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Table of Contents
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 56-59

Post infidelity stress disorder

Clinical Instructors, College of Nursing, NIMHANS, Bengaluru, India

Date of Web Publication28-Jun-2019

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-1505.261777

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How to cite this article:
Padmavathi N, Sunitha T S, Jothimani G. Post infidelity stress disorder. Indian J Psy Nsg 2013;5:56-9

How to cite this URL:
Padmavathi N, Sunitha T S, Jothimani G. Post infidelity stress disorder. Indian J Psy Nsg [serial online] 2013 [cited 2023 Mar 28];5:56-9. Available from: https://www.ijpn.in/text.asp?2013/5/1/56/261777

  Introduction Top

Post-infidelity stress disorder (PISD) is a type of anxiety disorder that develops out of extreme stress in the aftermath of learning that a significant other has been unfaithful. This term was coined by Ortman D.C (2005). A person’s natural psychological defenses end up being overwhelmed, leaving a person unable to function in a healthy manner. The anxiety associated with post-infidelity trauma is chronic and persistent. Researchers suggest that the prevalence rate is between 20% and 40%. Marriage and family counsellors often encounter couples whose chief complaint is Infidelity. Though historically men have been more likely to be engaged in an affair, currently females are as likely as males to be engaged in some sort of affair[1].

Brown (2001) believes that the mental health professionals have avoided the study of infidelity for some time, due to lack of knowledge about how to proceed and their own discomfort, fears as contributing factors in the avoidance of infidelity issues. Many victims of infidelity experience their psychic life threatened, and become preoccupied with the betrayal and filled with rage. Post infidelity stress disorder with the acronym PISD, which expresses the rage that is a primary symptom of the disorder[2].

  Definition Top

According to ICD-10 this disorder arises as a delayed and protracted response to an exceptionally stressful or catastrophic life event or situations, which is likely to cause pervasive distress in almost any person (e.g.-disaster, rape or torture, accident, infidelity).

Pittman (1993) adds the components of “a breach of trust, a betrayal of a relationship, a breaking of an agreement”. One must also consider the secrecy and dishonesty that affects the self esteem of the spouse, the rules that have been broken, the energy that keeps the secret from the marital relationship and the emotional turmoil specific to infidelity and betrayal.

Vulnerability to PISD

While all individuals who experience a partner’s infidelity experience significant distress, not all are equally traumatized. Persons who are more prone to get PISD are:

  • Individuals who have dependent personalities and find their identities in love are the most vulnerable to PISD. Women are especially susceptible to this illusion, which invites a self - sacrificing and dependent attitude in relationships.
  • Those who experienced physical or sexual abuse as children
  • People who have fragile self esteem that makes them vulnerable to PISD3,
  • [6]

Neurobiological Response

The human psyche is astounding in its ability to protect itself and to adapt in order to survive. It has been noticed that significant changes occur in the brain, particularly when intense emotions are experienced. There are three structures were predominantly involved in the processing of emotions.

The Amygdala - It place a role in detecting signals of fear, generating fear, and activating a defensive response, such as fight or flight reactions.

The Hippocampus - It is involved in storing memories of acts or events.

The Neocortex - It processes information that it receives from the senses and other parts of the brain. It is the control center that evaluates information, plans for the future, makes decisions for action and regulates the emotions. The following Neuro-circuitry model describes about neurobiological response to stress full event.

If the perceived danger is great enough or persistent enough, the brain adapts itself to the situation and operates under permanent high alert. There are actual measurable changes in brain functioning that inhibit the shutdown of the stress reaction system. That's why those who have been traumatized find it nearly impossible to relax or feel safe4.

Characteristics of PISD

Many individuals whose partners have been unfaithful exhibit PISD symptoms, these symptoms often mimic the symptoms of PTSD.

