Australian and New Zealand Journal of

Psychiatry
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Traumatic Entrapment, Appeasement and Complex Post-Traumatic Stress Disorder: Evolutionary

Perspectives of Hostage Reactions, Domestic Abuse and the Stockholm Syndrome
Chris Cantor and John Price
Aust N Z J Psychiatry 2007 41: 377
DOI: 10.1080/00048670701261178

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 Traumatic entrapment, appeasement and complex
post-traumatic stress disorder: evolutionary
perspectives of hostage reactions, domestic abuse
and the Stockholm syndrome

Chris Cantor, John Price

Evolutionary theory and cross-species comparisons are explored to shed new insights into
behavioural responses to traumatic entrapment, examining their relationships to the
Stockholm syndrome (a specific response to traumatic entrapment) and complex post-
traumatic stress disorder (PTSD). A selective literature review is undertaken examining
responses to traumatic entrapment (including hostage, domestic abuse and similar
situations) and the Stockholm syndrome, before examining mammalian, reptilian and
other defensive responses to relevant threats. Chimpanzees, the closest relatives of
humans, are closely examined from this perspective and commonalities in behavioural
responses are highlighted. The neurobiological basis of defensive behaviours underlying
PTSD is explored with reference to the triune brain model. Victims of protracted traumatic
entrapment under certain circumstances may display the Stockholm syndrome, which
involves paradoxically positive relationships with their oppressors that may persist beyond
release. Similar responses are observed in many mammalian species, especially primates.
Ethological concepts including dominance hierarchies, reverted escape, de-escalation and
conditional reconciliation appear relevant and are illustrated. These phenomena are
commonly encountered in victims of severe abuse and understanding these concepts
may assist clinical management. Appeasement is the mammalian defence most relevant to
the survival challenge presented by traumatic entrapment and appears to be the foundation
of complex PTSD. Evolutionary perspectives have considerable potential to bridge and
integrate neurobiology and the social sciences with respect to traumatic stress responses.
Key words: abuse, appeasement, complex PTSD, hostage, Stockholm.

Australian and New Zealand Journal of Psychiatry 2007; 41:377 384

Paradoxes initially appear absurd and conflict with dren and adults to their domestic abusers. These
conventional wisdom. Two of the greatest paradoxes victims may not only comply with their abusers but
in mental health are the Stockholm syndrome and the idealize them, even beyond the point of release.
cooperative behaviours often shown by abused chil- A number of authors have noted both Stockholm
and post-traumatic stress disorder (PTSD) character-
istics in victims of domestic abuse [1]. Judith Her-
Chris Cantor, Senior Lecturer (Correspondence) man’s landmark paper noted that ‘. . . prolonged,
Department of Psychiatry, University of Queensland, PO Box 1216, repeated trauma can occur only where the victim is
Noosa Heads, Qld 4567, Australia. Email: cantor98@powerup.com.au
in a state of captivity, unable to flee, and under the
John Price, Consultant Psychiatrist
control of the perpetrator’. She described the result as
South Downs Health NHS Trust, Brighton, United Kingdom.
‘complex PTSD’ [2].
Received 5 January 2007; accepted 7 January 2007.

# 2007 The Royal Australian and New Zealand College of Psychiatrists

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378 COMPLEX PTSD AND APPEASEMENT

Compared with ordinary PTSD, complex PTSD adding to the unpredictability of the experience [9]

