Gina Troisi- Department of Humanities, University of Naples Federico II, Naples, Italy
In a global context where the percentage of women who are victim of violence is still high (World Health Organization, 2013), intimate partner violence (IPV) can be considered the most widespread form of violence against women: in such cases violent attacks are perpetuated or threatened by a partner or ex-partner within an intimate relationship, which makes its recognition more difficult. IPV requires specific tools and, although the literature has highlighted the specific role played by some emotions (such as shame, guilt, and fear) that keep women experiencing this violence in a state of passivity and confusion, to date too little attention has been given to the construction of sound instruments able to detect post-traumatic affectivity. Such instruments could facilitate women who have suffered from IPV in recognizing it and in making the responses of women’s health services more sensitive and structured. This study illustrates a sequential item development process to elaborate a new self-report instrument (VITA Scale: Intimate Violence and Traumatic Affects Scale) for assessing the intensity of post-traumatic affect derived from IPV. Within a psychodynamic perspective, the scale is characterized by four affects: fear, as a state of alarm elicited by the avoidance of the danger; terror, as a paralyzing state that hinders an active process of reaction; shame as a strong exposure to the other that disarms the individual and the guilt as a defensive dimension aiming at the restoring of the link with the abusive partner. Trough specific methodological steps, a 28-item set was selected and administered to a sample of 302 Italian women who declared themselves as having suffered from IPV. Explorative and confirmatory factor analysis, as well as correlations with well-established concurrent tools were computed in order to investigate its psychometric property. A factorial structure composed of four factors, consistent with theoretical scales and a good internal consistency (Cronbach’s alphas from 0.80 to 0.90) emerged. The VITA Scale could be a useful tool for clinicians and researchers to investigate the intensity of the affective state of the woman suffered from IPV. It could be useful to better address the clinical practice and therapeutic intervention planning.
Introduction
Intimate Partner Violence
With an estimated global prevalence of 30% (World Health Organization, 2013), intimate partner violence (IPV), can be considered the most widespread form of violence against women.
According to the definition of the American Psychological Association and Presidential Task Force on Violence and the Family (1996), IPV, is the physical, sexual, psychological, economical or stalking abuse, both concrete and menaced, perpetuated by current or ex-partners. In the European Union Member States the 22% of women have suffered from physical and/or sexual violence by partners since the age of 15, with a prevalence across countries ranging from 13 to 32% (European Union Agency for Fundamental Rights, 2014). In Italy, according to a national survey by the National Institute of Statistics (ISTAT, 2015), two million eight hundred thousand women between 16 and 70 years have experienced at least one episode of sexual or physical violence by partner or ex-partner. Indeed current or ex-partners commit the most serious violence and are involved in 62.7% of rapes. IPV can include sexual assault: according of World Health Organization, Department of Injuries and Violence Prevention (2002) one in four women experiences sexual violence by her intimate partner. On the other hand, sexual harassment, such as sex-related verbal or physical behavior that is annoying or disrespectful to the person who suffers it Rubinstein (1987) and Piotrkowski and Brannen (2002) is perpetrated more frequently in the work environment by colleagues or employers. IPV and sexual harassment have many similarities: they are both mainly crimes against women by known perpetrators, and occur in places perceived as safe by victims, like the home or the workplace (Lawson, 2012).
Although it cannot be viewed as a unidirectional phenomenon, IPV concerns a higher percentage of violence of the man against the woman (World Health Organization, 2013). Furthermore, according to World Health Organization (2013) even if IPV can occur against men, men injured by their partners had high rates of IPV perpetration themselves and the violence carried out by women may often present itself as self-defense.
Initially, this phenomenon was investigated within Feminist Movements. In this perspective, IPV was linked to male dominance, rooted in the patriarchal traditions of heterosexual relationships, expressed through control and power dynamics (Dobash and Dobash, 1979; Pence and Paymar’s, 1993; Ferraro, 1997; Campbell et al., 1998). According to a recent overview (Bell and Naugle, 2008) the “Feminist Theory,” and the “Power Theory” constitute the Sociocultural theories, that derive the roots of violence not only from culture but also from the family structure (Straus, 1976).
On the other hand Individual Theories, include the “Social learning theory,” the “Background/situational model” (Riggs and O’Leary, 1996) and the “Personality/typology theories” that bring the origins of violent conduct back to behaviors learned during childhood (Mihalic and Elliott, 1997; Shook et al., 2000), or to situational factors or elements linked to individual background or, again, to personal characteristics of victims and perpetrators (Koss et al., 1994).
These two classifications were mentioned to explain the complexity of the phenomenon of IPV, whose origins can be traced both at a sociocultural level and in the relationship dynamics of the specific couple.
Other studies focused on the descriptive factors of different types of IPV. Johnson (1995) has distinguished two forms of male violence against female partners: intimate terrorism and situational couple violence. This distinction may be important in planning prevention and intervention programs and to understand the specific consequences that these two forms of violence can have at the psychic level. In intimate terrorism the perpetrator imposes strict control on the partner, through emotional abuse, using children, isolation, threats, intimidation, economic abuse, and blaming. On the other hand, situational couple violence concerns a certain altercation that turns into an unstoppable series of escalating violence but with no evidence of the perpetrator exerting control over the partner (Kelly and Johnson, 2008). It is most likely to be described within the conceptual framework of family conflict theory (Straus and Gelles, 1990; Bradbury et al., 2001). Intimate terrorism is probably best conceptualized through the patriarchal pattern of male dominance (Frieze and Browne, 1989). This violence is rarely an isolated incident, as it often turns into more severe episodes of violence in an escalation (Walker, 1977; Coleman, 1997), which may have dangerous consequences for the partner’s physical, psychological, and social well-being.
Several studies suggest that depression, panic attacks, inability to cope, suicide attempts, non-suicidal self- injury, post-traumatic stress disorder (PTSD), and alcohol or drugs abuse may be some possible consequences of IPV on the health of the victims (Campbell, 2002; Ellsberg et al., 2008; Pico-Alfonso et al., 2008; Gargiulo et al., 2014). However, few studies in this field have underscored the role of the subjective affective experience of victimization. The different forms in which the IPV can manifest itself within the couple can even result in different affective reactions (Jaquier and Sullivan, 2014).
Psychological violence is always present where there is any other form of violence within a romantic relationship and it is identified as their main source of distress by women who have suffered from IPV (Murphy and O’Leary, 1989; Ronfeldt et al., 1998; Hamby and Sugarman, 1999). IPV, in its form of Intimate terrorism can be conceptualized as a sort of private dictatorship that is developed through progressive and disguised attacks. The implicit aim of the abuser is to deprive the victim of his/her individuality, destroy his/her subjectivity, by imposing strict control and exerting physical and psychological violence in order to make the victim a powerless object at the mercy of the dominant partner. The affect of terror seems to play a major role. When the violence appears to be isolated and not restricted to a relationship that assumes the characteristics of private dictatorship, the affect of fear is more likely to be present with the behavioral reaction that follows. The victim would be forced to escape in anguish or, alternately, to react with anger and attack (Nunziante Cesàro and Troisi, 2016).
The subjective affective experience of the victim of violence plays a relevant role in the maintaining the violent relationship (Herman-Lewis, 1992; Hirigoyen, 2005).
Many studies testified how IPV is more difficult to be recognized both from the victims’ perspective (Herman-Lewis, 1992; Hirigoyen, 2005; Reale, 2011) and from the society perspective (Romito, 2005; Arcidiacono and Di Napoli, 2012).
Few studies focused on the reasons for exiting or remaining in the violent relationship (Bell and Naugle, 2005).
Several authors showed that the silence of victims of IPV and their ability of carry out help seeking strategies can be influenced by a combination of different factors (Tjaden and Thoennes, 1998; Rennison and Welchans, 2000) Together with cognitive, social and psychosocial factors, emotional factors, such as emotional dependence, fear, guilt and shame, play a main role in maintaining of abusive relationship (Tjaden and Thoennes, 2000; Margherita and Troisi, 2014).
This study focuses on emotional factors maintaining the violent relationship in particular guilt, shame, fear, and terror.
Affect and Trauma in Intimate Partner Violence
Trauma is the main consequence of IPV (Resnick et al., 1993; O’Keefe, 1998; Ehrensaft, 2009). If the traumatic events have occurred repeatedly or chronically, complex PTSD is diagnosed (Herman-Lewis, 1992). This involves specific alterations in affect regulation.
Several studies remark on the importance of emotion dysregulation in PTSD (Van der Kolk, 1996; Cloitre, 1998) since it leads to a lack of awareness of the emotional states the trauma may induce (Litz et al., 2000; Bouton et al., 2001; Hunt and Evans, 2004; Orsillo et al., 2004; Veazey et al., 2004). Through the negative effect on interpersonal relationships and on an individual’s overall functional capacity, emotion dysregulation may have an impact on the maintenance of PTS symptoms (Cloitre et al., 2002). Particularly, negative emotions were important for understanding the PTSD (Dalgleish and Power, 2004; Resick and Miller, 2009). Shame and guilt contribute to the development and maintenance of PTSD (Lee et al., 2001; Wilson et al., 2006).
Few empirical studies have addressed the specific relation between emotions and PTSD in IPV.
