J Fam Viol (2008) 23:577–588
Personality Disorder Symptoms in Women as a Result
of Chronic Intimate Male Partner Violence
Maria A. Pico-Alfonso & Enrique Echeburúa &
Published online: 19 March 2008
# Springer Science + Business Media, LLC 2008
Abstract This study explores the personality disorder
Keywords Intimate male partner violence . Women .
symptoms of women victims of intimate male partner
Personality disorder symptoms . MCMI-II profiles
violence (IPV), after controlling for the contribution of
experiences of childhood abuse. Victims of both physical
and psychological violence (n=73) or psychological vio-
lence alone (n=53) were compared with non-abused control
Intimate male partner violence (IPV) is a major public
women (n=52). Information about sociodemographic char-
health problem that has both short- and long-term physical
acteristics, childhood abuse, and personality characteristics
and mental health consequences for women (Campbell
(MCMI-II) was obtained through face-to-face structured
2002; Heru 2007; Watts and Zimmerman 2002; Weinbaum
et al. 2001). Research addressing mental health effects in
interviews. Women victims of IPV had higher scores than
controls in schizoid, avoidant, self-defeating personality
women victims of IPV has reported that the most prevalent
scales, as well as in the three pathological personality scales
psychological sequelae are depression, posttraumatic stress
disorder (PTSD), and anxiety (Campbell et al. 1996;
(schizotypal, borderline and paranoid). Both physical and
psychological IPV were strongly associated with personal-
Campbell 2002; Cascardi et al. 1999; Golding 1999;
ity disorder symptomatology, regardless of the effects of
Martinez et al. 2004; Woods 2000). In a recent study
(Stuart et al. 2006), violence victimization was significantly
childhood abuse. These findings underscore the need to
screen for personality disorder symptoms in women victims
related to symptoms of psychopathology: sexual and
of IPV when dealing with therapeutic interventions.
psychological abuse by partners were associated with the
presence of PTSD, depression, and generalized anxiety
disorder (GAD) diagnoses.
Despite the increasingly well-documented literature on
the association between IPV and DSM Axis I diagnostic
categories, there has been relatively less empirical focus on
Department of Psychobiology, Faculty of Psychology,
the interactions between IPV and personality disorders
University of Valencia,
(PDs). However, the assumption of the interaction between
inherited susceptibility and environmental factors, such as
traumatic experiences (Paris 1996), in this case chronic
Department of Personality and Psychological Treatment,
violence by the partner, could lead us to the hypothesis that
Faculty of Psychology, University of the Basque Country,
these victims are at high risk of developing PD symptoms.
San Sebastian, Spain
For example, Golier et al. (2003) found that subjects with
paranoid PD were more likely than those without it to have
M. A. Pico-Alfonso (*)
Stress Physiology Lab,
experienced physical assault in adulthood. Further, it is
Department of Evolutionary and Functional Biology,
reasonable to suppose that if women victims of IPV
University of Parma,
develop PD symptoms they may suffer worse detrimental
Parco Area delle Scienze, 11/a,
effects on their well-being and therefore may require
43100 Parma, Italy
specialized therapeutic intervention strategies.
J Fam Viol (2008) 23:577–588
Although there is a lack of homogeneity in the results
psychological abuse co-occurred, suggest that psychologi-
available due to the variability of the sample (size, context
cal IPV has a unique and possibly even greater impact on
from which women were recruited, such as shelters or
women’s psychological functioning and can be more
clinics), the personality assessment instruments, and the
predictive of psychopathology than physical abuse (Cogan
criteria for intimate partner violence, the general conclusion
and Porcerelli 1996; O’Leary 1999; Pico-Alfonso 2005;
is that IPV and PDs are frequently and positively associated
Ratner 1993; Sackett and Saunders 1999; Street and Arias
(Cogan and Porcerelli 1996; Danielson et al. 1998; Gellen
2001). Further, sexual violence may be concomitant with
et al. 1984; Khan et al. 1993; Palau 1981). Snyder and
both physical and psychological violence, thus enhancing
Fruchtman (1981) studied interviews from a battered
the impact of IPV on mental health (Bennice et al. 2003;
women’s shelter and identified a specific subgroup exhibit-
Campbell and Alford 1989; Wingood et al. 2000).