According to DSM-IV, the diagnostic criteria for PTSD include:

a) Exposure to a Life Threatening Event

b) Experience of Intense Fear, Helplessness or Horror

c) Re-experiencing the event

d) Avoidance of Reminders of the Event

e) Emotional Numbing

f) Heightened Anxiety

g) Irritability and Rage

a) Exposure to a Life Threatening Event

Erikson (1950) identified the first stage of human growth as the choice between trust and mistrust, and claimed that developing a sense of trust is "the cornerstone of a vital personality." Recognizing the trustworthiness of oneself and others opens individuals to relationships, love, and growth, whereas mistrust leads to estrangement and withdrawal from others into oneself.]

b) Experience of Intense Fear, Helplessness or Horror

Traumatized individuals become fixated on the horror of what they experienced. They live in fear that the dreaded catastrophe will happen again and feel helpless to prevent it. Victims of infidelity also live in fear of another infidelity; they need constant reassurance and helpless to prevent it.

c) Re-experiencing the event

Those who have been traumatized relieve the horror of the event and all of the overwhelming feelings, sometimes years later, they become preoccupied and obsessed with their partners affair.

d) Avoidance of Reminders of the Event

Affected individuals cope by trying to forget the terrible things that have happened to them by avoiding thoughts, feelings, or conversations associated with the trauma. Victims of infidelity exhibit the same sensitivity to triggers that remind them of their partner’s affairs, and often restrict their lifestyles’ to protect themselves.

e) Emotional Numbing

They become so overwhelmed by their feelings of anxiety, rage, and helplessness that they attempt to cope by withdrawing into an emotional “cocoon’. They detach from life and from themselves to survive the emotional storm.

f) Heightened Anxiety

Victims of infidelity manifest their symptoms in the form of restlessness and distractibility, stressful nights, worry, and preoccupation with the trauma, which keeps them awake, and when they sleep, nightmares disturb the rest. During the day, these individuals are tense and hyper vigilant.

g) Irritability and Rage

Individuals who have been traumatized become preoccupied with how they have been victimized, which cause them to become angry with the perpetrator, with life. Smoldering rage is characteristic of adultery victims[5],[6].


The treatment consists of the following measures.


  • Antidepressants: Imipramine Amitriptyline, Others : SSRI, MAOI
  • Anti anxiety: Alprazolam
  • Anticonvulsant: Valproate, Carbamazepine,
  • Proponalol: To treat adnergenic hyper activity


  • Cognitive behavioral therapy
  • Individual therapy
  • Group therapy
  • Family therapy

Among all these psychotherapy, individual psycho therapy plays a vital role in recovery process of PISD.

Individual Psychothrapy-- Process of Recovery

According to Ortman D.C 2005, recovery from the trauma of infidelity can be a long process of rediscovering oneself and rebuilding a life. It involves three steps:

A. Establishing a sense of safety

B. Making a decision about the relationship

C. Healing through forgiveness.

A. Establishing a Sense of Safety Many victims of adultery lose hope in the future and do not believe they will ever trust anyone again. The sense of loneliness and isolation can be devastating. The first step toward recovery is establishing a sense of safety and security. The clients are advised to refrain from making any major life decisions until they have achieved some emotional stability. The tendency is to make a hasty decision either to welcome back the unfaithful partner due to sense of panic, or to seek divorce in anger.

The initial stages of the grief process radically disorient individuals, tossing them on a sea of stormy emotions or numbing them with frozen feelings. As individuals adjust to the loss of the relationship as they had known it, they live with a sense of unreality. Their emotional instability interferes with their ability to make clear, rational decision for their future.

B. Making a decision about the relationship:

Only after individuals have achieved a degree of emotional calmness, they are in a position to enter the second stage of recovery and making a decision about the relationship. Many of the clients were shocked to discover their partner’s adultery and had not believed the person capable of such betrayal. In light of this traumatic discovery, victims need to carefully assess their partner’s character and ask, “Is my partner a trustworthy personfi”And “Can I be assured this betrayal will never happen again?”