In traumatic experiences such as sexual/physical abuse perpetrated by a known and/or trusted perpetrator, heightened levels of shame compared to fear that would probably accompany a trauma characterized by physical threat, in particular among women (Andrews et al., 2000).
In this study guilt, shame, fear, and terror are considered “affects” within a metapsychological and psychoanalytic framework.
“Affects” were defined as a range of emotions, feelings and passions, which could be represented by a metaphorical image (Green, 1973; Imbasciati, 1991).
Psychoanalytic theories on the trauma suggest how it leads to the collapse of the construction of the meanings processes (Bohleber, 2007; Levine, 2014) and how it disrupts the capacity for representation of mentalization (Levine, 2014).
In literature little attention has been devoted to the affect of shame in interpersonal violence.
In victims of violence, the sense of passivity and helplessness and the feeling of being treated as an object could be traced back to the affect of shame, understood as something that makes the victim feel exposed, naked at the mercy of the other, who, as in the primary impotence at the origin of the life, has the power of life and death over the subject (Margherita and Troisi, 2014). A masking of shame through guilt can more easily permit forgiveness, through a reparative gesture, assuring the maintenance of the link with the partner and restoring an active position in the relationship by taking responsibility for other’s behavior. This could explain why self-blaming and silence are such widespread phenomena in IPV (Margherita et al., 2014).
More recently the psychodynamic of affects is moving toward a more precise differentiation between guilt and shame (see, for example Tisseron, 1992; Morrison, 1999; Tangney and Dearing, 2002; Ciccone and Ferrant, 2015). Shame was conceptualized as an archaic and destructive affect that draws the individual’s primary impotence and puts a narcissistic failure at stake. Shame accompanies the perception of a failure and the Self is placed in a passive state, where hiding prevails (Morrison, 1999).
In contrast, guilt may be associated with transgression and the Self remains active, absorbed in the action, even during the repair (Tisseron, 1992).
A previous qualitative study allowed an in-depth analysis of the role played by the affects of fear, shame, and guilt in women victims of IPV (Nunziante Cesàro and Troisi, 2016). Authors underscored the difference between fear, associated with the escape from danger and therefore understood as an active defense, and terror associated with paralysis and freezing, in line with psychoanalytical (Diel, 1956; Clit, 2002) and neurophysiological studies (Hagenaars et al., 2014). Considering the three possible reactions that an individual can develop in the face of danger, the attack is associated with anger, the escape is associated with fear and abandonment is associated with terror. Fear, therefore, seems to be a protection that puts the subject in a state of activity and makes them alert, activating sensorial and perceptive systems linked to the awareness of an event that is perceived as traumatic (Nunziante Cesàro and Troisi, 2016).
It would be inappropriate to involve the affect of fear, instead, in situations of private dictatorship because it presupposes an actual danger and foresees a peculiar reactivity on both the behavioral and psychic level.
The situations of extreme violence crystallize the experiences of archaic terror, re-actualize the proven perceptions and the defenses used by the subject (Nunziante Cesàro and Troisi, 2016).
Measuring the Traumatic Affect in Intimate Partner Violence
Affectivity involved in IPV requires valid and specific tools to be measured for quality and quantity. Among existing screening instruments used for the identification of women victims of IPV as the Index of Spouse Abuse (ISA; Hudson and McIntosh, 1981), the Abuse Risk Inventory (ARI; Yegidis, 1989), the Composite Abuse Scale (CAS; Hegarty et al., 1999), or the Conflict Tactics Scale (CTS; Straus, 2017) should be mentioned. However, these screening tools seem to take into account all possible forms of violence. More importantly, to our knowledge (Rabin et al., 2009) a comprehensive examination of their psychometric properties is lacking. There are also several validated IPV risk assessment instruments, for example Danger Assessment (DA; Campbell, 2004) to assess risk factors for Intimate Partner Femicide, the Ontario Domestic Risk Assessment (ODARA; Hilton et al., 2004) and Spousal Assault Risk Assessment (SARA; Kropp and Hart, 2000; Baldry, 2006).
However, with the aim of measuring the consequences of IPV, several, non-IPV specific tools are used, and the distress is often just evaluated asking the women to assess their general mood.
Exemples of tools used for symptom detection, or multidimensional self-report symptom inventories include: Symptom Checklist-90-R (SCL – 90; Derogatis and Cleary, 1977), or scales that investigate specific dimensions such as depression, using by Beck Depression Inventory (BDI; Beck, 1961), or PTSD tools like The Post-traumatic Stress Disorder Checklist (PCL; Weathers et al., 1991) or the Peritraumatic Dissociative Experiences Questionnaire (PDEQ; Marmar et al., 1997) or the Peritraumatic Distress Inventory (PDI; Brunet et al., 2001) or scales that measure psychological well-being, such as the Psychological General Well-Being Index (PGWBI; Dupuy, 1984), or the quality of life, such as Quality of life (QOL; Flanagan, 1978) or on resilience, such as Resilience Scale for Adult (RSA; Friborg et al., 2003).
However, no tools were developed to measure the traumatic impact that IPV can generate on the affective world of women, hence the necessary importance to the level of emotional abuse that accompanies victimization is not considered (Jaquier and Sullivan, 2014).
The development of a valid and reliable scale could aim at measuring the post-traumatic affectivity in situations of IPV, facilitating the identification and the therapeutic process of women victims of IPV, as well as making the responses of health services more sensitive and structured. This study illustrates methodological steps aimed at the development of a self-report instrument for identifying the post-traumatic affectivity in women who have suffered from IPV.
Materials and Methods
Participants
The sample comprised 302 Italian women (M: 30.63; SD: 18.5 years) recruited online, through mailing lists and social networks. The whole sample was split randomly into two congruous subsamples (subsamples A and B) for the analysis of its factor structure (Bollen, 1989).
The two sub-samples did not differ significantly in age (t290 = 1.39, p = 0.164) marital status (t300 = 0.124, p = 0.901), nor awareness of violence (t217 = 1.94, p = 0.06) and period of violence (t217 = 1.58, p = 0.116).
Subjects included in the whole sample were mostly unmarried (81.4%) while 12.6% were married, 1.9% divorced, 3.5% separated and 0.6% through a divorce.
Regarding sexual orientation, 87.1% stated that they were heterosexual, 6% bisexual, 2.2% homosexual. The study participants mostly had a high level of education: 31.3% had a master’s degree and 20.2% a 3-year degree, 16.7% a post-graduate degree and 30% a high-school diploma. As regards the employment, 34.4% of the entire sample were students, 25.5% were self-employed workers, 15.5% were employed, 5.4% was made up of women without any employment and the 1.9% of the sample were managers.
At the time of the compilation of the questions, 71.3% of the subjects were involved in a current romantic relationship, while 28.4% were single. Moreover, 84.5% of women had no children and the remaining had from one to three offspring.
Measures
Intimate Violence and Traumatic Affect Scale (VITA Scale) (Troisi, 2017)
The original version of the VITA is an Italian 28-item self-report measure used to assess the intensity to affects in women that suffered from IPV. Of all the items, 5 were related to the affect of fear, 7 belonged to the affect of terror, 10 were related to shame and 6 to guilt. Items are rated on a Likert type scale (from 1 = never to 5 = often). In the present study, the Cronbach’s alpha was 0.79 for Fear, 0.9 for Terror, 0.93 for Shame, 0.87 for Guilt and 0.93 for the total scale. The process of the development of VITA Scale is described below.
Intimate Partner Violence Check List
The checklist was obtained from the National Association DiRe “Networking of Women against violence,” the first Italian association of non-institutional anti-violence centers. The descriptions are set up in the form of questions rated on five-point Likert type scale (from 1 = never to 5 = always). Five forms of violence are included: psychological violence (18 items) containing every form of abuse that damages the identity of the victim; sexual violence (3 items) including the imposition of sexual practices or sexual relationships that cause physical harm obtained through threats of various kinds; physical violence (7 items) including the use of any act guided by the intention to do evil or to terrorize the woman who has suffered violence; stalking (8 items) including controlling behavior performed by the persecutor, economic violence (6 items) as a form of direct control, which limits the victim’s economic independence. This checklist was used for descriptive purposes to identify what kind of violence the study participants suffered.
Questions About Violence
Further questions on the awareness of violence (Have you ever suffered any form of violence?), on the period of her life in which the violence had been experienced, on the author of the violence, on the intensity of suffered violence (if isolated or repeated).
Questions About Help Seeking
These questions aimed at identifying the presence or absence of reporting and a help seeking process, and if present the type of help requested (informal and formal), if absent the reasons behind the failure to request help.
Difficulties in Emotion Regulation Strategies (DERS) (Gratz and Roemer, 2004)
It is a 36-item multidimensional self-report measure of difficulties in emotion regulation. Items are assessed on a five-point Likert scale ordered from 1 = almost never to 5 = almost always. The DERS assesses difficulties in six clinically relevant dimensions of emotion regulation: (a) non-acceptance of emotional (Non-acceptance), (b) difficulty engaging in goal-directed behavior in distress situations (Goals), (c) inability to control behavior when distressed (Impulse), (d) lack of awareness of emotions (Awareness), (e) limited access to strategies that are perceived as effective for emotion regulation, and (f) lack of emotional clarity. The DERS showed adequate construct and predictive validity, as well as good test–retest reliability (ρI = 0.88; Gratz and Roemer, 2004). Also, the Italian adaptation it showed good psychometric properties (Giromini et al., 2012). In the present study, internal consistencies for the total and subscale scores were good, ranging from 0.81 (for Awareness) to 0.89 (for Non-acceptance).