ing chronic problems associated with PDs. Back et al. (1982)
By the 1980s, the Millon Clinical Multiaxial Inventory
examined the personality features of battered women from a
(MCMI) joined the MMPI as a broad assessment instru-
psychiatric facility and found that 83% of them were given a
ment able to detect personality disorders (Millon 1987).
discharge diagnosis of borderline, passive-dependent, or
The MCMI is derived from Millon’s bioevolutionary theory
passive-aggressive PDs. In comparison, only 45% of non-
on the development of personality styles and personality
abused psychiatric patients were diagnosed with a PD. Other
disorders (Millon and Davis 1994). This instrument has
researchers have observed a high prevalence of antisocial
generated a large literature base (Craig 1993a; Millon 1997)
personality disorder and of obsessive–compulsive disorder
including interpretive manuals (Choca and Van Denburg
(Gleason 1993), even accompanied by more frequent
1997; Craig 1993b), and critical reviews (Craig 1999;
paranoid ideation (Riggs et al. 1992) in women victims of
Wetzler 1990). Even though originally the MCMI-II was
IPV. Moreover, Shields et al. (1990) found a positive
normed as a clinical test, researchers have used it with non-
correlation between the severity and extent of current IPV
psychiatric samples, including medical patients, military
and the severity of Borderline personality disorder.
recruits, and other specific populations (Craig and Olson
So far, the instrument more frequently used to assess
1992; Craig and Weinberg 1992; Echeburua et al. 2005;
PDs in abused women has been the Minnesota Multiphasic
Craig 2003; Espelage et al. 2002). Craig and Weinberg
Personality Inventory (MMPI; Hathaway and McKinley
(1992) found that some specific personality disorder scales
1943). MMPI studies attempting to explore the differences
of the MCMI-II were quite accurate in classifying patients
between women victims of IPV and control women
into DSM-III-R Axis II diagnostic categories. Cogan and
confirmed that the former show higher overall levels of
Porcerelli (1996) administered MCMI-II to women attending
psychopathology (Gellen et al. 1984; Palau 1981; Rhodes
couples therapy for violent relationships, finding that 28% of
1992). For example, Rosewater (1988) found that battered
them were clinically elevated on the Dependent personality
women had elevated MMPI profiles, with scales 4, 6, and
disorder scale, compared with 10% in Millon’s normative
8 showing the highest elevations (i.e., T-score >70 in
sample. In the field of domestic violence, MCMI has been
Psychopathic Deviate, Paranoia, and Schizophrenia Scales).
used to assess personality characteristics of batterers (Craig
Khan et al. (1993) studied the MMPI-II profiles of 31
2003; Hamberger and Hastings 1989; Fortunata and Kohn
battered women in transition and also found elevations on
2003) and survivors of childhood abuse (Haller and Miles
clinical scales 4, 6, 8, and 9 (i.e., Psychopathic Deviate,
2004). To our knowledge, there is no literature concerning
Paranoia, Schizophrenia, and Hypomania Scales). Both
MCMI-II’s assessments with women victims of IPV.
studies concluded that in their samples MMPI scale
Personality disturbance in this population is an important
elevations were likely related to a reactive state to IPV
area of study, since its presence supposes significant
rather than to an underlying pathological process.
symptoms and impairment in social functioning for the
An important issue is the type of violence to which
women at follow-up (De Groot et al. 2003). Moreover,
women have been exposed. Although women may experi-
research suggests that problems pertaining to intimate
ence varying and often complex combinations of physical,
relationship matters are unique risk factors for imminent
psychological, and sexual IPV, most studies have focused just
suicide attempts among subjects with personality disorders
on physical IPV (Martinez et al. 2004). Rollstin and Kern
(Yen et al. 2005). The assessment of PDs in women victims
(1998) distinguished between physically and psychologically
of different types of IPV (i.e., physical, psychological, and
abused women in a intimate partner relationship and found
sexual) would allow a greater understanding of the problem,
that MMPI-II scores were positively correlated with both
in view of achieving more effective therapeutical strategies.
types of abuse.