involves more complex, diffuse and tenacious symp- unpredictability being a potent inducer of anxiety in
toms, characteristic personality changes, and vulner- mammals generally [10].
ability to repeated harm, both self-inflicted and by The civilian case of Patty Hearst is illustrative. In
the hands of others. The DSM-IV PTSD Field Trial 1974 Patty Hearst was kidnapped from her wealthy
referred to complex PTSD as ‘disorders of extreme American family by the Symbionese Liberation Army
stress not otherwise specified’ (DESNOS), its compo- (SLA), who kept her blindfolded in two small closets,
nents being alterations in regulating affective arousal subjecting her to sensory deprivation, repeated rape
(e.g. anger, self-destructive and sexual behaviours), and threats of death [11]. In 2 months she was
alterations in attention and consciousness (e.g. dis- allowed out of the closet for two baths and on ‘lucky’
sociation), somatization, characterological changes days the door to her closet was left open for fresh air,
(e.g. chronic guilt and shame, idealization of the when she would hear her captors voicing propa-
abuser, difficulties with trust and a tendency ganda. After 2 months she was too weak to flee from
to revictimization) and alterations in systems of her heavily armed captors. Finally, before she
meaning [3]. appeared to capitulate, she was offered a choice:
This paper has two aims: first, to propose an she could go free or join the SLA. She knew from
evolutionary theory of complex PTSD specific to former interrogations that requesting the former
those trapped in traumatic subordinate relationships; meant she would be killed, so she requested to join
and second, to illustrate the relevance of evolutionary the SLA to live, at least for the present. She was then
theory and cross-species comparisons generally to told that joining was contingent on her persuading
PTSD research. Traumatic entrapment includes each group member of her worthiness for acceptance
sieges (military and civilian), concentration camps, into the group. Having earned acceptance she was
wartime prisons, torture, kidnapping, abusive cults forced to participate in lawbreaking, including her
and domestic abuse. Readers must judge, but a infamous bank robbery for which she was convicted
measure of success would be if the paradox at the (and many years later pardoned). She is said to have
start has disappeared by the end of the paper. developed PTSD [12].
We proceed by setting the scene of traumatic
entrapment and the Stockholm syndrome, explaining
their relevance to complex PTSD, illustrating related
defensive phenomena in other species, before discuss- Stockholm syndrome
ing a neuroscientific model especially relevant to
PTSD research and clinical practice. The Stockholm syndrome refers to the paradoxical
development of reciprocal positive feelings between
hostages and their captors, which may enhance
Traumatic entrapment captives’ coping with traumatic experiences [13].
The Stockholm syndrome originally referred to a
Recent global conflicts have increased the need to 1973 bank robbery in Stockholm, in which four
understand hostage experiences. Hostage captor re- hostages were held captive for several days [14].
lationships involve massive power imbalances. Tor- Following release the hostages displayed paradoxi-
ture may be involved and is associated with high rates cally positive feelings towards their captors, and to
of PTSD [4], particularly if victims are caught a lesser extent the captors to their hostages. The
unprepared [5] and if torture involves sexual assault hostages defended their captors, condemning
[6]. Domestic abuse often shares this oppressive the police, their rescuers. One female hostage subse-
relationship orientation. quently developed an intimate relationship with one
In prolonged captivity sensory deprivation is of her captors, illustrating the depth of the bonds.
usually induced through blindfolding and isolation. In another incident, criminals discovered an under-
Unhygienic conditions, physical abuse, threats of cover police agent in their midst. The leader of the
impending death, powerlessness, dehumanization, criminals left instructions that the agent be killed, if
general humiliation and the need to avoid incurring he (the leader) did not phone in to confirm his
the further wrath of captors are also characteristic [7]. successful escape. The phone call followed, the agent
Captors cultivate hostile environments involving total lived, and subsequently resisted testifying against the
domination to massively disempower their victims leader for several years, feeling that the leader had
[8]. Threats may be vague and incomprehensible, saved his life [15].