Impact of Event Scale (IES) (Horowitz et al., 1979)
It is a self-report measure composed of 15 items on a four-point Likert scale (ranging from 1 = not at all to 4 = often). The IES tapped two-specific answers to traumatic events: (a) intrusion, intended as emerging of undesired ideas, images, feelings, or dreams that remind to the event and (b) avoidance, intended as elusion of certain ideas, feelings, or situations linked to the stressful situation. In its Italian version Cronbach’s alphas were 0.84 for the intrusion subscale and 0.71 for the avoidance subscale (Pietrantonio et al., 2003). In the present study, the IES total score yielded Cronbach’s alpha of 0.93, 0.92 for the intrusion subscale and 0.89 for the avoidance subscale.
Other as Shamer Scale (OAS) (Goss et al., 1994)
It includes 18 items to measure the external shame, as a global judgment about how the self is evaluated by others. Items are rated on a five-point Likert-type scale (ranging from 0 = neverto 4 = almost always). It was made up of three subscales: (a) inferiority, related to being seen as inferior; (b) emptiness, related to being seen as empty; and (c) mistake, related to how others are vigilant to mistakes one makes (Goss et al., 1994). In the Italian version of OAS, the Cronbach’s alphas were 0.87 (Balsamo et al., 2015c; Saggino et al., 2017).
In the present study, the OAS yielded Cronbach’s alpha of 0.94 for the total score and 0.92 for the Inferiority, 0.83 for Emptiness, and 0.86 for Mistake subscale.
Coping Orientation to Problems Experienced 25 (COPE-NVI-25) (Foà et al., 2015)
This 25-item scale is a reduced form of the Coping Orientation to Problem Experienced (COPE-NVI) developed by Carver et al. (1989). Items ask to assess how often the subject implements a certain coping process in difficult or stressful situations. The selected subscales measure: Avoidance Strategies (5 items), which concern the negation and natural detachment; Transcendent Orientation (4 items); Positive Attitude (6 items); Social Support (5 items) related to the search for understanding, information and of emotional outpouring; Problem Orientation (5 items) related to the use of active planning strategies and suppression of alternative activities. The Cronbach’s alpha was 0.70 for all dimensions, excepting for avoidance strategies, which nevertheless presents values considered satisfactory (Sica et al., 2008). In our sample, for the COPE-NVI 25 total score Cronbach α is equal to 0.85. For the different subscales, it was 0.76 for avoidance strategies 0.96 for transcendent orientation = 0.80 for positive attitude, 0.94 for social support and 0.83 for orientation to the problem.
Teate Depression Inventory (TDI) (Balsamo and Saggino, 2014; Balsamo et al., 2014)
It is a 21-item self-report tool that aims to measure depressive symptoms as described by the latest editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2013) on a five-point Likert-type scale (ranging from 0 = always to 4 = never). It was developed via Rasch logistic analysis of responses (Rasch, 1960), within the framework of Item Response Theory, in order to overcome psychometric weaknesses of existing measures of depression (Balsamo and Saggino, 2007). Recent literature suggested that TDI demonstrate good psychometric properties (Balsamo et al., 2013a,c, 2015a,b; Innamorati et al., 2013; Carlucci et al., 2018; Contardi et al., 2018; Saggino et al., 2018). In the present sample, Cronbach’s α was 0.95.
Procedure
Questionnaire Development
Generation of the preliminary item list
In a qualitative study, a group of 10 women (age M: 42.25; SD: 4.9 years) who had suffered from IPV and who had sought help services, were interviewed. Affects of guilt, shame, fear, and terror were identified and explored as associated with the situation of violence suffered by the women (Nunziante Cesàro and Troisi, 2016). A pilot study was carried out, through an online ad hoc questionnaire developed, in order to test this method of administration. The on-line administration appeared to be more appropriate for recruiting participants who did not want to access the help services, because guaranteed them protection and respect for their own privacy. Furthermore, the pilot study allowed investigation of the means of expression, the sequencing rule for the questions and the types of IPV suffered and to evaluate the response format (Troisi, 2017).
A qualitative selection of the pool of items was carried out on the basis of the words used by the women in the qualitative study, the results from the pilot study and the theoretical assumption. Items were expressed in the metaphorical form. Typically, the language of affects can be more readily evoked by the use of metaphor, often linked to a shared collective symbolization (Imbasciati, 1991; Tisseron, 1992). Therefore, items have been organized through their insertion into different areas related to the following affects: fear, terror, shame, and guilt.
Within the semantic area related to the fear, fear was considered as a state of alarm elicited by the avoidance of the danger (Diel, 1956; Hagenaars et al., 2014). Within the semantic area of the terror, this affect was framed as a paralyzing state that hinders an active process of reaction to danger (Clit, 2002; Nunziante Cesàro and Troisi, 2016). The semantic area of the shame defines it as a strong exposure to the other that disarmed the individual and makes him animated by a sense of failure and passivity (Tisseron, 1992; Lewis, 1995; Pandolfi, 2002; Ciccone and Ferrant, 2015). The semantic area of the guilt focused on its defensive dimension aimed at the restoration of the relationship with the partner, assuming responsibility for the violence suffered and taking an active position in the relationship (Tisseron, 1992; Pandolfi, 2002; Ciccone and Ferrant, 2015).
As a strategy for developing items useful for capturing the meaning of the psychological constructs of affects here defined, three experts, of whom one psychotherapist/researcher and two clinical psychologists, were asked independently to assess items on a Likert type scale. The item pool generated by these procedures comprised 30 items, including 6 for the semantic area of fear, 7 for the semantic area of terror, 10 for the semantic area of shame and 7 for the semantic area of guilt. A five-point Likert-type scale raking from 1 = never to 5 = often, was chosen as appropriate response format for these items.
Refinement of the initial item pool
The resulting 30-item pool was examined by a second group of three experts, composed of one psychologist, one psychoanalyst and one social methodologist who were asked to independently rate the relevance to the construct of each item on a 1 to 5 Likert scale (1 = strongly disagree, 5 = strongly agree). The psychoanalyst and the psychologist expert of the health services set up for violence against women evaluated the relevance of the emerged item pool with theoretical principles and with studied phenomenology in order to guarantee the content validity of the instrument. The methodologist, instead, rated the degree of adherence to the response format and the formulation of the items according to the criteria of brevity, simplicity, exclusion of possible linguistic ambiguities. Based on the collected rating, the 30-item pool underwent syntactic changes and reformulations, which led to a reduction in the number of items. Two items were deleted; one, related to the area of the affect of fear, was evaluated redundant, and another, belonging to the area of the affect of guilt, resulted ambiguous. Furthermore, linguistic ambiguities, double statements, multiple negations and redundant frequency adverbs in the response format were deleted and some changes were made to the instructions and to the terminology.
At the end of this selection, 28 items were retained and grouped as follows: 5 related to fear, 7 related to terror, 10 related to shame, and 6 related to guilt.
The 28-item pool was submitted to a further screening aimed at examining its comprehensibility. It was administered to the same group of 10 women who had participated in the qualitative study described above, since it was considered as a representative sample of the population under examination. This preliminary administration confirmed the comprehensibility of the item and, therefore, did not result in any changes.
All aspects of the study involved the informed consent of each participant, according to the ethical guidelines of Helsinki Declaration. Moreover, participants were informed about the confidentiality of their responses and their anonymous treatment. Participants read a web page with the informed consent document before starting the online survey. The online consent form containing all the required elements, consisting of purpose of the research, nature of participation, description of research procedures, description of risks, voluntariness of participation, right to withdraw at any time without penalty, handling of data (anonymity and confidentiality), contact information for researcher, and contact information for concerns about the project were read and submitted by clicking a button below the text to consent to participate to the survey. There was no honorarium for completing the assessment.
The protocol was approved by the ethics committee of Section of Psychology and Education Sciences, University of Naples Federico II, Italy.
Statistical Analysis
A split-sample cross-validation procedure (Bollen, 1989) was performed on our sample. Data from subsample A and subsample B were respectively subjected to an exploratory factor analysis (EFA- study 1), and to a confirmatory factorial analysis (CFA- study 2), based on the factor structure derived from the exploratory analysis. Model fit was measured by means of the following fit indexes that are suggested as most important (Hu and Bentler, 1998, 1999; MacCallum and Austin, 2000): (a) the chi-square (χ2) statistic and its degrees of freedom; (b) the Tucker–Lewis Index (TLI); (c) the comparative fit index (CFI); (d) the root-mean-square error of approximation (RMSEA) and its 90% confidence interval (CI); and (e) the standardized root mean square residual (SRMR). According to Schermelleh-Engel et al. (2003), the model fit the data when: χ2/df < 2, CFI and TLI > 0.97, SRMR < 0.05, and RMSEA < 0.05 (90% CI: the lower boundary of the CI should contain zero for exact fit and be <0.05 for close fit), in any case also values between 0.05 and 0.08 were considered by some authors as indicatory of a good suitability of the model (Browne and Cudeck, 1993; Hu and Bentler, 1999).