An increasing number of retrospective reports suggest
The few studies that have assessed the impact of
that psychiatric disorders may be related to childhood abuse
psychological IPV alone (Coker et al. 2000; Follingstad et
(Bradley et al. 2005; Bryer et al. 1987; Grilo et al. 1999).
al. 1990; O’Leary 1999), and those where physical and
Saleptsi et al. (2004) explored the relationship between
J Fam Viol (2008) 23:577–588
psychiatric diagnoses (i.e., alcohol-related, schizophrenic,
would minimize psychological stress for participant and
affective, and personality disorder groups) and negative life
interviewer. In general, each woman was interviewed four to
events during childhood in 192 patients, finding that
six times by the same psychologist, each session taking
emotional, physical, and sexual abuse was more often
approximately one and a half hours. Comprehensive ques-
reported by patients with PDs. On the other hand, a history
tionnaires were designed for a face-to-face interview. The
of childhood abuse seems to increase the risk for adult IPV
majority of questions were devised to yield objective factual
victimization (Coid et al. 2001; Wind and Silvern 1992).
reports. The questionnaires from which information for the
In summary, there are many studies in which physical,
present study was obtained are described below, and more
sexual, and psychological abuse by partners were associat-
detailed information is given in Garcia-Linares et al. (2005).
ed with the presence of PTSD, depression, and GAD
diagnoses. However, investigations are needed in order to
Sociodemographic Profile Variables
assess personality disorder symptomatology in abused
women, carefully separating the contribution of childhood
Data about age, number of children, level of education, and
abuse and experiences of IPV. The current study was aimed
marital status of the women were obtained.
at evaluating the personality disorder symptomatology of
women exposed to physical and psychological IPV, or to
Violence Perpetrated by an Intimate Male Partner
“only” psychological IPV with MCMI-II. It was hypoth-
esised that women victims of IPV would exhibit signifi-
The majority of the widely-used measures of IPV are in the
cantly higher prevalence rates and greater levels of Axis II
English language. Therefore, on the basis of scientific
psychopathological symptoms than control women. Finally,
literature about the instruments to measure violence by the
the impact of concomitant sexual IPV on personality
partner, a questionnaire was constructed to obtain detailed
disturbances was also considered. A better knowledge of
information about the different types of violence (physical,
these variables would allow the design of more effective
sexual, and psychological) perpetrated by the batterer. Each
therapeutical strategies to cope with IPV and would
type of violence consisted of one or more of the acts
encourage further research on this relevant topic.
described below. Women were asked to answer “yes” or
“no” to the incidence of each act. When the woman
answered positively, she was asked about duration, fre-
quency, and use of coercive instruments, in order to obtain
a severity marker of the violence experienced.
(a) Physical violence, including punches, kicks, slaps,
pushes, bites, and strangling.
The present study is part of a larger research project on the
(b) Sexual violence, including: (1) forced sex (vaginal or
impact of IPV on women’s health, carried out between 2000
anal penetration, oral sex from her to him or from him to
and 2002, and involving a sample of 182 women from the
her, objects inserted in vagina or anus), (2) forced to have
Valencian Community of Spain (Garcia-Linares et al. 2004,
homosexual sex, (3) forced sex with animals, (4) forced
2005; Pico-Alfonso 2005; Pico-Alfonso et al. 2004, 2006).
to prostitute herself, (5) forced to have sex in public, (6)
Women victims of IPV were recruited from the 24 h centers
physical violence during sexual intercourse (bites, kicks,
for helping women, an outpatient counselling agency for
blows and slaps), (7) threats to hit the woman or children
battered women located in the three provinces of the
if rejecting sex, (8) threats with knives, guns or other
Community (Alicante, Castellon, and Valencia). Control
weapons in order to have sex, (9) involvement of
women, who lived in a non-violent intimate partner
children in forced sex or witnessing sexual attacks and
relationship, were contacted through Women’s associations.
(10) forced use of pornographic films and photos.
All participants were of Spanish nationality. The study was
(c) Psychological violence, including: (1) verbal attacks
approved by the University of Valencia research ethics
(insults, humiliations), (2) control and power (isolation
committee, and prior informed written consent was
from family and friends, impeding decision-making,
obtained from all participants at the outset.
economic abandonment), (3) pursuit and harassment, (4)
verbal threats (woman and family’s life threatened,
threats regarding the custody of children, intimidating
phone calls), and (5) blackmail (economic or emotional).
The study consisted of a structured interview in which four
trained female licensed psychologists asked women about
Control women were also asked all the questions, in
their lives and health. The psychologists were well
order to ensure that they had had no experience of violence
informed about how to use the questionnaires in a way that
in any intimate partner relationship.