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 C. CANTOR, J. PRICE 379

In the 2002 Chechen led siege involving more than as dominant and the more they perceived them as
800 hostages in a Moscow theatre, 130 hostages died friendly, the better was the hostage adjustment.
when Russian Special Forces stormed the theatre. Both the Stockholm syndrome and complex PTSD
Subsequent interviews of a sample of 11 hostages share the central characteristic of a seemingly
found that 10 displayed Stockholm characteristics paradoxical idealization of the abuser. It is this
[16]. phenomenon on that we will now focus on from an
The development of the Stockholm syndrome in evolutionary perspective.
hostages is considered protective, with the paradox-
ical bonds opposing the captors’ inclinations to kill
their hostages. The longer the siege, the more likely it
is that the syndrome will develop [15]. However, in Appeasement: a mammalian defence
prolonged sieges police may be unable to trust
hostages who become unreliable witnesses [17]. Anxiety and fear have been essential to survival.
Four conditions form the basis for the formation of Further, anxiety disorder subtypes are associated
the Stockholm syndrome: (i) perceived threat to one’s with symptoms that make sense from a survival
physical or psychological survival at the hands of an perspective [20,21]. Fear of heights is associated
abuser(s); (ii) perceived small kindnesses from the with freezing, making one less liable to falling. Blood
abuser to the victim; (iii) isolation from perspectives phobias are associated with fainting, which helps
other than those of the abuser; and (iv) the inescap- restore blood pressure in bleeding individuals. Bracha
ability of the situation [18]. et al. have recently proposed detailed and specific
In Sardinia (Italy) kidnapping is common and was evolutionary origins for anxiety subtypes, including
associated with a 21% mortality rate for the period PTSD [22,23]. Nesse has also emphasized the adap-
1960
1980 [19]. PTSD was found in as many as tiveness of physiological defences including pain and
fever [24].
45.9% of former captives, similar to that associated
Cantor proposed a comprehensive theory of PTSD
with concentration camps and torture. Humiliating
suggesting that it is a disorder of mammalian
and deprivation experiences predicted the develop-
defences complemented by vigilance and risk assess-
ment of the Stockholm syndrome, but not PTSD,
ment, operating on high alert over extended periods
suggesting that the Stockholm syndrome has impor-
[25]. The theory emphasizes that most of Homo
tant differences from PTSD.
sapiens’ genes involved in defence evolved millions
Suggested explanations for the Stockholm syn-
of years prior to the advent of the first hominid
drome have included identification with the aggressor
(upright great ape) 5 million years ago. Homo sapiens
and introjection of the valued attributes of the captor arrived as recently as approximately 150 000 years
[9]. Victims may regress, identifying with their captors ago. Fundamental survival behaviours such as
as a child might with an abusive parent [15]. breathing, eating, drinking and those involved in
Cognitive dissonance is also involved [18]. The victim reproduction are highly conserved throughout the
reduces emotional discomfort arising from contra- animal world. They did their jobs effectively and their
dictory cognitions by bending those cognitions to functions were so central to survival that major
accommodate the situation
the ‘‘all husbands beat mutations affecting these functions would have
their wives’’ perspective. As is wont in cognitive tended to be fatal. Another fundamental survival
psychology this may be causal or largely an echo of behaviour (collectively) is defence.
inner experiences. Brainwashing has been suggested The DSM-IV PTSD criteria include re-experiencing
as another explanation. This usually involves captives phenomena, which Cantor suggests represent exag-
being repeatedly debased and threatened with death gerated recall of threats: an inability to forget [25].
or other grave consequences, if they do not confess Heightened memory would be a prerequisite for
their inferior and shameful status. Termination of this learning a more defensive strategy [26]. Avoidance
torture requires compliance with the oppressors. behaviours are clearly defensive even though the
The Stockholm syndrome has been experimentally DSM-IV grouping confuses true avoidance, with-
tested from the perspective of interpersonal theory drawal (flight) and numbing phenomena. Similarly,
using simulated captivity [13]. This involved two DSM-IV overarousal symptoms represent hypervigi-
central interpersonal dimensions: control (dom- lance phenomena plus aggressive defence (irritability/
inance
submission) and affiliation (friendliness
hos- anger). Hypervigilance in mental health tends to be
tility). The less the ‘hostages’ perceived the ‘terrorists’ interpreted in its physiological sense, but in zoologi-

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380 COMPLEX PTSD AND APPEASEMENT