Cronbach’s alpha and correlations have been used to assess descriptive statistics and internal consistency.
Results
Study 1
Subsample A
The sample included 151 participants (age M: 30.23; SD: 8.87 years). As regards their marital status, 83.4% of the women was unmarried, 10.6% married, 2.6% divorced, 2% separated, and 1.3% through a divorce. As regards the sexual orientation 83.4% of the women were heterosexual, 5.3% bisexual and 1.3% homosexual. Regarding level of education: 39.1% had a master’s degree, 21.2% a 3- year degree and 21.3% a high-school diploma and 16.7% a post- graduate degree. As regards the employment 29.8% of subjects were students, 25.2% were self- employed workers, 14.6% were employed and 4.6% were unemployed. Moreover, 68.9% of study participants were involved in a current romantic relationship, 88.1% had no children and the remaining had from one to three offspring.
Exploratory factor analysis (EFA)
The structure of the VITA Scale has been evaluated through a series of EFA using the principal axis factoring (PFA) method in subsample A. PFA has been chosen because of its capacity to recover weak factors and be fairer than principal component analysis (Widaman, 1993) especially when working on small samples (Briggs and MacCallum, 2003). Firstly, it has been tested a one-factor model where all the VITA Scale items were free to load on a single latent component. The one-factor solution explained the 37.54% of the total variance, with eigenvalue equal to 11.05. Absolute factor loadings for each item were greater than 0.30, except for the items (#5) “Ho reagito alla paura chiedendo aiuto” (“I reacted to the fear by asking for help”) and (#3) “L’agitazione mi ha spinto a reagire” (“Agitation pushed me to react”). However, a careful inspection of the scree test (Cattell, 1966) and the inclusion of the factor with eigenvalues > 1 (Kaiser, 1960) suggested the extraction of four or five factor latent components. Based on the previous results, a second PFA was performed extracting five factors with Direct Oblimin rotation. Despite the solution accounting for more than 60% of the total variance, several double factor loadings (>0.30) were observed in the pattern structure. Again, the fifth factor resulted to be composed of a single item “Mi sento/sentivo sporca” (#20) (“I fee/felt dirty”). Therefore, the five-factor model tested could not retained as a reliable solution, both from the statistical and theoretical examination. The last model tested the presence of four factor latent components. Following the authors construct theory of the VITA Scale, a four-factor solution was extracted using PFA with Direct Oblimin rotation. The Kaiser-Meyer-Olkin index was 0.900 suggesting an appropriate measure of sampling adequacy (Tabachnick and Fidell, 2007). The significant Bartlett’s Test of Sphericity (2767,990; gdl = 153; p = 0.001) suggested the adequacy of sample to the EFA. According to the scree test (Cattell, 1966), four factors could be extracted, accounting for the 63.96% of the total variance. All the VITA Scale items showed absolute loadings for each item greater than 0.30 (see Table 1). Only six items showed secondary loadings (#2, #10, #13, #15, #18, and #25). Based on the content analysis, nine items (from #13 to #22, without #18) loaded on the first factor called “Shame”; five items (from #1 to #5) loaded on the second factor called “Fear”; six items (#from #23 to #28) loaded on “Guilt” factor; and, eight items (from #6 to #12 and item #18) loaded on factor defined “Terror.”
TABLE 1. Exploratory factor analysis (EFA) loadings performed on subsample A (N = 151).
Study 2
Subsample B
The sample included 151 participants (M: 30.53; SD: 23.7 years). 79.5% of the women was unmarried, 14.3% married, 0.7% divorced, 5.3% separated. 90.7% of the women are heterosexual, 6% bisexual, 3.3% homosexual. Regarding level of education: 40.4% had a high-school diploma 22.5% had a master’s degree, 18.5% a 3- year degree and 17.2% a post- graduate degree. 41.7% of the women were female students, 27.2% was self-employed workers, 6.6% were without any employment, 13.2% were employed.
74.2% were in romantic relationship, 84.1% had no children and the remaining had from 1 to 3 offspring.
Confirmatory factor analysis (CFA)
A CFA (Bollen, 1989) was carry out using the MPLUS 7 statistical package (Muthén and Muthén, 2012) on the subsample B. Descriptive statistics for the Subsample B revealed no missing values and several departures from the normality of the data. Specifically, item #10 showed skewness and kurtosis values that exceed the cut-off criteria of ±3 (Curran et al., 1996).
Due to the asymmetrical distribution of data, the responses to the VITA Scale items should be better evaluated at the categorical rather than the metric level. However, the robust unweighted least squares (ULSMW) method using a diagonal weight matrix and robust standard errors and a mean- and variance adjusted χ2 test statistic (Muthén and Muthén, 1998, 2004) was used to estimate parameters. Like WLSMV, the ULSMV estimator were more likely to catch small structural links with precision when data was slightly or moderately asymmetric, and when small sample sizes were used.
The one-factor and the four-factor refined models (without items with double loadings) emerged from the previous EFA, versus the four-factor model, that followed authors’ theoretical assumptions (Troisi, 2017), were tested. The unstable five-factor model was excluded from the comparison, based on the results from the previous EFA.
As seen in Table 2, the four-factor model fit the data slightly better than the refined four-factor model and the one-factor model. Specifically, the one-factor model fitted the data worst. All the chi-squared values were significant (p < 0.001), and the ratio χ2/df indicated a slightly better fit of the four-factor model (χ2 = 540.789; χ2/df = 1.57) than the refined model (χ2 = 355.389; χ2/df = 1.75). Likewise, CFI (four-factor, 0.970; refined model, 0.960) and RMSEA (four-factor, 0.062; refined model, 0.071) indices confirmed the better fit of the four-factor model. The TLI index of the two models showed no difference. TLI and CFI were all above 0.97 and SRMR was close to 0.05 (Schermelleh-Engel et al., 2003), indicating a close fit of both models to the empirical data. These results showed that the exclusion of the items with EFA double loadings (#2, #10, #13, #15, #18, and #25) did not contribute to improving the model.
TABLE 2. Confirmatory factorial analysis (CFA) indices performed on the subsample B.
In Figure 1 the standardized factor loadings of the four-factor CFA model was shown, as well as the path coefficients, among the four latent factors. All the items loaded considerably (>0.75) on the respective factors, and all the four latent factors highly correlated (from 0.68 to 0.89).
FIGURE 1. Confirmatory factorial analysis (CFA) standardized estimate for the four-factor model of the VISTA scale (subsample B, N = 151).
Construct validation
Pearson correlational analyses were used to explore the associations between the VITA subscales and other related measures (Table 3).
TABLE 3. Pearson correlations between VITA and external measures and descriptive statistics.
The subscales of the VITA Scale Shame and Guilt were positively correlated with the DERS subscales Non-acceptance, Goals and Impulse, with both subscales of the IES (Intrusion and Avoidance) and with all subscales of the OAS (inferiority, emptiness, and mistake). Furthermore, the subscale of Shame and Guilt were positively correlated with the subscale of COPE-NVI 25 that were Avoidance Strategies and Positive Attitude and with the total score of the TDI. The VITA subscale of Shame was positively correlated with the DERS subscale of Strategies.
The VITA subscale of Terror was positively correlated with the DERS subscales of Non-acceptance, Goals and Impulse and Strategies, with both the subscales of IES (Intrusion and Avoidance), with all subscales of OAS and with the subscale of COPE-NVI 25 related to Avoidance Strategies.
VITA-Scale Fear was positively correlated with both the IES subscales (Intrusion and Avoidance) and positively correlated with the COPE-NVI 25 subscale of Problem Orientation.
Significant correlations were found between the total score of the VITA and the total scores the used concurrent measures, that were OAS, IES, DERS (p < 0.01) and TDI (p < 0.05).
Discussion
Intimate partner violence is the most common form of violence against women (Campbell, 2002). Unfortunately, it is also the most difficult form of violence to recognize (Herman-Lewis, 1992; Hirigoyen, 2005).
The results of the current study widely confirmed the main role played by four affects of terror, fear, guilt and shame, in situation of IPV in line with the authors’ theoretical assumptions (Margherita and Troisi, 2014; Margherita et al., 2014; Nunziante Cesàro and Troisi, 2016).
Particularly, this research confirmed the main role, within the women’s subjective affective experience of victimization, of the affect of shame (Follingstad et al., 1991; Sippel and Marshall, 2011; Shorey et al., 2011), of guilt (Beck et al., 2011), and of fear (Kilpatrick et al., 1989; Riggs et al., 1992; Weaver and Clum, 1995; Scheffer Lindgren and Renck, 2008).
Summing up, the current study aimed at measuring the variety and the complexity of the post-traumatic affectivity of the women suffered from IPV experienced through a specific and newly developed instrument, named VITA Scale (Intimate Violence and Traumatic Affects Scale).
This scale showed a clear factor structure and strong psychometric properties in a sample composed of women suffered from IPV.