J Fam Viol (2008) 23:577–588
Endorsement or lack thereof of any of the acts of physical,
responding disorder and completed the test” (Millon 1987,
sexual, or psychological violence was used as criteria to
p. 95). A BR score of 85 and above signifies the “most
designate women as abused or non-abused. The presence or
prominent” disorder (e.g., “severe”), a BR score of 75 to 84
absence of any of the acts of physical violence was used to
reflects the “presence of characteristics” of the disorder (e.g.,
assign abused women to two subgroups: physically/
“moderate”), while a score of 65 to 74 suggests that the
psychologically abused and “only” psychologically-abused.
patient has some of the traits defined by the scale (e.g.,
The presence of any of the acts of concomitant sexual
“mild”). According to the conservative criteria of Wetzler
violence was specifically considered within both subgroups
(1990), a BR score >84 is considered to be significant.
of abused women.
The test has 22 scales, plus three Modifier indices and a
In order to evaluate more features of recent IPV, women
Random Response Index. Their names and designations are as
were also asked whether they had been physically,
follows. The Modifier Indices include the scales of Disclosure
psychologically or sexually abused during the last year.
(X), Desirability (Y), and Debasement (Z). There is also a
The maintenance of the cohabitation with the partner at the
Random Index, consisting of four unusual items which, if
time of the interviews was also considered.
answered in the endorsed direction, suggest profile invalidity
(“I have never seen a car in the past ten years”). In this study,
only women with valid profiles have been considered. The
Clinical Personality Scales include Schizoid (1), Avoidant
Women were asked about the incidence, duration, frequency,
(2), Dependent (3), Histrionic (4), Narcissistic (5), Antisocial
and use of coercive instruments to perpetrate physical, sexual
(6A), Aggressive/Sadistic (6B), Compulsive (7), Passive–
or psychological abuse during their childhood (prior to
Aggressive (8A), and Self-defeating (8B). Scales measuring
14 years of age).
severe Personality Pathology are Schizotypal (S), Borderline
(C), and Paranoid (P). Scales measuring Clinical Syndromes
(a) Childhood physical abuse was defined as above (see
were not analysed (Millon 1987).
(b) Childhood sexual abuse included one or more of the
following acts: forced sex, forced to touch a male’s
sexual organs or being touched, forced exposure to the
The three groups of women (non-abused, physically/
display of sexual organs, and threats of forced sex.
psychologically abused, and psychologically abused) were
(c) Childhood psychological abuse was defined as above
compared with respect to age, BR scores of the scales by
(see “Methods”), but without variables regarding child
means of one-way analysis of variance (ANOVA). Post-hoc
custody and impeded decision making.
comparisons were carried out by Scheffé’s test.
Pearson’s chi-square tests were used to examine the
associations between the incidence of IPV (non-abuse,
physical/psychological abuse, and psychological abuse) and
The personality assessment tool was Millon Clinical
categorical variables represented by educational level, cohab-
Multiaxial Inventory-II (MCMI-II) normed and validated
itation with the partner, violence by the partner during the last
for the Spanish populations by TEA Ediciones (2000),
year and the proportion of women with BR scores above 84.
instead of MCMI-III, because this latter version was not
Within both abused groups, t-tests were performed to
available in Spain. The questionnaire was verbally read to
examine the difference between the BR scores of person-
the participants and their answers filled in by the inter-
ality scales of women who experienced (or not) sexual IPV.
viewer. The MCMI-II is a 175-item true/false self-report
Principal component factor analysis with varimax
inventory which objectively measures personality styles,
oblique rotation was performed to obtain the underlying
severe personality disorders (Axis II), and clinical syn-
structure of all measures (duration, frequency and use of
dromes (Axis I) as categorized in the DSM-III-R (American
coercive instruments in childhood and IPV). The criteria to
Psychiatric Association 1997; Millon 1987). Previous
determine the number of components were eigenvalues of
research has found that the sensitivity of the MCMI-II
greater than 1. The saturation for each item in every
subscales ranged from 59% to 79%, while the specificity
component was greater than 0.70. The components which
ranged from 91% to 99% (Choca and Van Denburg 1997).
emerged were used as predictor variables of MCMI-II
Raw scores are converted to Base Rate (BR) scores, a
personality scales scores. Hierarchical multiple regression
“transformed score which ensures that the proportion of
analyses were conducted to investigate the relationship
patients who score above each scale’s cut-off point matches
between IPV and childhood abuse variables and the
the actual prevalence among a representative national
personality scores. The analyses were conducted entering:
population of patients who possess each scale’s cor-
at Step 1 – childhood variables (physical, psychological and
J Fam Viol (2008) 23:577–588
sexual abuse); and at Step 2 – IPV (physical, psychological
73), and psychologically abused (n=53) by their intimate
and sexual IPV) variables. The level of significance for all
analyses was set at p<0.05.
