See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/5819575 'Stockholm syndrome': Psychiatric diagnosis or urban myth? Article in Acta Psychiatrica Scandinavica · February 2008 DOI: 10.1111/j.1600-0447.2007.01112.x · Source: PubMed CITATIONS READS 71 29,030 6 authors, including: Nicola Tufton Elizabeth L Sampson Queen Mary, University of London University College London 40 PUBLICATIONS 283 CITATIONS 246 PUBLICATIONS 10,928 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: The MARQUE project View project The CoMPASs:IOn Programme (Care Of Memory Problems in Advanced Stages: Improving Our kNowledge) Developing an intervention to improve end of life care in advanced dementia. View project All content following this page was uploaded by Elizabeth L Sampson on 19 January 2018. The user has requested enhancement of the downloaded file. Acta Psychiatr Scand 2007: 1–8 Copyright Ó 2007 The Authors All rights reserved DOI: 10.1111/j.1600-0447.2007.01112.x ACTA PSYCHIATRICA SCANDINAVICA Review ÔStockholm syndromeÕ: psychiatric diagnosis or urban myth? Namnyak M, Tufton N, Szekely R, Toal M, Worboys S, Sampson EL. M. Namnyak, N. Tufton, R. Szekely, ÔStockholm syndromeÕ: psychiatric diagnosis or urban myth? M. Toal, S. Worboys, E. L. Sampson Objective: ÔStockholm syndromeÕ is a term used to describe the positive Department of Psychiatry and Behavioural Sciences, bond some kidnap victims develop with their captor. High-profile cases Hampstead Campus, Royal Free and University College are reported by the media although the diagnosis is not described in Medical School, London, UK any international classification system. Here we review the evidence base on ÔStockholm syndromeÕ. Method: Databases (PubMED, EMBASE, PsycINFO, CINAHL) were systematically searched. We compared features of cases widely reported in the English language media to identify common themes which may form a recognizable syndrome. Key words: ÔStockholm syndromeÕ; review, systematic; Results: We identified 12 papers that met inclusion criteria. The hostage; mass media existing literature consists mostly of case reports; furthermore there is Elizabeth L Sampson, Department of Psychiatry and ambiguity in the use of the term. No validated diagnostic criteria have Behavioural Sciences, Hampstead Campus, Royal Free been described. Four common features were found between the five and University College Medical School, Rowland Hill cases studied. Street, London, NW3 2PF, UK. Conclusion: There is little published academic research on ÔStockholm E-mail: [email protected] syndromeÕ although study of media reports reveals similarities between well publicized cases. This may be due to reporting and publication bias. Accepted for publication September 21, 2007 Summations • ÔStockholm syndromeÕ is commonly used by media sources as a term to describe the positive bond a kidnap victim develops towards their captor. • No validated diagnostic criteria for ÔStockholm syndromeÕ have been described; existing literature is of limited research value and does little to support ÔStockholm syndromeÕ as a psychiatric diagnosis. • Analysis of cases widely reported in the media reveals four common features in victims of ÔStockholm syndromeÕ; each victim experienced direct threats, they were kept in isolation, had an opportunity to ÔescapeÕ during their period of captivity but failed to use it and showed sympathy with their captors postcaptivity. This suggests an identifiable pattern of experience and behaviour may exist amongst victims described by the media. Considerations • ÔStockholm syndromeÕ is not a recognized Medical Subject Heading (MeSH). • Sources of information for widely publicized cases were of varying reliability in terms of the events that lead to the diagnosis of ÔStockholm syndromeÕ; the authors had no access to primary sources. • Identification of a pattern of features exhibited in ÔStockholm syndromeÕ may be due to reporting bias. emotional bond a kidnap victim may develop Introduction towards their captor. It is speculated that this bond The term ÔStockholm syndromeÕ, eponymously develops as part of the victimÕs defence mechanism named after a failed bank robbery in Stockholm, to allow them to sympathize with their captor, Sweden, has been used to describe the positive leading to an acceptance of the situation, limiting 1 Namnyak et al. defiance ⁄ aggression toward the captor and thus and describe any existing diagnostic criteria. We maintaining survival in an otherwise potentially will compare and contrast the features of high- high-risk scenario (1). The terms Ôterror bondingÕ profile cases of victims of ÔStockholm syndromeÕ to and Ôtraumatic bondingÕ have been used as syn- identify common features between