cal ecology it relates more to heightened scanning for ‘post conflict anxiety’ in chimpanzees (measured by
sources of threat. self-directed behaviour such as scratching) [31]. After
Diseases can be properly conceptualized only if a fight both contestants show anxiety, especially
their associated normal functions are understood [27]. the loser, and this anxiety is assuaged by affiliative
Psychiatry has neglected the study of mammalian behaviour (e.g. hugging and kissing) between the
defences, commonly grossly oversimplifying them as former combatants. If defeated animals turned to
‘fight or flight’ [25,28]. There are six major mamma- other group members for comfort, victors might
lian groups of defensive behaviours, all of which are interpret this as enlisting agonistic support for come-
found in exaggerated states in PTSD [25]. A logical backs.
sequence for approaching defences recognizes the The dominant having accepted the subordinate
needs for energy conservation and minimization back, may later repeat threatening behaviour causing
of injuries. Accordingly, the first defence is avoidance further arousal and reverted escape, reinforcing the
of threats, followed in approximate order of physical dominant/subordinate orientation and bonds. Male
proximity and risk by attentive immobility (freezing baboons herd their female baboons by neck bites,
as a prelude to more definitive action), withdrawal resulting in reverted escape by the female baboons
(including ‘flight’), aggressive defence (including and strengthening of bonds [32]. Social structures are
‘fight’), appeasement and tonic immobility. The latter more stable if there is acceptance of the hierarchy.
is a physiologically different form of freezing to Further, conflict or extrusion from the group carry
attentive immobility. It is the final defence typically costs to both the subordinate individual and the
used when a predator is about to eat its prey. Victims group because the group loses whatever potential
by freezing may yet deter predators by confusing resources the individual may bring [33]. The latter is
them, inhibiting attack reflexes and simulating dead the reason for taking hostages.
and possibly contaminated meat. Different mammals manifest different appeasement
Traumatic entrapment situations are well beyond behaviours. Many reduce their apparent size, signal-
the avoidance stage; withdrawal may be desired but is ling ‘no threat’. Humans cower, bow, kneel, prostrate
impossible; aggressive defence is not viable because of themselves, and doff their hats. Dogs may submit by
much lesser status and the situation is not yet way of infantile mimicry, rolling on their backs like
terminal (tonic immobility). This leaves appeasement puppies. Human appeasement may be expressed with
as potentially more relevant. the metaphor of sickness, conveying the message,
Appeasement comprises pacification, conciliation ‘I am a weak sick person’ [34]. Somatic PTSD
and submission. It is primarily a defence strategy symptoms may reflect this. Many primates use sexual
relevant only to conspecifics (one’s own species) and strategies. Submitting adult male primates may offer
mostly social species. It is generally an irrelevant their genital regions to the dominant, conveying the
response to predators, in contrast to all the other message, ‘‘I am like a weak female’’. Dominants may
mammalian defences in which predation threat has respond by emphasizing their rank by token mount-
figured prominently in their evolution [25]. If trapped ing actions [34]. In humans this expression of
subordinate individuals under serious threats from dominance is recognized in violent closed subcultures
dominants attempted to use withdrawal or aggressive such as prisons and sometimes the armed forces.
defence they would escalate the risks. Appeasement Newcomers may be sodomized as a means of
serves a de-escalating function [25,29]. Subordinates promoting submission and acceptance of their sub-
using appeasement suspend efforts to win the con- ordinate status. Similar dominance behaviours have
tests, but thereby decrease the costs of losing. been documented in the recent Iraq conflict. They are
Studies of contemporary primates provide clues as understandable from a mammalian perspective, but
to how affiliative tendencies may have become incompatible with civilized standards.
associated with coercive control situations in our Hunter
gatherer women have been remarkably
hominid ancestors. Ethopharmacologist Michael frequently kidnapped by opposing tribes, with little
Chance noted that, after being attacked, monkeys likelihood of rescue. From an evolutionary perspec-
and apes tend to turn to the attacker for comfort and tive defiance in such circumstances carries the
safety [30]. He called this ‘reverted escape’, because prospect of death and the non-transmission of related
after fleeing from the attack the attacked animal genes. Submission and defection may promote
returns, or reverts, to the attacker rather than turning genetic survival. This has been described as ‘cap-
to another member of the group for succour. This ture-bonding’ [35]. Thus the transmission of genes for
observation has been confirmed by recent work on appeasement may have been facilitated.

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 C. CANTOR, J. PRICE 381

Appeasement followed by conditional sures have driven the evolution of these hierarchical
reconciliation in chimpanzees aggressive and affiliative intra-group behaviours.