The mean age of the women was 44.21 years old (SD=
11.43; range: 20 to 76). The sociodemographic profile of
the three groups of women (non-abused, physically/
psychologically abused, and psychologically abused) is
given in Table 1. There were no differences between groups
in age and number of children per woman. The mean
education level was primary school (range extending from
A total of 182 women completed the MCMI-II, but four of
illiterate to 5–6 years of university studies). There was no
them provided invalid responses to the test and were
association between educational level and IPV. However,
discarded from the following analysis. Therefore, 178
there was an association between the marital statuses,
women were considered and distributed into three groups:
particularly single, separated or divorced status, and the
non-abused (n=52), physically/psychologically abused (n=
IPV (Table 1).
Table 1 Sociodemographic profile, intimate partner violence (IPV) and childhood abuse variables of non-abused, physically/psychologically
abused, and psychologically abused women (%)
abused women (n=73)
Number of children per woman
χ2(12, N=178)=7.9; n.s.
Able to read and write
Incomplete primary school
University Studies: 3–4 years
University Studies: 5–6 years
Single not living with partner
Single living with partner
Cohabiting with the partner
during last year
Concomitance of sexual IPV
χ2 (2, N=178)=20.5;
IPV during last year
χ2(2, N=173)=4.2; n.s.
J Fam Viol (2008) 23:577–588
Violence Perpetrated by the Intimate Male Partner
aggressive (sadistic), passive aggressive/negativistic, self-
defeating (masochistic) personality scales, and also in the three
All women who were subjected to physical violence also
pathology personality scales (schizotypal, borderline, and
suffered from some form of psychological violence (physically/
paranoid). Psychologically abused women had higher scores
psychologically abused group). Further, 31.5% of them were
as compared to non-abused women in schizoid, avoidant, self-
also sexually abused. On the other hand, 17% of psycholog-
defeating (masochistic) personality scales and in the three
ically abused women had also been sexually abused by their
pathology personality scales (schizotypal, borderline, and
batterers (Table 1).
paranoid). However, there were no differences between the
Chi-square analyses revealed that there was an association
two groups of women victims of IPV in any of the MCMI-II
between IPV and the cohabitation with the partner during the
personality scales considered.
last year. The proportion of physically/psychologically and
Table 3 shows the percentages of physically/psychologically,
psychologically abused women cohabiting with the partner
psychologically and non-abused women in each range of
was lower than expected by chance [χ2(2, N=178)=7.0,
BR scores. A significant association between higher
scores in the personality scales and IPV was found. The
When the incidence of IPV referred to the 12 months
percentages of women scoring above 84 in personality
preceding the first interview (last year), it was found that
scales was higher than expected by chance in physically/
most women of the physically/psychologically abused
psychologically and psychologically abused women in the
group experienced violence by the batterer. In particular,
following personality scales: schizoid [χ2(2, N=178)=
89% experienced physical abuse, 97.3% psychological
13.49, p = 0.001], narcissistic [χ2(2, N=178)=6.79, p<
abuse, and 17.1% sexual abuse. Similarly, 88.2% of the
0.05], antisocial [χ2(2, N=178)=6.94, p<0.05], passive
psychologically abused women experienced continued
aggressive/negativistic [χ2(2, N =178) = 9.77, p< 0.01],
psychological abuse during the last year, 4% also being
schizotypal [χ2(2, N=178)=12.91, p<0.01], borderline
[χ2(2, N=178)=11.57, p<0.01], paranoid [χ2(2, N=178)=
No association was found between IPV (either physical
or psychological) and BR scores above 84 in the person-
There was a history of childhood abuse in all three groups.
ality scales: avoidant [χ2(2, N =178) = 4.03, p= 0.13],
As shown in Table 1, chi-square tests revealed that both
dependent [χ2(2, N=178)=3.78, p=0.15], histrionic [χ2(2,
physical and sexual childhood abuse were associated with
N=178)=1.19, p=0.55], aggressive (sadistic) [χ2(2, N=
IPV [physical: [χ2(2, N=178)=9.8, p<0.01; sexual: χ2(2,
178)=0.91, p=0.64], compulsive [χ2(2, N=178)=0.02, p=
N=178)=10.4, p<0.01], although this was not the case for
0.99], and self-defeating [χ2(2, N=178)=3.68, p<0.16]
psychological abuse [χ2(2, N=173)=4.2, n.s.]. The inci-
dence of physical and sexual childhood abuse was higher
than that expected by chance in the two abused groups but
Sexual Violence by the Intimate Male Partner
not in the non-abused group.