Reliability analysis indicated that the VITA Scale, as well its subscales related to the different affects, showed an excellent Cronbach alpha value. The EFA and CFA showed a fully satisfactory fit. The dimensions emerging from these analyses were in line with theoretical expectations (Margherita and Troisi, 2014; Margherita et al., 2014; Nunziante Cesàro and Troisi, 2016).
Results of correlational analysis was in line with the theoretical expectations: the intensity of post-traumatic affectivity was positively and significantly correlated with external shame, the intensity of depression, the impact of trauma, the affective dysregulation and the lack of strategies and it is not related to the implementation of coping skills. The VITA subscale of terror was positively correlated with the subscale avoidance strategy of the COPE-INV25 and the subscale of fear was positively correlated with the Problem Orientation subscale of the COPE-NVI. These last two correlations showed that fear was more associated with the possibility of facing the problem in an “activity” dimension, while terror was more associated with a “passive” avoidance response.
Particular attention should be devoted to the distinction of the affects of terror and fear. While fear assumes a more protective function, terror is denoted as a psychic state, more intense than fear: it emerges when facing with a threat of extreme danger, that could be real or fictitious and would lead to a state of passivity (Clit, 2002; Nunziante Cesàro and Troisi, 2016; Troisi, 2017).
Previous studies, not making a specific distinction between fear and terror, considered fear in the IPV resulting from both the perceived risk of violence and the uncontrollability of this risk (Smith et al., 1995). The distinction between fear and terror, as proposed in the current study, is also supported by neurophysiological studies, which underlined that neuronal circuits of the amygdala, the hypothalamus and the periaqueductal gray substance had sub-zones distinguished for active defenses, such as attack-escape, and for passive ones, such as freezing (Hagenaars et al., 2014).
In the face of danger, the emergence of the affects of terror and shame shows itself as the first defense to maintain the psychic equilibrium, a first form of protection against the disorganization induced by the trauma. If, in dealing with the malaise, the possible actions are no longer adaptive, these affects can come into play with the loss of the feeling of Self.
There are, for example, two different levels of shame: a toxic shame, associated with a sense of constriction, anger and withdrawal, and with an intolerable punitive isolation, and on the other level a humanizing shame that sharpens empathy. This is a shame that has been given recognition either by others or by themselves or by both (Kilborne, 2002).
Feeling shame is the first sign of subjectivation, of being still a subject among subjects, this affect besides being first human feeling, it is a social feeling at the limit between intra and inter-subjective (Barazer, 2000).
Several studies have shown that the affect of shame is associated with the maintenance of PTSD symptoms over time (Andrews et al., 2000).
In the guilt proneness of women who have suffered from violence, not specifically psychoanalytic approaches identify a tendency to feel regrets or remorse for past behavior judged as wrong, while shame refers more to a lowering of self-esteem and emptiness feelings (Gilbert, 2000) and sense of inferiority to the other (Tangney, 1996; Tangney and Dearing, 2002), and is considered a less adaptive affects than the guilt.
Some other studies have questioned whether shame could be a predisposing factor, rather than a consequence of IPV (Harper and Arias, 2004).
Working with such affects, in situations of violence, can be useful in processing the trauma, in order to return to the victim that functional role for the psychic life of the individual that allows a subject to became aware of his/her own internal world and to inscribe the traumatic experience in temporality (Herman-Lewis, 1992; Bohleber, 2007; Levine, 2014).
It is necessary that these affects can emerge to be recognized and elaborated, to limit the disruptive effects of the trauma and reconstruct the event by placing it in a space and in a time and to increase the woman’s ability to think and elaborate those affective experiences that escape any attempt of nomination.
Also, in line with this assumption, the scale of post-traumatic affects here built (VITA Scale) has foreseen the use of metaphor, which stands as a mediator between unspeakable affections and representations (Tisseron, 1992).
It is important to underline that the traumatic experience of the women who suffered from IPV differs from traumas after another stressful event of life. Trauma after IPV is an interpersonal trauma, caused by another person. This type of trauma, whose nature is relational and lasting, is often a “complex trauma” (Herman-Lewis, 1992), whereas the traumatic experience is not a single event but it is repeated and prolonged. This specific situation can make the nervous system reactive, as if in a constant state of alarm and has a higher PTSD risk than other types of trauma, such as trauma associated with natural disasters (Kessler et al., 2017).
The VITA Scale could be a useful tool for the clinician to investigate the affective state of the woman at the time of access to services, to assess the awareness of the woman in her internal world after the trauma, in order to better address the clinical practice and therapeutic intervention planning. Moreover, the use of the instrument could facilitate the recognition of the affects that emerged in the woman following the traumatic experience. This tool could also be useful to broaden the scientific knowledge on the subjective affective experience of victimization, for which several studies have emphasized the need (Harper and Arias, 2004) and for recognition of change in the therapeutic process (Halfon et al., 2016). Furthermore the VITA Scale may be helpful in investigating the role played by affects in different situations of violence.
The treatment of the traumatized woman requires specific clinical work aimed at developing the ability to process traumatic affects and only an adequate tuning with the precise affective states can support the therapeutic alliance and reconstruct the sense of security threatened by the traumatic event (Caretti et al., 2013; De Luca Picione et al., 2017, 2018).
This study presented several limitations. The sample recruited online is not actually discriminant of a clinical sample (e.g., Balsamo et al., 2013b). Furthermore, the validation study was not aimed at identifying the effectiveness of the tool in monitoring the therapeutic intervention process and in understanding the specificities that these affects take on in relation to the type of specific violence suffered. Another limitation consists in the fact that the explored affectivity may not be exhaustive of the complexity of the women’s emotional reaction following trauma. Future research needs to confirm the results on a clinical sample and to measure whether this instrument is sensitive to changes in the therapeutic process with women who have suffered from IPV. Future directions will be addressed to a more in-depth exploration of the consequences of violence for women’s emotional experience to refine the content validity of the scale.
Author Contributions
The author contributes at the whole article, in each of its part.
Conflict of Interest Statement
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Pub. doi: 10.1176/appi.books.9780890425596
American Psychological Association and Presidential Task Force on Violence and the Family (1996). Violence and the Family: Report of the American Psychological Association Presidential Task Force on Violence and the Family. Washington, DC: American Psychological Association.
Andrews, B., Brewin, C. R., Rose, S., and Kirk, M. (2000). Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse. J. Abnorm. Psychol. 109, 69–73. doi: 10.1037/0021-843X.109.1.69
Arcidiacono, C., and Di Napoli, I. (eds). (2012). Sono Caduta Dalle(scale): I Luoghi e Gli Attori Della Violenza di Genere, Vol. 40. Milano: Franco Angeli.
Baldry, A. C. (2006). Dai Maltrattamenti All’omicidio. La Valutazione del Rischio di Recidiva e Dell’uxoricidio. Milano: Franco Angeli.
Balsamo, M., Carlucci, L., Murdock, K. K., Sergi, M. R., and Saggino, A. (2015a). The mediating role of early maladaptive schemas in the relation between co-rumination and depression in youths. PLoS One 10:e0140177. doi: 10.1371/journal.pone.0140177
Balsamo, M., Giampaglia, G., and Saggino, A. (2014). Building a new Rasch-based self-report inventory of depression. Neuropsychiatr. Dis. Treat. 10, 153–165. doi: 10.2147/NDT.S53425
Balsamo, M., Innamorati, M., Van Dam, N. T., Carlucci, L., and Saggino, A. (2015b). Measuring anxiety in the elderly: psychometric properties of the state trait inventory of cognitive and somatic anxiety (STICSA) in an elderly Italian sample. Int. Psychogeriatr. 27, 999–1008. doi: 10.1017/S1041610214002634
Balsamo, M., Imperatori, C., Sergi, M. R., Belvederi Murri, M., Continisio, M., Tamburello, A., et al. (2013a). Cognitive vulnerabilities and depression in young adults: an ROC curves analysis. Depress. Res. Treat. 2013:407602. doi: 10.1155/2013/407602
Balsamo, M., Lauriola, M., and Saggino, A. (2013b). Work values and college major choice. Learn. Individ. Dif. 24, 110–116. doi: 10.1016/j.lindif.2012.12.022
Balsamo, M., Macchia, A., Carlucci, L., Picconi, L., Tommasi, M., Gilbert, P., et al. (2015c). Measurement of external shame: an inside view. J. Pers. Assess. 97, 81–89. doi: 10.1080/00223891.2014.947650
Balsamo, M., Romanelli, R., Innamorati, M., Ciccarese, G., Carlucci, L., and Saggino, A. (2013c). The state-trait anxiety inventory: shadows and lights on its construct validity. J. Psychopathol. Behav. Assess. 35, 475–486. doi: 10.1007/s10862-013-9354-5
Balsamo, M., and Saggino, A. (2007). Test per l’assessment della depressione nel contesto italiano: un’analisi critica. Psicoter. Cogn. Comport. 13, 167–199.
Balsamo, M., and Saggino, A. (2014). Determining a diagnostic cut-off on the teate depression inventory. Neuropsychiatr. Dis. Treat. 10, 987–995. doi: 10.2147/NDT.S55706
Barazer, C. (2000). Hontes sans issue. Documents et débats, Bulletin de l’Association psychanalytique de France. Paris: PUF.