each case. We onyms to ÔStockholm syndromeÕ (2). will evaluate the current evidence regarding ÔStock- On the morning of Thursday 23 August 1973, a holm syndromeÕ; is it a valid psychiatric construct, 32-year-old prison-escapee, Janne Olsson, armed or merely a convenient label adopted by the media with a submachine gun, walked into the Sveriges for high-profile cases? Kreditbanken in Norrmalmstorg Square, Stock- holm, Sweden. He fired several rounds from his weapon, injuring one police officer. He then took Material and methods four bank clerks hostage. OlssonÕs first demand Systematic review was that his prison-mate, 26-year-old Clark Olo- fsson, should be released from prison and allowed We developed a broad search strategy as we were to join him; the Swedish government agreed to the aware that little work in this field had been demand. Olofsson joined Olsson and the pair published and we wished to include as many proceeded to barricade themselves and their four papers as possible for final review. An initial hostages into the bankÕs 3.3 · 14.3 m vault (3). search strategy was developed for the PubMED The ensuing chain of events would lead to what is database by searching the text term ÔStockholm now known as ÔStockholm syndromeÕ. The four syndromeÕ (it is of note that it has not been hostages appeared to bond with the captors: they allocated a MeSH). We searched for ÔStockholm seemingly did not want to be rescued by the police. syndromeÕ and then searched for the following text One is quoted as saying ÔThis is our world now … terms: Ôterror bondÕ, Ôtraumatic bondÕ, Ôkidnap sleeping in this vault to survive. Whoever threatens victimÕÔhostageÕ (MeSH term) and the names of this world is our enemyÕ (4). high-profile kidnap victims. The name ÔNils Bej- To date, there have been few studies on the erotÕ was also searched as he was the psychiatrist frequency of ÔStockholm syndromeÕ amongst involved in hostage negotiations at the original kidnap victims or its long-term effects on their Stockholm bank robbery and coined the phrase mental health. Furthermore, although different ÔStockholm syndromeÕ. All search terms were then ratings scales exist for identifying ÔStockholm combined with ÔStockholm syndromeÕ using the syndromeÕ in women who have experienced domes- ÔANDÕ Boolean and were translated and repeated in tic abuse (2) and in soldiers involved in combat a range of databases. Those searched up until 31 (where it is described as Ôacute operational stressÕ) January 2007 were EMBASE (Excerpta Medica (5), ÔStockholm syndromeÕ is not included in any Database 1980+), PsycINFO (1876+), CINAHL international classification system of psychiatry. In (Cumulative Index to Nursing and Allied Health ICD-10 the category ÔAcute stress reactionÕ 1982+), PubMED, SIGLE, Googleä Scholar, ISI (F43.0), includes Ôtransient disorders triggered by Web of Knowledge and The Cochrane Library. exceptionally stressful life eventsÕ, is probably the Reference lists in retrieved papers and reviews of most relevant (6). the subject were hand searched. Criteria have been proposed to describe ÔStock- Papers were selected using the following criteria: holm syndromeÕ; the most widely quoted are articles had to include the term ÔStockholm syn- GrahamÕs (1995) criteria based on a study of nine dromeÕ and be published in the English or Swedish different victimized groups (2) Graham postulates language. If there was disagreement as to the four precursors to the development of ÔStockholm inclusion of a publication, the paper was reviewed syndromeÕ: i) that there exists a perceived threat to by an independent reviewer (ELS). All findings survival and belief that the threat will be carried were tabulated (Table 1). out, ii) that the captiveÕs perceive some small kindness from the captor in the context of terror, Analysis of cases reported by the media iii) that the hostage experiences isolation from perspectives other than those of the captor and iv) These cases were identified using common internet that the hostage has a perceived inability to escape. search engines (i.e. Googleä) and media databases including LIBRIS (the National Library of Swe- denÕs online bibliographic service) using the search Aims of the study term ÔStockholm syndromeÕ. A detailed narrative To systematically review the existing published on each case was prepared by individual authors literature on ÔStockholm syndromeÕ and identify using British and USA media archives (Times 2 Stockholm syndrome Table 1. Summary of published literature on ÔStockholm syndromeÕ Author Methodology No. of subjects Main findings Favaro et al. (1) Retrospective, semi-structured 24 ÔStockholm syndromeÕ is an indicator of severity of the experience, interview