and Personality Scales
MCMI-II Personality Scales
The relationship between BR scores of personality scales
and sexual IPV is given in Table 4. In the group of
Means and Standard deviations of MCMI-II BR scores for the
physically/psychologically abused women, those who had
total sample are presented in Table 2. One-way analysis of
also been sexually abused had higher scores of schizoid (t=
variance (ANOVA) revealed that there were statistically
−2.06, p<0.05) and paranoid (t=−2.02, p<0.05) personality
significant differences between groups in BR scores of the
scales than women who had not experienced sexual abuse.
following MCMI-II personality scales: schizoid [F(2, 175)=
The presence or absence of sexual abuse did not influence
6.86, p=0.001], avoidant [F(2,175)=16.99, p<0.001], nar-
the scores of the other personality scales. Within the group
cissistic [F(2,175)=3.50, p<0.05], antisocial [F(2,175)=4.79,
of psychologically abused women, those who had also been
p=0.01], aggressive (sadistic) [F(2,175)=5.03, p<0.01],
sexually abused had higher scores only for compulsive
passive aggressive/negativistic [F(2,175)=5.03, p<0.01],
personality scale (t=−2.84, p=0.01) (Table 4).
self-defeating [F(2,175)=17.62, p<0.001], schizotypal [F
(2,175)=18.13, p<0.001], borderline [F(2,175)=20.01, p<
Contribution of IPV and Childhood Abuse to MCMI-II
0.001], and paranoid personality [F(2,175)=9.35, p<0.001].
Personality Scales Scores
In particular, Scheffè’s test showed that physically/
psychologically abused women had higher scores than non-
Hierarchical multiple regression analyses were carried out
abused women in schizoid, avoidant, narcissistic, antisocial,
to control for the contribution of the IPV and experiences of
J Fam Viol (2008) 23:577–588
Table 2 Means and standard deviations of base rate scores of MCMI-II’s personality scales of non-abused, physically/psychologically abused,
and psychologically abused women
abused women (n=73)
F(2, 175)=6.86, p=0.001
F(2,175)=2.16, p=0.12, ns
F(2,175)=2.18, p=0.12, ns
F(2,175)=1.17, p=0.31, ns
*p<0.05, Scheffé’s test; differs from non-abused group corresponding value
**p<0.01, Scheffé’s test; differs from non-abused group corresponding value
***p<0.001, Scheffé’s test, differs from non-abused group corresponding value
childhood abuse to the variance of the personality scale scores.
hood variables had been controlled for in the following
The analyses revealed childhood abuse variables as unique
personality scales: schizoid [F(3,119)=5.13; ΔR2=0.108, p<
predictors of histrionic [F(2,122)=4.35, ΔR2=0.07, p<0.05],
0.01] and antisocial [F(3,119)=2.75; ΔR2=0.061, p<0.05].
narcissistic [F(2,122)=4.32, ΔR2=0.07, p<0.05], and com-
IPV variables were predictor factors after childhood
pulsive [F(1,122)=3.31, ΔR2=0.05, p<0.05] scale scores.
variables had been controlled for in the following personality
On the other hand, the analyses revealed that childhood
scales: aggressive-sadistic [F(3,119)=3.61; ΔR2=0.081, p<
abuse variables had a significant predictive effect on the
0.05], passive-aggressive [F(3,119)=3.750; ΔR2=0.084, p<
schizoid [F(2,122)=3.81, ΔR2=0.059, p<0.05] and antiso-
0.05], self-defeating [F(3,119)=8.41; ΔR2=0.174, p<0.001],
cial [F(2,122) =4.24, ΔR2=0.065, p<0.05] scale score
schizotypal [F(3,119)=11.12; ΔR2=0.217, p<0.001], bor-
variance. The overall effect of IPV variables on the increase
derline [F(3,119)=10.21; ΔR2=0.203, p<0.001] and para-
in the scores remained highly significant even after child-
noid [F(3,119)=6.35; ΔR2=0.138, p<0.001]. The analyses
Table 3 Percentages (%) of MCMI-II personality scale BR scores in non-abused, physically/psychologically abused, and psychologically abused
Non abused women (n=52)
abused women (n=73)
J Fam Viol (2008) 23:577–588
Table 4 Means and standard deviations of base rate scores of personality scales from MCMI-II (Millon Clinical Multiaxial Inventory) for
physically/psychologically abused women and psychologically abused women with or without concomitance of sexual abuse
Psychologically Abused women
abused women (n=73)
showed that neither childhood abuse variables nor IPV
physical abuse, although the latter always involves psycho-
variables predicted the score in the dependent personality
logical violence too (Arias and Pape 2001; Kramer et al.
