Stockholm syndrome

Stockholm syndrome refers to a group of psychological symptoms that occur in some persons in a captive or hostage situation. It has received considerable media publicity in recent years because it has been used to explain the behavior of such well-known kidnapping victims as Patty Hearst (1974) and Elizabeth Smart (2002). The term takes its name from a bank robbery in Stockholm, Sweden, in August 1973. The robber took four employees of the bank (three women and one man) into the vault with him and kept them hostage for 131 hours. After the employees were finally released, they appeared to have formed a paradoxical emotional bond with their captor; they told reporters that they saw the police as their enemy rather than the bank robber, and that they had positive feelings toward the criminal. The syndrome was first named by Nils Bejerot (1921–1988), a medical professor who specialized in addiction research and served as a psychiatric consultant to the Swedish police during the standoff at the bank. Stockholm syndrome is also known as Survival Identification Syndrome.

Stockholm syndrome is considered a complex reaction to a frightening situation, and experts do not agree completely on all of its characteristic features or on the factors that make some people more susceptible than others to developing it. One reason for the disagreement is that it would be unethical to test theories about the syndrome by experimenting on human beings. The data for understanding the syndrome are derived from actual hostage situations since 1973 that differ considerably from one another in terms of location, number of people involved, and time frame. Another source of disagreement concerns the extent to which the syndrome can be used to explain other historical phenomena or more commonplace types of abusive relationships. Many researchers believe that Stockholm syndrome helps to explain certain behaviors of survivors of World War II concentration camps; members of religious cults; battered wives; incest survivors; and physically or emotionally abused children as well as persons taken hostage by criminals or terrorists.

Most experts, however, agree that Stockholm syndrome has three central characteristics:

Stockholm syndrome does not affect all hostages (or persons in comparable situations); in fact, a Federal Bureau of Investigation (FBI) study of over 1200 hostage-taking incidents found that 92% of the hostages did not develop Stockholm syndrome. FBI researchers then interviewed flight attendants who had been taken hostage during airplane hijackings, and concluded that three factors are necessary for the syndrome to develop:

In addition, people who often feel helpless in other stressful life situations or are willing to do anything in order to survive seem to be more susceptible to developing Stockholm syndrome if they are taken hostage.

People with Stockholm syndrome report the same symptoms as those diagnosed with posttraumatic stress disorder (PTSD): insomnia, nightmares, general irritability, difficulty concentrating, being easily startled, feelings of unreality or confusion, inability to enjoy previously pleasurable experiences, increased distrust of others, and flashbacks.

Stockholm syndrome is a descriptive term for a pattern of coping with a traumatic situation rather than a diagnostic category. Most psychiatrists would use the diagnostic criteria for acute stress disorder or posttraumatic stress disorder when evaluating a person with Stockholm syndrome.

Treatment of Stockholm syndrome is the same as for PTSD, most commonly a combination of medications for short-term sleep disturbances and psychotherapy for the longer-term symptoms.

Coping — In psychology, a term that refers to a person's patterns of response to stress. Some patterns of coping may lower a person's risk of developing Stockholm syndrome in a hostage situation.

Flashback — The re-emergence of a traumatic memory as a vivid recollection of sounds, images, and sensations associated with the trauma. The person having the flashback typically feels as if they are reliving the event. Flashbacks were first described by doctors treating combat veterans of World War I (1914–1918).

Identification with an aggressor — In psychology, an unconscious process in which a person adopts the perspective or behavior patterns of a captor or abuser. Some researchers consider it a partial explanation of Stockholm syndrome.

Regression — In psychology, a return to earlier, usually childish or infantile, patterns of thought or behavior.

Syndrome — A set of symptoms that occur together.

The prognosis for recovery from Stockholm syndrome is generally good, but the length of treatment needed depends on several variables. These include the nature of the hostage situation; the length of time the crisis lasted, and the individual patient's general coping style and previous experience(s) of trauma.

Prevention of Stockholm syndrome at the level of the larger society includes further development of crisis intervention skills on the part of law enforcement as well as strategies to prevent kidnapping or hostage-taking incidents in the first place. Prevention at the individual level is difficult as of the early 2000s because researchers have not been able to identify all the factors that may place some persons at greater risk than others; in addition, they disagree on the specific psychological mechanisms involved in Stockholm syndrome. Some regard the syndrome as a form of regression (return to childish patterns of thought or action) while others explain it in terms of emotional paralysis ("frozen fright") or identification with the aggressor.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.

Graham, Dee L. R., with Edna I. Rawlings and Roberta K. Rigsby. Loving to Survive, Chapter 1, "Love Thine Enemy: Hostages and Classic Stockholm Syndrome." New York and London: New York University Press, 1994.

Herman, Judith, MD. Trauma and Recovery, 2nd ed., revised. New York: Basic Books, 1997. Chapter 4, "Captivity," is particularly helpful in understanding Stockholm syndrome.

Bejerot, Nils. "The Six-Day War in Stockholm." New Scientist 61 (1974): 486-487.

Fuselier, G. Dwayne, PhD. "Placing the Stockholm Syndrome in Perspective." FBI Law Enforcement Bulletin (July 1999): 23-26.

Grady, Denise. "Experts Look to Stockholm Syndrome on Why Girl Stayed." International Herald Tribune, 17 March 2003. A newspaper article about the Elizabeth Smart kidnapping case.

American Psychiatric Association. 1400 K Street, NW, Washington, DC 20005. www.psych.org.

Federal Bureau of Investigation (FBI). J. Edgar Hoover Building, 935 Pennsylvania Avenue, NW, Washington, DC 20535-0001. (202) 324-3000. http://www.fbi.gov.

Carver, Joseph M., PhD. Love and Stockholm Syndrome: The Mystery of Loving an Abuser. http://www.drjoecarver.com/stockholm.html.