The relationship between torturers, other oppres-

sors and their entrapped victims can be illustrated by
observations of chimpanzees, the closest relative of From chimpanzees to human entrapment
H. sapiens . While female chimpanzees tend to change
groups at puberty, male chimpanzees remain for life If the common ancestor of humans and chimpan-
in the same small groups (usually under 10 indivi- zees had a similar social structure to present-day
duals), living in clear dominance hierarchies. Peace is chimpanzees, we can see how the infliction of punish-
interspersed with occasional aggressive challenges ment onto defenceless human victims is compatible
by subordinates for dominance. Dominant male with the development of affiliative relationships.
chimpanzees are strongly motivated to protect Nevertheless, these chimpanzee appeasement beha-
the resources associated with dominance and may viours contrast with usual contemporary human
engage in savage retaliation, for example tearing off experiences whereby oppressed individuals can seek
the challenger’s testicles [36]. Escape is not an option solace from others within a larger, multigenerational,
for the vanquished subordinate because the natal dual-sex group, or from beyond the group. However,
group is the only one that will accept a male in the closed environment of a hostage situation the
chimpanzee. hostage may have only dominant oppressors to turn
Defeated chimpanzees seek comfort from the to (reverted escape). Being seen to seek comfort from
winner because of the importance of agonistic other hostages may be perilous and interpreted as
(aggression-driven) alliances [37]. In such small closed insubordination. In the closed environment of a
groups if the loser sought safety and comfort from psychiatric ward we might refer to such comfort
seeking as ‘splitting’.
other individuals this could be misinterpreted as
Appeasement is also activated in situations of
seeking help for a further challenge and result in the
domestic abuse. Leaving the family group is not to
renewal of punishment; therefore the only permissible
be undertaken lightly. The abused child or partner,
source of comfort is the chimpanzee that has just
like the hostage, may be forced by circumstance to
defeated the subordinate, and who therefore com-
accept their subordinate status and their oppressive
bines the roles of both the punisher and source of
abusers. The battered wife may undergo conditional
safety. Reverted escape is followed by ‘conditional
reconciliation with her dominant partner, perhaps by
reconciliation’, hugging and kissing each other, with
a tearful childlike flirtatious display of inferiority (a
reconciliation conditional on subordinates accepting behaviour remarkably similar to that observed in
their lesser rank [32]. A period of ‘post-conflict chimpanzees). Furthermore, she had best not be seen
anxiety’, more marked in the losing chimpanzee, turning to her friends for comfort. Herman [2] noted,
may be indicated by self-directed scratching [31]. ‘To the chronically traumatized person, any indepen-
Similarly, humans may bite their nails. Depression dent action is insubordination, which carries the risk
complements anxiety in post-conflict reconciliation. of dire punishment’.
Anxiety motivates safety and comfort seeking [38], As observed in primates, sexual offerings may be
whereas depression demotivates the loser from used to appease the oppressive dominant individual.
regaining his former rank, fulfilling a longer-term Adult stalking victims may at times consent to sexual
de-escalating function. It induces an ‘involuntary intercourse with their stalkers in desperate attempts
subordinate self-perception’ (analogous to low to appease them
another manifestation of reverted
self-esteem), reconciling the losing animal to its escape. Submitting humans may use diverse beha-
subordinate status [34,39]. vioural strategies including shrinkage in size, infantile
To reproduce, the male chimpanzee confined to his and sexual behaviours as suits the situation [34]. Self-
group has to achieve a certain rank in the hierarchy, destructive behaviour may represent a metaphor for
by forging alliances with both subordinates and lowering of one’s status.
dominants and intimidating those ranking below Appeasement is associated with the emotions fear
him [37]. In this highly social species the restoration and shame [41]. Fear motivates defence; shame
of cooperation following conflict is important for facially and otherwise signals ‘no threat’. Shame is
group cohesion and defence against predators and an emotion that is so uncomfortable that dissociation
out-group conspecifics [40]. Strong selection pres- is often involved in the context of PTSD [42]. Shame