2004; O’Leary 1999; Pico-Alfonso et al. 2004, 2006;
Sutherland et al. 2002; Weaver and Etzel 2003).
Moreover, the physically/psychologically abused women,
who had also been sexually abused, had higher scores of
schizoid and paranoid personality scales. In other words,
The current study aimed at evaluating the personality disorder
concomitance of sexual violence is associated with higher
symptoms of women victims of IPV. As compared to non-
scores in these personality disorders; it is a relevant result
abused controls, both physically/psychologically and psycho-
that one third of physically/psychologically abused women
logically abused women had higher scores in schizoid,
were also victims of sexual violence by the partner. The
avoidant, self-defeating personality scales, as well as in the
psychologically abused women who had been sexually
three pathology personality scales (schizotypal, borderline,
abused had higher scores in the compulsive personality
and paranoid). In particular, physically/psychologically
scale. It is worth mentioning that sexually abused women
abused women had higher scores than non-abused women in
were underrepresented in our psychologically abused women
schizoid, avoidant, narcissistic, antisocial, aggressive,
group, which makes it rather difficult to explore associations
passive-aggressive (negativistic), self-defeating, schizotypal,
between sexual abuse and personality features. We are aware
borderline, and paranoid personality scales. On the other hand,
that due to the sample size the statistical power is low. This is
psychologically abused women differed from their non-
one limitation of our study which requires further research.
abused counterparts in schizoid, avoidant, self-defeating,
In the current study, physically/psychologically and
schizotypal, borderline, and paranoid personality scale scores.
psychologically abused women reported higher rates of
Generally speaking, these findings are in agreement with
childhood physical and sexual abuse experiences than
earlier results showing that battered women exhibit more
expected by chance. This evidence is in agreement with
personality disturbances as compared to non-abused women
other studies showing that women reporting childhood
(Danielson et al. 1998; Gleason 1993; Khan et al. 1993).
abuse had an increased risk of physical and psychological
The strength of this study lies in the assessment of the
IPV in adulthood (Coid et al. 2001; Chu and Dill 1990;
personality disorder symptoms in abused women, also
Desai et al. 2002; Gilbert et al. 1997; Mandoki and
including a group of “only” psychologically abused
Burkhart 1989; Stuart et al. 2006; Wind and Silvern
women. Interestingly, there were no differences in person-
1992). This association might be explained by suggesting
ality scale scores between the two groups. This result
that childhood abuse potentiates individual vulnerability
supports the view that psychological IPV alone can be
through feelings of low self-worth or powerlessness,
associated with psychological disturbances as much as
insecure attachment styles, or post-traumatic stress symp-
J Fam Viol (2008) 23:577–588
toms that decrease women’s emotional well-being in
were explained uniquely by childhood abuse variables. In
adulthood, either directly or through difficulty in protecting
particular, the relationship between borderline PD and
themselves or forming positive relationships (Bensley et al.
childhood abuse has received the majority of research
2003; Briere 1992).
attention. In the present study, childhood abuse was not
Indeed, experiences of childhood abuse are frequently
associated with borderline scale scores, but it was strongly
implicated in the development of personality disorders
predicted by IPV variables. The contribution of IPV to the
(Battle et al. 2004; Johnson et al. 1999). In order to control
borderline PD scale score is in agreement with previous
for these contributions, data about childhood abuse were
results by Shields et al. (1990), who found a positive
included in the analyses of the impact of IPV on MCMI-II
relationship between severity of IPV (including physical
personality scale score variance. However, after controlling
and/or sexual abuse) and severity of Borderline personality
for the effect of childhood abuse, the block of variables
disorder. On the other hand, our data are inconsistent with
related to IPV turned out to be the strongest predictor in
the results of Weaver and Clum (1996), who provided
most of the MCMI-II scales. This result is in agreement
evidence that borderline personality characteristics in
with studies showing a strong association between adult
battered women were associated with their experiences of
victimization (with or without IPV) and specific personality
childhood abuse, current physical and sexual abuse being
disorders (Haller and Miles 2003; Shields et al. 1990).
negligible predictors. Such inconsistency may be due to
These findings underline the importance of also assessing
differences in the type of mental health assessment tools
PD symptomatology when delineating the treatment of IPV
and sample differences (in their sample, women had been
either exposed to physical abuse or threatened).
