Andrew J. Hewitt, PMHNP-BC
Caliper Wellness — Pasco County, Florida
Author note. Correspondence concerning this article should be addressed to Andrew J. Hewitt, PMHNP-BC, Caliper Wellness, Pasco County, FL. This blog is informational and not a substitute for individualized medical or mental-health care. If you are in danger, call 911. If you are experiencing intimate partner violence, contact The National Domestic Violence Hotline (1-800-799-SAFE) or StrongHearts Native Helpline (1-844-7NATIVE).
Abstract
“Stockholm syndrome” is a popular label for the paradoxical attachment victims may display toward an abuser or captor. Fairy-tale retellings like Rapunzel are often invoked to explain it—“she’s bonded to the tower and the woman who trapped her.” But in 2024–2025 scholarship and clinical guidance, the term remains descriptive, controversial, and not a formal diagnosis, with many experts urging clinicians to focus instead on coercive control, traumatic bonding, and survival-oriented adaptations. This blog (a) clarifies what “Stockholm syndrome” is and is not, (b) reframes the Rapunzel narrative using contemporary concepts like coercive control and identification with the aggressor, (c) summarizes recent evidence relevant to clinical care, and (d) offers practical, trauma-informed guidance for patients and clinicians in an integrative, holistic model of care. Key sources from the last two years are cited throughout.
Introduction: Why fairy tales stick—and why precision matters
The image is familiar: a young woman in a tower, isolated from supportive relationships, living under surveillance, told the outside world is dangerous, and rewarded with fleeting affection when she complies. The Rapunzel trope maps neatly onto what pop culture calls “Stockholm syndrome.” It’s compelling—and dangerously imprecise.
As a psychiatric nurse practitioner working within a holistic, empathy-driven practice, I’ve seen how labels shape care. “Stockholm syndrome” can become shorthand for “why didn’t you just leave?”—a question that betrays the complexity of trauma physiology, coercive control, and the social determinants that entrap people far more effectively than any tower. Contemporary guidance reminds us that Stockholm syndrome isn’t recognized in DSM-5-TR, and that clinical focus should be on the measurable harms of coercive control and the mechanisms of traumatic bonding, not on pathologizing a survivor’s survival strategy.
What “Stockholm syndrome” means today (and what it doesn’t)
Not a diagnosis
Major medical references updated in 2025 describe Stockholm syndrome as a descriptive psychological response—not a codified disorder—and emphasize that the behaviors observed (appeasing the abuser, minimizing danger, defending or aligning with the perpetrator) often function as short-term survival adaptations under conditions of captivity and threat. The diagnostic manuals (including DSM-5-TR and its 2024/2025 text updates) do not list “Stockholm syndrome.” Clinically, we evaluate the constellation of symptoms—PTSD, anxiety, depression, dissociation—rather than a standalone syndrome.
From “hostages” to everyday entrapment
While the term emerged from a 1973 bank siege, current writing acknowledges similar dynamics in intimate partner violence (IPV), trafficking, cults, and other coercive environments. Framing these patterns through coercive control—a deliberate campaign of isolation, surveillance, intimidation, gaslighting, economic control, and threats—better captures the day-to-day realities many survivors face. Jurisdictions worldwide are actively codifying coercive control in law or policy, underscoring its tangible harms to autonomy and mental health.
Rapunzel, revisited
Read as a clinical parable, Rapunzel is less about a captive “falling in love” with her captor and more about how forced dependency, information control, intermittent “kindness,” and threat can produce behaviors that look like loyalty—but are, in effect, survival. Contemporary research and reviews recommend shifting language from “she bonded with her captor” to “she adapted to coercive control,” which avoids blaming the survivor and directs care toward interventions that restore safety, agency, and connection.
What recent research adds (2024–2025)
1) Traumatic bonding has measurable correlates
A 2024 study in the Journal of Social and Personal Relationships found that among IPV survivors, need for cognitive closure was linked with stronger traumatic bonding, mediating how violence sustains attachment to the perpetrator. Clinically, that suggests work targeting intolerance of uncertainty, rumination, and black-and-white thinking may loosen the bond and improve safety planning.
2) Coercive control damages mental health—even when there’s no visible bruise
A 2024 systematic review reports moderate associations between exposure to coercive control and PTSD and depression, supporting trauma-informed interventions even when physical injuries are absent. This aligns with frontline reports and evolving legal frameworks recognizing coercive control as an actionable harm.
3) Policy and practice are catching up
In 2025, U.S. reporting highlighted growing state-level recognition of coercive control in civil and family courts (and direct criminalization in at least one U.S. jurisdiction as a pilot), reflecting a move to protect survivors where traditional assault-oriented statutes fell short. For clinicians, that means documentation of patterns—not just incidents—matters more than ever.