Beck, A. T. (1961). A systematic investigation of depression. Compr. Psychiatry 2, 163–170. doi: 10.1016/S0010-440X(61)80020-5
Beck, J. G., McNiff, J., Clapp, J. D., Olsen, S. A., Avery, M. L., and Hagewood, J. H. (2011). Exploring negative emotion in women experiencing intimate partner violence: shame, guilt, and PTSD. Behav. Ther. 42, 740–750. doi: 10.1016/j.beth.2011.04.001
Bell, K. M., and Naugle, A. E. (2005). Understanding stay/leave decisions in violent relationships: a behavior analytic approach. Behav. Soc. Issues 14, 21–45. doi: 10.5210/bsi.v14i1.119
Bell, K. M., and Naugle, A. E. (2008). Intimate partner violence theoretical considerations: moving towards a contextual framework. Clin. Psychol. Rev. 28, 1096–1107. doi: 10.1016/j.cpr.2008.03.003
Bohleber, W. (2007). Remembrance, trauma and collective memory: the battle for memory in psychoanalysis. Int. J. Psychoanal. 88, 329–352. doi: 10.1516/V5H5-8351-7636-7878
Bollen, K. A. (1989). A new incremental fit index for general structural equation models. Sociol. Methods Res. 17, 303–316. doi: 10.1177/0049124189017003004
Bouton, M. E., Mineka, S., and Barlow, D. H. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychol. Rev. 108, 4–32. doi: 10.1037/0033-295X.108.1.4
Bradbury, T. N., Rogge, R., and Lawrence, E. (2001). “Reconsidering the role of conflict in marriage,” in Couples in Conflict, eds A. Bootj, A. C. Crouter, and M. Clements (Mahwah, NJ: L. Erlbaum Associates), 59–81.
Briggs, N. E., and MacCallum, R. C. (2003). Recovery of weak common factors by maximum likelihood and ordinary least squares estimation. Multivariate Behav. Res. 38, 25–56. doi: 10.1207/S15327906MBR3801_2
Browne, M. W., and Cudeck, R. (1993). “Alternative ways of assessing model fit,” in Testing Structural Equation Models, Vol. 154, eds K. A. Bollen, and J. S. Long (Newbury Park, CA: Sage), 136–136.
Brunet, A., Weiss, D. S., Metzler, T. J., Best, S. R., Neylan, T. C., Rogers, C., et al. (2001). The peritraumatic distress inventory: a proposed measure of PTSD criterion A2. Am. J. Psychiatry 158, 1480–1485. doi: 10.1176/appi.ajp.158.9.1480
Campbell, J., Rose, L., Kub, J., and Nedd, D. (1998). Voices of strength and resistance: a contextual and longitudinal analysis of women’s responses to battering. J. Interpers. Violence 13, 743–762. doi: 10.1177/088626098013006005
Campbell, J. C. (2002). Health consequences of intimate partner violence. Lancet 359, 1331–1336. doi: 10.1016/S0140-6736(02)08336-8
Campbell, J. C. (2004). Danger Assessment. Ann Arbor, MI: Inter-University Consortium for Political and Social Research.
Caretti, V., Craparo, G., and Schimmenti, A. (eds). (2013). “Emozioni, corpo, mentalizzazione: il trattamento delle sindromi traumatiche,” in Memorie Traumatiche e Mentalizzazione, (Rome: Casa Editrice Astrolabio Ubaldini Editore), 169–182.
Carlucci, L., D’Ambrosio, I., Innamorati, M., Saggino, A., and Balsamo, M. (2018). Co-rumination, anxiety, and maladaptive cognitive schemas: when friendship can hurt. Psychol. Res. Behav. Manage. 11, 133–144. doi: 10.2147/PRBM.S144907
Carver, C. S., Scheier, M. F., and Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. J. Pers. Soc. Psychol. 56, 267–283. doi: 10.1037/0022-3514.56.2.267
Cattell, R. B. (1966). The scree test for the number of factors. Multivariate Behav. Res. 1, 245–276. doi: 10.1207/s15327906mbr0102_10
Ciccone, A., and Ferrant, A. (2015). Honte, Culpabilité et Traumatisme. Malakoff: Dunod. doi: 10.3917/dunod.cicco.2015.01
Cloitre, M. (1998). “Intentional forgetting and clinical disorders,” in Intentional Forgetting: Interdisciplinary Approaches, eds J. M. Golding and C. M. MacLeod (Mahwah, NJ: Lawrence Erlbaum Associates Publishers), 395–412.
Cloitre, M., Koenen, K. C., Cohen, L. R., and Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. J. Consult. Clin. Psychol. 70, 1067–1074. doi: 10.1037/0022-006X.70.5.1067
Coleman, F. L. (1997). Stalking behavior and the cycle of domestic violence. J. Interpers. Violence 12, 420–432. doi: 10.1177/088626097012003007
Contardi, A., Imperatori, C., Amati, I., Balsamo, M., and Innamorati, M. (2018). Assessment of affect lability: psychometric properties of the ALS-18. Front. Psychol. 9:427. doi: 10.3389/fpsyg.2018.00427
Curran, P. J., West, S. G., and Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychol. Methods 1, 16–29. doi: 10.1037/1082-989X.1.1.16
Dalgleish, T., and Power, M. J. (2004). Emotion-specific and emotion-non-specific components of posttraumatic stress disorder (PTSD): implications for a taxonomy of related psychopathology. Behav. Res. Ther. 42, 1069–1088. doi: 10.1016/j.brat.2004.05.001
De Luca Picione, R., Martino, M. L., and Freda, M. F. (2017). Understanding cancer patients’ narratives: meaning-making process, temporality and modalities. J. Constr. Psychol. 30, 339–359. doi: 10.1080/10720537.2016.1227738
De Luca Picione, R., Martino, M. L., and Freda, M. F. (2018). Modal articulation: the psychological and semiotic functions of modalities in the sensemaking process. Theory Psychol. 28, 84–103. doi: 10.1177/0959354317743580
Derogatis, L. R., and Cleary, P. A. (1977). Confirmation of the dimensional structure of the SCL-90: a study in construct validation. J. Clin. Psychol. 33, 981–989. doi: 10.1186/1471-2288-11-114
Diel, P. (1956). La Peur et L’angoisse: Phénomène Central de la Vie et de Son Évolution, Vol. 116. Paris: Payot.
Dobash, R. E., and Dobash, R. (1979). Violence Against Wives: A Case Against the Patriarchy. New York, NY: Free Press, 179–206.
Dupuy, H. J. (1984). “The psychological general well-being (PGWB) index,” in Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies, eds N. K. Wenger, M. E. Mattson, C. D. Furberg, and J. Elison (New York, NY: Le Jacq Publishing), 184–188.
Ehrensaft, M. K. (2009). “Family and relationship predictors of psychological and physical aggression,” in Psychological and Physical Aggression in Couples: Causes and Interventions, eds K. D. O’Leary and E. M. Woodin (Washington, DC, US: American Psychological Association), 99–118.
Ellsberg, M., Jansen, H. A., Heise, L., Watts, C. H., and Garcia-Moreno, C. (2008). Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet 371, 1165–1172. doi: 10.1016/S0140-6736(08)60522-X
European Union Agency for Fundamental Rights (2014). Violence Against Women: An EU-Wide Survey. Technical Report IUB-CS-TR61. Vienna: FRA.
Ferraro, K. J. (1997). “Battered women: strategies for survival,” in Violence between Intimate Partners: Patterns, Causes, and Effects, ed. A. Carderelli (New York, NY: Macmillan), 124–143.
Flanagan, J. C. (1978). A research approach to improving our quality of life. Am. Psychol. 33, 138–147. doi: 10.1037/0003-066X.33.2.138
Foà, C., Tonarelli, A., Caricati, L., and Fruggeri, L. (2015). COPE-NVI-25: validazione italiana della versione ridotta della coping orientation to the problems experienced (COPE-NVI). Psicol. Salute 2, 121–138.
Follingstad, D. R., Wright, S., Lloyd, S., and Sebastian, J. A. (1991). Sex differences in motivations and effects in dating violence. Fam. Relat. 40, 51–57. doi: 10.2307/585658
Friborg, O., Hjemdal, O., Rosenvinge, J. H., and Martinussen, M. (2003). A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment? Int. J. Methods Psychiatr. Res. 12, 65–76. doi: 10.1002/mpr.143
Frieze, I. H., and Browne, A. (1989). Violence in marriage. Crime Justice 11, 163–218. doi: 10.1086/449154
Gargiulo, A., Plener, P. L., Baus, N., Margherita, G., Brunner, R., Kaess, M., et al. (2014). Autolesività non suicidaria (NSSI) e Disturbo da comportamento suicidario (SBD) nella recente pubblicazione del DSM-5. Minerva Psichiatr. 56, 83–90.
