the University of Connecticut, and a master's in Marriage and Family Therapy from Syracuse University. She is an Associate Professor in the Psychology Department at the University of the Andes, Colombia. Her research interests are couple violence, infidelity, and quality of couple relationships.

Gabriela Baquero Henao has a bachelor’s degree in psychology from the University of the Andes, Colombia, and a master’s in Counselling Psychology from Columbia University, USA.

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Depression,Anxiety,and Posttraumatic Stress Disorder Following Intimate Partner Violence: The Role of Self-Criticism,Guilt,and Gender Beliefs

Abstract

Keywords

Introduction

Methods

Participants

Measures

Procedure

Data Analysis

Results

Correlation Analysis

Regression Analysis

Discussion

Description of Sample

Impact of Gender Role and Gender Violence Beliefs (H1 and H2)

The Role of Self-Criticism and Guilt

Clinical Implications

Study Limitations and Future Research

Conclusions

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

Author Biographies

References

Impact of Gender Role and Gender Violence Beliefs (H₁ and H₂)