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382 COMPLEX PTSD AND APPEASEMENT

is experienced in rape victims who blame themselves complex PTSD. Appeasement may be associated with
for their humiliation. changes in the chemistry and anatomy of the brain.
Such work is currently being carried out on cyno-
molgus monkeys [50], tree shrews [51], rats [52], mice
Neurobiology, evolutionary psychology and the [53] and cichlid fish [54].
social sciences Appeasement may operate at any of the triune
brain levels. In its most primitive form appeasement
Evolutionary psychology has great potential to is an all-or-nothing response, as seen in some
bridge the gulf between the biological and social contemporary reptiles, in which appeasement takes
sciences. Neurophysiology can be related to social the form of total body colour change. An adult male
function [43]. The early study of PTSD was heavily Anolis carolinensis may lose its bright colouring,
socially orientated but currently is facing an unpre- reverting to the muddy brown of immature animals,
cedented neurobiological swing. The following but if a dominant
subordinate pair is broken up then
section demonstrates how these sciences can be the subordinate’s colour often becomes lighter again
simultaneously understood, with new insights. Un- [55]. Sometimes the colour change is irreversible,
derstanding PTSD symptoms from this perspective becoming progressively darker and the lizards die,
may aid both research and therapy because it suggests reflecting pathological processes associated with sta-
answers to questions of why and how. tus change. Interestingly this colour-changing animal
Paul MacLean, the developer of the well-known cannot appease one rival while dominating another.
limbic system concept [44], also developed the con- This all-or-nothing characteristic of reptilian
cept of the ‘triune brain’ [45], which assists under- appeasement is one reason we allocate to the reptilian
standing the ‘sociophysiology’ of defence and PTSD level of the forebrain the strategy selection between
[43]. The triune brain suggests both anatomically and elevation and depression of mood, both of which
functionally that brain structures evolved in three have pervasive effects on behaviour. Complex PTSD
major eras: the reptilian era (originating approxi- entails more depressive elements than simple PTSD,
mately 300 million years ago), the early mammalian consistent with our emphasis on appeasement.
era (from 200 million years ago) and the new The middle, or palaeomammalian level, of the
mammalian era (from 65 million years ago) [45,46]. triune brain involves the limbic system and emotional
Some features of PTSD are purely involuntary, for reactions. The subordinate rodent, canid or primate
example the startle reflex, hence are likely to be feels fear and a sense of being chastened by
activated by older brain structures and have been the dominant. Depressed emotion is context depen-
located as emanating from the brainstem [47]. dent, unlike the pervasiveness of depressed mood,
MacLean’s theory has been criticized, but only in reflecting the fact that in mammalian hierarchies
matters of detail [48]. The main point is that there are most animals operate in the middle and, while being
at least three ‘central processing assemblies’ arranged chastened from above, may be aggressive to those
rostrally/caudally in the forebrain, and that each lower in rank. They express anxiety looking up but
assembly makes decisions relatively independently in irritability looking down the hierarchy. Also, because
dealing with the environment. This contrasts with the sanctions may be applied by the group as well as by
idea of a gradual and homogeneous accretion of individuals, they feel shame when not reaching the
brain volume during evolution. The triune concept group’s standards. Human blushing forms part of
reflects the difficulty that sophisticated humans this primitive appeasement display.
experience in reconciling discordant emotions with At the neomammalian level we have the rational,
logical cognitive appraisals. With fundamental survi- voluntary, conscious adoption of appeasement, which
val behaviours, the neomammalian forebrain has may require considerable social skill, as in a flowery
relatively little control over the reptilian and palaeo- speech of submission. Moreover, appeasement at this
mammalian levels. level may be either genuine or simulated, in which the
Panksepp emphasized the desirability of examining individual appears appeasing but lacks submissive
psychiatric disorders from the bottom-up by way of feelings and may be planning a comeback or rebellion
‘endophenotypes’, primal brain functions that can be (a possibility which Milton, an expert in appeasement
linked to neural circuits and the underlying genetic or the lack of it, has Satan consider, and reject, in the
controls [49], similar to the ‘psychobiological re- first book of Paradise lost ). Patty Hearst described
sponse patterns’ of Gilbert [39]. We propose that during her captivity being orientated to doing what-
appeasement is the most likely endophenotype for ever was needed to survive, but found herself also led

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 C. CANTOR, J. PRICE 383

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