Gilbert, P. (2000). The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clin. Psychol. Psychother. 7, 174–189. doi: 10.1002/1099-0879(200007)7:3<174::AID-CPP236>3.0.CO;2-U
Giromini, L., Velotti, P., de Campora, G., Bonalume, L., and Cesare Zavattini, G. (2012). Cultural adaptation of the difficulties in emotion regulation scale: reliability and validity of an Italian version. J. Clin. Psychol. 68, 989–1007. doi: 10.1002/jclp.21876
Goss, K., Gilbert, P., and Allan, S. (1994). An exploration of shame measures—I: The other as Shamer scale. Pers. Individ. Dif. 17, 713–717. doi: 10.1016/0191-8869(94)90149-X
Gratz, K. L., and Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J. Psychopathol. Behav. Assess. 26, 41–54. doi: 10.1023/B:JOBA.0000007455.08539.94
Green, A. (1973). Le Discours Vivant: La Conception Psychanalytique de L’affect, Vol. 2. Paris: Presses universitaires de France.
Hagenaars, M. A., Oitzl, M., and Roelofs, K. (2014). Updating freeze: aligning animal and human research. Neurosci. Biobehav. Rev. 47, 165–176. doi: 10.1016/j.neubiorev.2014.07.021
Halfon, S., Çavdar, A., Orsucci, F., Schiepek, G. K., Andreassi, S., Giuliani, A., et al. (2016). The non-linear trajectory of change in play profiles of three children in psychodynamic play therapy. Front. Psychol. 7:1494. doi: 10.3389/fpsyg.2016.01494
Hamby, S. L., and Sugarman, D. B. (1999). Acts of psychological aggression against a partner and their relation to physical assault and gender. J. Marriage Fam. 959–970. doi: 10.2307/354016
Harper, F. W., and Arias, I. (2004). The role of shame in predicting adult anger and depressive symptoms among victims of child psychological maltreatment. J. Fam. Violence 19, 359–367. doi: 10.1007/s10896-004-0681-x
Hegarty, K., Sheehan, M., and Schonfeld, C. (1999). A multidimensional definition of partner abuse: development and preliminary validation of the composite abuse scale. J. Fam. Violence 14, 399–415. doi: 10.1023/A:1022834215681
Herman-Lewis, J. (1992). Trauma and Recovery: The Aftermath of Violence-From Domestic Abuse to Political Terror. New York, NY: Basic Books.
Hilton, N. Z., Harris, G. T., Rice, M. E., Lang, C., Cormier, C. A., and Lines, K. J. (2004). A brief actuarial assessment for the prediction of wife assault recidivism: the Ontario domestic assault risk assessment. Psychol. Assess. 16, 267–275. doi: 10.1037/1040-3590.16.3.267
Hirigoyen, M. F. (2005). Femmes Sous Emprise: Les Ressorts de la Violence Dans le Couple. OH! Éditions. London: Pocket.
Horowitz, M., Wilner, N., and Alvarez, W. (1979). Impact of event scale: a measure of subjective stress. Psychosom. Med. 41, 209–218. doi: 10.1097/00006842-197905000-00004
Hu, L. T., and Bentler, P. M. (1998). Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychol. Methods 3, 424–453. doi: 10.1037/1082-989X.3.4.424
Hu, L. T., and Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct. Equ. Model. Multidiscip. J. 6, 1–55. doi: 10.1080/10705519909540118
Hudson, W. W., and McIntosh, S. R. (1981). The assessment of spouse abuse: two quantifiable dimensions. J. Marriage Fam. 43, 873–888. doi: 10.2307/351344
Hunt, N., and Evans, D. (2004). Predicting traumatic stress using emotional intelligence. Behav. Res. Ther. 42, 791–798. doi: 10.1016/j.brat.2003.07.009
Imbasciati, A. (1991). Affetto e Rappresentazione. Per una Psicoanalisi dei Processi Cognitive. Milano: Franco Angeli.
Innamorati, M., Tamburello, S., Contardi, A., Imperatori, C., Tamburello, A., Saggino, A., et al. (2013). Psychometric properties of the attitudes toward self-revised in Italian young adults. Depress. Res. Treat. 2013:209216. doi: 10.1155/2013/209216
Jaquier, V., and Sullivan, T. P. (2014). Fear of past abusive partner (s) impacts current posttraumatic stress among women experiencing partner violence. Violence Against Women 20, 208–227. doi: 10.1177/1077801214525802
Johnson, M. P. (1995). Patriarchal terrorism and common couple violence: two forms of violence against women. J. Marriage Fam. 57, 283–294. doi: 10.2307/353683
Kaiser, H. F. (1960). The application of electronic computers to factor analysis. Educ. Psychol. Meas. 20, 141–151. doi: 10.1177/001316446002000116
Kelly, J. B., and Johnson, M. P. (2008). Differentiation among types of intimate partner violence: research update and implications for interventions. Fam. Court Rev. 46, 476–499. doi: 10.1111/j.1744-1617.2008.00215.x
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., et al. (2017). Trauma and PTSD in the WHO world mental health surveys. Eur. J. Psychotraumatol. 8:1353383. doi: 10.1080/20008198.2017.1353383
Kilpatrick, D. G., Saunders, B. E., Amick-McMullan, A., Best, C. L., Veronen, L. J., and Resnick, H. S. (1989). Victim and crime factors associated with the development of crime-related post-traumatic stress disorder. Behav. Ther. 20, 199–214. doi: 10.1016/S0005-7894(89)80069-3
Koss, M. P., Goodman, L. A., Browne, A., Fitzgerald, L. F., Keita, G. P., and Russo, N. F. (1994). No Safe Haven: Male Violence against Women at Home, at Work, and in the Community. Worcester, MA: American Psychological Association. doi: 10.1037/10156-000
Kropp, P. R., and Hart, S. D. (2000). The spousal assault risk assessment (SARA) guide: reliability and validity in adult male offenders. Law Hum. Behav. 24, 101–118. doi: 10.1023/A:1005430904495
Lawson, J. (2012). Sociological theories of intimate partner violence. J. Hum. Behav. Soc. Environ. 22, 572–590. doi: 10.1080/10911359.2011.598748
Lee, D. A., Scragg, P., and Turner, S. (2001). The role of shame and guilt in traumatic events: a clinical model of shame-based and guilt-based PTSD. Psychol. Psychother. Theory Res. Pract. 74, 451–466. doi: 10.1348/000711201161109
Levine, H. B. (2014). Psychoanalysis and trauma. Psychoanal. Inq. 34, 214–224. doi: 10.1080/07351690.2014.889475
Litz, B. T., Orsillo, S. M., Kaloupek, D., and Weathers, F. (2000). Emotional processing in posttraumatic stress disorder. J. Abnorm. Psychol. 109, 26–39. doi: 10.1037/0021-843X.109.1.26
MacCallum, R. C., and Austin, J. T. (2000). Applications of structural equation modeling in psychological research. Annu. Rev. Psychol. 51, 201–226. doi: 10.1146/annurev.psych.51.1.201
Margherita, G., and Troisi, G. (2014). Gender violence and shame. The visible and the invisible, from the clinical to the social systems. La Camera Blu 10, 166–185.
Margherita, G., Troisi, G., and Nunziante Cesàro, A. (2014). “La vergogna e il femminile: del rendersi invisibile,” in Chiaroscuri dell’identità. Sessuazione, Sesso e Genere, ed. A. Nunziante Cesaro (Roma: Franco Angeli).
Marmar, C. R., Weiss, D. S., and Metzler, T. J. (1997). The peritraumatic dissociative experiences questionnaire. Assess. Psychol. Trauma PTSD 2, 144–168.
Mihalic, S. W., and Elliott, D. (1997). A social learning theory model of marital violence. J. Fam. Violence 12, 21–47. doi: 10.1023/A:1021941816102
Morrison, A. P. (1999). Shame, on either side of defense. Contemp. Psychoanal. 35, 91–105. doi: 10.1016/j.lpm.2014.06.037
Murphy, C. M., and O’Leary, K. D. (1989). Psychological aggression predicts physical aggression in early marriage. J. Consult. Clin. Psychol. 57, 579–582. doi: 10.1037/0022-006X.57.5.579
Muthén, L. K., and Muthén, B. O. (1998). Mplus: The Comprehensive Modeling Program for Applied Researchers; User’s Guide; [Version 1.0]. Los Angeles, CA: Muthén & Muthén.
Muthén, L. K., and Muthén, B. O. (2004). Mplus User’s Guide: Statistical Analysis with Latent Variables: User’s Guide. Los Angeles, CA: Muthén & Muthén.
Muthén, L. K., and Muthén, B. O. (2012). Mplus Statistical Modeling Software: Release 7.0. Los Angeles, CA: Muthén & Muthén.
Nunziante Cesàro, A., and Troisi, G. (2016). Le ferite della violenza tra paura e terrore. La Camera Blu. Rivista di Studi di Genese 14, 90–112.
O’Keefe, M. (1998). Factors mediating the link between witnessing interparental violence and dating violence. J. Fam. Violence 13, 39–57. doi: 10.1023/A:1022860700118
Orsillo, S. M., Batten, S. V., Plumb, J. C., Luterek, J. A., and Roessner, B. M. (2004). An experimental study of emotional responding in women with posttraumatic stress disorder related to interpersonal violence. J. Trauma Stress 17, 241–248. doi: 10.1023/B:JOTS.0000029267.61240.94
Pandolfi, A. M. (2002). La Vergogna. Un Affetto Psichico Che Sta Scomparendo. Milano: Franco Angeli.