4) IPV remains prevalent and clinically consequential
Recent national and global summaries emphasize that IPV is common and strongly tied to mental-health burden, especially for women and adolescents. In 2024–2025 reporting, IPV correlates with anxiety, depression, suicidality, and functional impairment; barriers to care include stigma, financial dependence, and fear of retaliation. These data reinforce the need for routine screening and integrated mental-health services in primary and specialty care.
Mechanisms: How coercive control produces “Rapunzel-like” adaptations
Physiology of threat
Under chronic threat, the brain’s salience and fear networks dominate, narrowing attention to cues that minimize danger. Appeasing the abuser, anticipating moods, and “aligning” with rules bring immediate safety gains—even as they erode autonomy. This can look like “affection” for the abuser but functions as safety-seeking behavior.
Intermittent reinforcement
Periods of “kindness” amidst abuse function like variable-ratio rewards, powerfully reinforcing compliance. Survivors often describe clinging to brief, idealized moments—the “honeymoon phase”—because abandoning them feels like abandoning hope itself.
Cognitive constraints and “closure”
The 2024 mediation findings suggest that the more intolerable uncertainty feels, the more a survivor may cling to controlling narratives (“If I do X, he won’t explode”), even if those narratives are false, because they reduce immediate anxiety. Therapy focused on tolerating uncertainty and disconfirming unsafe rules can be corrective.
Identification with the aggressor
Classic psychoanalytic writing (revisited in 2024–2025 scholarship) describes identification with the aggressor: adopting the abuser’s view of reality to feel safer and gain a shard of control. In practice, that can look like minimizing harm, internalizing blame, or policing oneself to pre-empt punishment. For clinicians, recognizing this defense reduces judgment and points toward gentle, reality-restoring work rather than confrontation.
Clinical translation: From myth to measurable care
At Caliper Wellness, our integrated model blends talk therapy, medication management, and whole-person supports. Here’s how we apply current evidence when “Rapunzel” shows up in the exam room.
1) Assessment that honors survival
- Screen for pattern-based abuse (isolation, monitoring, threats, economic control), not just discrete assaults. Document patterns; they support legal advocacy and safety planning in states recognizing coercive control.
- Evaluate trauma spectrum symptoms (PTSD, panic, depression, dissociation) and health sequelae (sleep, pain, substance use).
- Explore cognitive style (need for closure, black-and-white thinking) that can sustain traumatic bonds—an actionable therapy target.
2) Trauma-informed psychotherapy
- CBT/ACT to recalibrate threat appraisals, build tolerance for uncertainty, and align choices with values (not the perpetrator’s rules).
- Stabilization skills (grounding, paced breathing, sleep hygiene) to widen the window of tolerance before processing trauma.
- Psychoeducation reframing “I must love him because I protect him” as safety-seeking under duress, which reduces shame and self-blame.
- Safe-relationship mapping to rebuild pro-social ties: one of the most potent antidotes to coercion is connection.
3) Medication management that supports safety and function
- Treat comorbid anxiety, depression, PTSD symptoms, and sleep disturbance, accounting for interactions with other medications and the survivor’s safety plan (e.g., sedating agents may have safety implications).
- Medications are never the whole answer; they support therapy and safety steps by reducing symptom load so choices are possible.
4) Safety planning and legal coordination
- Collaborate with advocates and attorneys where appropriate; provide detailed, pattern-focused clinical letters when survivors seek protective orders or custody protections under coercive-control statutes/policies.
- Document technology-facilitated control (GPS stalking, account takeover), increasingly recognized in law and research.
5) Practical supports that stabilize the base of the tower
- Connect to financial advocacy, transportation, childcare, and housing resources; unmet practical needs often are the tower.
- Encourage use of confidential helplines (National Domestic Violence Hotline; StrongHearts Native Helpline) and local shelters.
Communicating about “Stockholm syndrome” without harm
Use accurate, survivor-centered language
Reference coercive control and traumatic bonding rather than supposing “mutual affection.” Emphasize that apparent attachment in captivity often reflects calculated, adaptive compliance. This precision helps courts, families, and even survivors themselves understand the why behind the what.
Normalize survival intelligence
Statements like, “The strategies that kept you alive in the tower may not be the ones you need to rebuild your life on the ground,” validate adaptive behaviors while inviting change.
Replace “Why didn’t you leave?” with “What would you have needed to be safe enough to leave?”
This reframing opens doors to concrete problem-solving: financial safety, legal protection, childcare, technology safety, community support.
