Stockholm syndrome - Part 2 - Diagnosis and management

Causes & symptoms

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:

• The crisis situation lasts for several days or longer.
• The hostage takers remain in contact with the hostages; that is, the hostages are not placed in a separate room.
• The hostage takers show some kindness toward the hostages or at least refrain from harming them. Hostages abused by captors typically feel anger toward them and do not usually develop the syndrome.

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.

Diagnosis

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 foracute stress disorder or posttraumatic stress disorder when evaluating a person with Stockholm syndrome.

Treatment

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.

Prognosis

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

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.