Pence, E., and Paymar, M. (1993). Education Groups for Men Who Batter: The Duluth Model. New York, NY: Springer Publishing Company. doi: 10.1891/9780826179913
Pico-Alfonso, M. A., Echeburúa, E., and Martinez, M. (2008). Personality disorder symptoms in women as a result of chronic intimate male partner violence. J. Fam. Violence 23, 577–588. doi: 10.1007/s10896-008-9180-9
Pietrantonio, F., De Gennaro, L., Di Paolo, M. C., and Solano, L. (2003). The impact of event scale: validation of an Italian version. J. Psychosom. Res. 55, 389–393. doi: 10.1016/S0022-3999(02)00638-4
Piotrkowski, C. S., and Brannen, S. J. (2002). Exposure, threat appraisal, and lost confidence as predictors of PTSD symptoms following September 11, 2001. Am. J. Orthopsychiatry 72, 476–485. doi: 10.1037/0002-9432.72.4.476
Rabin, R. F., Jennings, J. M., Campbell, J. C., and Bair-Merritt, M. H. (2009). Intimate partner violence screening tools: a systematic review. Am. J. Prev. Med. 36, 439–445. doi: 10.1016/j.amepre.2009.01.024
Rasch, G. (1960). Studies in Mathematical Psychology: I. Probabilistic Models for Some Intelligence and Attainment Tests. Oxford: Nielsen & Lydiche.
Rennison, C. M., and Welchans, S. (2000). Intimate Partner Violence. Washington, DC: U.S. Department of Justice. doi: 10.1037/e378132004-001
Resick, P. A., and Miller, M. W. (2009). Posttraumatic stress disorder: anxiety or traumatic stress disorder? J. Trauma Stress 22, 384–390. doi: 10.1002/jts.20437
Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., and Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J. Consult. Clin. Psychol. 61, 984–991. doi: 10.1037/0022-006X.61.6.984
Riggs, D. S., Kilpatrick, D. G., and Resnick, H. S. (1992). Long-term psychological distress associated with marital rape and aggravated assault: a comparison to other crime victims. J. Fam. Violence 7, 283–296. doi: 10.1007/BF00994619
Riggs, D. S., and O’Leary, K. D. (1996). Aggression between heterosexual dating partners: an examination of a causal model of courtship aggression. J. Interpers. Violence 11, 519–540. doi: 10.1177/088626096011004005
Romito, P. (2005). Un Silenzio Assordante: la Violenza Occultata su Donne e Minori, Vol. 36. Milano: Franco Angeli.
Ronfeldt, H. M., Kimerling, R., and Arias, I. (1998). Satisfaction with relationship power and the perpetration of dating violence. J. Marriage Fam. 70–78. doi: 10.2307/353442
Rubinstein, M. (1987). The Dignity of Women at Work: Report on the Problem of Sexual Harassment in the Member States of the European Community. Brussels: Publication Office of the European Community.
Saggino, A., Balsamo, M., Carlucci, L., Cavalletti, V., Sergi, M. R., da Fermo, G., et al. (2018). Psychometric properties of the Italian version of the young schema questionnaire l-3: Preliminary results. Front. Psychol. 9:312. doi: 10.3389/fpsyg.2018.00312
Saggino, A., Carlucci, L., Sergi, M. R., D’Ambrosio, I., Fairfield, B., and Balsamo, M. (2017). A validation study of the psychometric properties of the other as Shamer scale-2. SAGE Open 7, 1–10. doi: 10.1177/0706743716673320
Scheffer Lindgren, M., and Renck, B. (2008). ‘It is still so deep-seated, the fear’: psychological stress reactions as consequences of intimate partner violence. J. Psychiatr. Ment. Health Nurs. 15, 219–228. doi: 10.1111/j.1365-2850.2007.01215.x
Schermelleh-Engel, K., Moosbrugger, H., and Müller, H. (2003). Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol. Res. 8, 23–74.
Shook, N. J., Gerrity, D. A., Jurich, J., and Segrist, A. E. (2000). Courtship violence among college students: a comparison of verbally and physically abusive couples. J. Fam. Violence 15, 1–22. doi: 10.1023/A:1007532718917
Shorey, R. C., Sherman, A. E., Kivisto, A. J., Elkins, S. R., Rhatigan, D. L., and Moore, T. M. (2011). Gender differences in depression and anxiety among victims of intimate partner violence: the moderating effect of shame proneness. J. Interpers. Violence 26, 1834–1850. doi: 10.1177/0886260510372949
Sica, C., Magni, C., Ghisi, M., Altoè, G., Sighinolfi, C., Chiri, L. R., et al. (2008). Coping orientation to problems experienced-nuova versione Italiana (COPE-NVI): uno strumento per la misura degli stili di coping. Psicoter. Cogn. Comport. 14, 27–53.
Sippel, L. M., and Marshall, A. D. (2011). Posttraumatic stress disorder symptoms, intimate partner violence perpetration, and the mediating role of shame processing bias. J. Anxiety Disord. 25, 903–910. doi: 10.1016/j.janxdis.2011.05.002
Smith, P. H., Tessaro, I., and Earp, J. A. L. (1995). Women’s experiences with battering: a conceptualization from qualitative research. Womens Health Issues 5, 173–182. doi: 10.1016/1049-3867(95)00615-X
Straus, M. A. (2017). “Measuring intrafamily conflict and violence: the conflict tactics (CT) scales,” in Physical Violence in American Families, eds M. A. Straus, and R. J. Gelles (Abingdon: Routledge), 29–48.
Straus, M. A., and Gelles, R. J. (1990). How violent are American families? Estimates from the national family violence resurvey and other studies. Phys. Violence Am. Fam. 8, 95–112.
Tabachnick, B. G., and Fidell, L. S. (2007). Using Multivariate Statistics. Boston, MA: Allyn & Bacon.
Tangney, J. P. (1996). Conceptual and methodological issues in the assessment of shame and guilt. Behav. Res. Ther. 34, 741–754. doi: 10.1016/0005-7967(96)00034-4
Tangney, J. P., and Dearing, R. L. (2002). Emotions and Social Behavior. Shame and Guilt. New York, NY: Guilford.
Tjaden, P., and Thoennes, N. (1998). Prevalence, Incidence, and Consequences of Violence against Women: Findings from the National Violence against Women Survey. Washington, DC: National Institute of Justice and the Centers for Disease Control and Prevention.
Tjaden, P. G., and Thoennes, N. (2000). Extent, Nature, and Consequences of Intimate Partner Violence. Washington, DC: National Institute of Justice. doi: 10.1037/e300342003-001
Troisi, G. (2017). Gli Affetti e la Violenza: Uno Studio Sull’intimate Partner Violence. Ph.D. thesis, University of Naples Federico II, Naples.
Van der Kolk, B. A. (1996). “The complexity of adaptation to trauma: self-regulation, stimulus discrimination, and characterological development,” in Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, eds B. A. van der Kolk, A. C. McFarlane, and L. Weisaeth (New York, NY: Guilford Press), 182–213.
Veazey, C. H., Blanchard, E. B., Hickling, E. J., and Buckley, T. C. (2004). Physiological responsiveness of motor vehicle accident survivors with chronic posttraumatic stress disorder. Appl. Psychophysiol. Biofeedback 29, 51–62. doi: 10.1023/B:APBI.0000017863.35714.a1
Weathers, F., Huska, J., and Keane, T. (1991). The PTSD Checklist Military Version (PCL-M). Boston, MA: National Center for PTSD, 42.
Weaver, T. L., and Clum, G. A. (1995). Psychological distress associated with interpersonal violence: a meta-analysis. Clin. Psychol. Rev. 15, 115–140. doi: 10.1016/0272-7358(95)00004-9
Widaman, K. F. (1993). Common factor analysis versus principal component analysis: differential bias in representing model parameters? Multivariate Behav. Res. 28, 263–311. doi: 10.1207/s15327906mbr2803_1
Wilson, J. P., Droždek, B., and Turkovic, S. (2006). Posttraumatic shame and guilt. Trauma Violence Abuse 7, 122–141. doi: 10.1177/1524838005285914
World Health Organization, Department of Injuries and Violence Prevention (2002). The Injury Chart Book: A Graphical Overview of the Global Burden of Injuries. Geneva: World Health Organization.
World Health Organization [WHO] (2013). Responding to Intimate Partner Violence and Sexual Violence against Women: WHO Clinical and Policy Guidelines. Geneva: World Health Organization.
Keywords: intimate partner violence, shame, guilt, terror, fear, psychodynamic perspective, women’s health
Citation: Troisi G (2018) Measuring Intimate Partner Violence and Traumatic Affect: Development of VITA, an Italian Scale. Front. Psychol. 9:1282. doi: 10.3389/fpsyg.2018.01282
Received: 17 April 2018; Accepted: 04 July 2018;
Published: 26 July 2018.
Edited by:
Marco Innamorati, Università Europea di Roma, ItalyReviewed by:
Nicoletta Cera, Universidade do Porto, PortugalElisa Pedroli, Istituto Auxologico Italiano (IRCCS), Italy
Rosa Scardigno, Università degli Studi di Bari Aldo Moro, Italy
Copyright © 2018 Troisi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Gina Troisi, Z2luYS50cm9pc2kyQHVuaW5hLml0