A brief clinical vignette (composite)
“Rae,” 27, presents with panic attacks, insomnia, and “confusion about my relationship.” She describes her partner checking her phone, controlling money, isolating her from friends, and sending dozens of messages when she’s at work. She minimizes incidents of shoving and blames stress. When he’s “sweet,” she says, “it reminds me of how good it can be.”
We screen for coercive control and traumatic bonding using open-ended questions and validated symptom measures. We reflect ambivalence as a survival adaptation, not pathology. Over 12 weeks, we combine skills-based therapy, an SSRI for panic and sleep, and a safety plan involving a trusted friend, discreet savings, and tech-safety steps. We document patterns for Rae’s legal consultation. As Rae learns to tolerate uncertainty and test predictions (“If I don’t reply in three minutes, does the worst happen?”), the traumatic bond loosens. She describes feeling “less like a person in a tower, more like a person with a map.”
For survivors who see themselves in Rapunzel
- Your reactions make sense. Aligning with someone who can harm you is a survival strategy, not proof of love or weakness.
- Patterns matter. Even without hitting, control, surveillance, and threats are abuse with documented mental-health harms.
- Help is available. Confidential advocates can safety-plan around finances, tech, pets, and children—quietly and on your timeline (The Hotline; StrongHearts).
- Therapy can help you reclaim choice. Skills that build tolerance for uncertainty and self-trust are powerful antidotes to traumatic bonds.
For clinicians: practical pearls
- Don’t “diagnose” Stockholm syndrome. Treat what’s in front of you—PTSD, anxiety, depression—and name the pattern of coercive control.
- Document patterns over incidents. Your notes can be pivotal for legal protections where coercive control is recognized.
- Target cognitive closure. Intolerance of uncertainty can glue traumatic bonds; tailor CBT/ACT accordingly.
Conclusion: Let’s retire the tower—and the myth
“Stockholm syndrome” and the Rapunzel metaphor can help us start a conversation, but they shouldn’t be where we end it. In 2024–2025, the center of gravity has shifted toward coercive control, traumatic bonding, and survivor-centered, trauma-informed care. When we swap myth for mechanism, we make better clinical decisions, craft smarter safety plans, and offer survivors a way down from the tower that doesn’t blame them for how they survived inside it.
If this resonates, our team at Caliper Wellness can coordinate talk therapy, medication management, and practical supports—discreetly and on your terms. You are not alone.
References (APA, last two years emphasized)
American Psychiatric Association. (2024, 2025). Updates to DSM-5-TR criteria and text (Sept. 2024 & Sept. 2025 updates). https://www.psychiatry.org/ (DSM-5-TR supplements noting no Stockholm-syndrome entry). American Psychiatric Association
Isaiah, U. S., Effiong, J. E., Udokang, I., Ogwuche, S., Udoukok, E. N., & Iorfa, S. K. (2024). Need for closure is linked with traumatic bonding among victims of intimate partner violence: A mediation approach. Journal of Social and Personal Relationships, 41(7), 2006–2022. https://doi.org/10.1177/02654075241234074 SAGE Journals
KFF (Kaiser Family Foundation). (2025). Women’s experiences with intimate partner violence. https://www.kff.org/ KFF
Marshall Project. (2025, June 28). Is coercive control a crime? Domestic abuse laws may expand in these states. https://www.themarshallproject.org/ The Marshall Project
Sage Journals (Trauma, Violence, & Abuse). (2024). The trauma and mental-health impacts of coercive control: A systematic review. (PDF). https://journals.sagepub.com/doi/10.1177/15248380231162972 (moderate associations with PTSD/depression). SAGE Journals
WebMD. (2025). Stockholm syndrome explained (updated 2025). https://www.webmd.com/mental-health/what-is-stockholm-syndrome (notes lack of DSM recognition; overview). WebMD
Oxford Statute Law Review. (2025). Criminalizing coercive control: Cross-jurisdictional lessons (Northern Ireland 2024 review and implications). https://academic.oup.com/slr/ OUP Academic
CDC. (2024, May 16). National Intimate Partner and Sexual Violence Survey (NISVS) — About. https://www.cdc.gov/nisvs/about/ (ongoing national survey infrastructure). CDC
WHO. (2024). Violence against women: Fact sheet (health consequences of IPV, including mental health). https://www.who.int/news-room/fact-sheets/detail/violence-against-women World Health Organization
Verywell Mind / Health & science reporting on traumatic bonds and related constructs are omitted here to privilege the sources above. For survivor services: The National Domestic Violence Hotline—Domestic Violence Statistics page (updated regularly). https://www.thehotline.org/ The Hotline