Moreover, the amount of abusive relationships experi-
According to previous research (Khan et al. 1993;
enced seems to be positively associated with PDs (Coolidge
Rosewater 1988), the higher incidence of PD symptoms of
and Anderson 2002). Our study revealed that both types of
women victims of IPV could be due to a reactive state to the
abuse (childhood and IPV) contributed significantly to
chronic exposure to this violence. In fact, as suggested by
schizoid and antisocial personality scale score variances. In
Bremner (1999) some personality disturbances could be part
this sample, we found a strong association between IPV and
of the stress-related disorder spectrum. According to that
PD symptoms and between IPV and childhood abuse.
model, traumatic stress can alter structural and functional
Childhood experiences can predispose women to develop
aspects of the brain and lead to the development of a range
personality characteristics (Haller and Miles 2004) and, at
of psychiatric disorders that share in common a relationship
the same time, they can increase the likelihood of being
to stress. Undoubtedly, the exposure to chronic physical and/
engaged in abusive relationships when adults (Bensley et
or psychological violence by the partner is a stressful
al. 2003). This allows us to hypothesize that IPV might
condition for the women. The effects of stress increase
facilitate the emergence of specific psychopathological
liability to psychiatric illness in general, and over time may
personality traits. This is an exploratory study and the
produce the quasi-stable constellations of maladaptative traits
findings have to be taken cautiously. It has a relatively
and behaviours and pervasive dysfunctions that are typical of
small sample and the results are based on cross-sectional
PDs (Grilo and McGlashan 1999; Heru 2007). PDs are
data. Although we have observed specific associations, a
characterized by specific sets of individual assumptions
causality link cannot be established. The reliance on cross-
(Beck et al. 1990) and could be modulated by the chronic
sectional data hampers the possibility to discern whether
stressful experience of being under threat and/or a victim of
personality adaptations occurred in response to IPV or
repetitive violent acts. Future prospective research studies
whether diffuse character pathology predisposed women to
including larger samples are needed in order to provide more
experience violent relationships. A further limitation of this
empirical data which can shed light on the complex
study is that experiences of violence were assessed
interactions between different experiences of abuse and PDs.
retrospectively. Although it may be argued that psychiatric
In summary, these findings underscore the need to screen
symptoms may be associated with biased memory or
for PDs in women that have been exposed to IPV as some
reporting of early traumatic life events, there is little
abused women could be resistant to psychological treat-
evidence to suggest that PD women tend to overreport
ment because comorbid PDs complicate the clinical picture.
adverse events (Maughan and Rutter 1997).
This question should represent an important issue to be
We found that physical and psychological IPV have a
considered when dealing with therapeutic interventions.
strong association with PD symptomatology, even after
removal of the effects of experiences of childhood abuse.
Supported by the Institute of the Woman,
Ministry of Work and Social Affairs (ref: 53/98), FEDER and the
The results of the hierarchical regression analysis taking
Ministry of Science and Technology (Plan Nacional de Investigación
into account the intensity of childhood abuse suggest that
Científica, Desarrollo e Innovación Tecnológica; ref: BSO2001-3134),
only histrionic, narcissistic and compulsive scale scores
and the Conselleria D’Empresa, Universitat i Ciencia, Generalitat
J Fam Viol (2008) 23:577–588
Valenciana (GRUPOS2004/15) Spain. Special thanks are given to
Coid, J., Petruckevitch, A., Feder, G., Chung, W. S., Richardson, J., &
Miriam Phillips for the revision of the English style, and to Dr.
Moorey, S. (2001). Relation between childhood sexual and
Vicente Gonzalez-Roma for the statistical help. Thanks are also given
physical abuse and risk of revictimization in women: a cross-
to the Conselleria of Social Welfare and the 24 h Centers for Helping
sectional survey. Lancet, 358, 450–454.
Women of the Valencian Community of Spain for their assistance in
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