In making this assessment, among other considerations, it is important to determine whether the infidelity was an isolated incident or a well established behavior pattern, and whether the unfaithful partner is willing to seek help and change. Obviously, such a decision takes time and patience. It also requires courage because there is no way to predict the outcome of the decision.

C. Healing Through Forgiveness

The third phase of recovery from infidelity involves healing the painful memories of the trauma, whether or not the victim decides to continue the marriage. This healing can only be accomplished through forgiveness. Forgiveness is not easy and may take time to achieve.

The first step is for victims of infidelity to forgive themselves. Such self blame needs to be given up before the victims can concentrate on addressing the personality deceits that led to their victim role. The main work of recovery begins when the victims look honestly at themselves to understand their vulnerability to an unhealthy relationship.

The second co-occurring steps for victims to forgive their unfaithful partners. It involves seeing and accepting their partner as they really are, with all of their strengths and weaknesses.

Experiencing the trauma of infidelity can be a wake-up call that something was seriously lacking in the relationship and the partners. What was lacking needs to be explored honestly, whether or not the couple decides to stay together? If victims of adultery are preoccupied with blaming their partners, they will not allow themselves to be fully engaged in the self exploratory process necessary for recovery[7],[8],[9]

Nurse’s Role as a Therapist

  • Collects history and assess for any risk factors.
  • Assesses individual and relationship concerns.
  • Enhances communication which brings about intimacy.
  • Normalizes the reactions and feelings present in both partners.
  • Provides psycho education.
  • Reminds them that the therapeutic process will assist them with making an informed decision about the relationship.
  • Helps them for absolute honesty from both partners.
  • Maintains a strong alliance with both clients.
  • Facilitates the process of forgiveness.
  • Fosters unifying factors of empathy, commitment, hope and remains non-judgemental and Neutral10.

  Conclusion Top

In our unstable society, relationships are fragile. Couples live together without making lifelong commitments, and the majority of marriages end in divorce. Many relationship ends because of an infidelity by one or both partners. The effects of betrayal on the victim can be traumatic, and they may experience the infidelity as a death to the relationships and their psychic wellbeing. Forgiveness is the key element in facilitating recovery among couples experiencing PISD.[10]

  References Top

Ortman DC. Post Infidelity stress disorder. Psychosocial Nursing. 2005 Oct; 43(10): 46-54.  Back to cited text no. 1
Brown EM. Pattern of Infidelity and their Treatment. 2nd Ed. Brunner-Rout ledge. New York. 2001.251-269.  Back to cited text no. 2
Gelder M. Shorter Oxford text book of Psychiatry.5th Ed. Oxford University Press. New York. 2006.154-162.  Back to cited text no. 3
Jeffery Newport D, Charles B. Neurobiology of Posttraumatic Stress Disorder. Focus. 2003, 1:313-321.  Back to cited text no. 4
Dennis A, Bagarozzi. Understanding and Treating Marital Infidelity: A Multidimensional Model. The American Journal of Family Therapy. 2007; 36(1): 1-17.  Back to cited text no. 5
Pittman FS. Beyond betrayal: Life after Infidelity. Psychology Today. 1993; 26: 78-82.  Back to cited text no. 6
Milewski, Hertlein K, Wetchler JL. Handbook of the Clinical Treatment of Infidelity. Ist Ed . Routledge. Philadelphia. 2005. 242-262.  Back to cited text no. 7
Ortman DC. Transcending Post-Infidelity Stress Disorder. The Six Stages of Healing. Ist Ed. Crown Publishers. 2009. 68-183.  Back to cited text no. 8
Glass SP, Gurman S. Clinical Handbook of Couple Therapy.3rd Ed. Guildford Press. New York. 2002.  Back to cited text no. 9
Parker ML; Berger AT, Campbell K. Deconstructing Couples’ Experiences With Infidelity. Journal of Child and Adolescent Psychiatric Nursing. 2008 Oct; 18(3): 53-61.  Back to cited text no. 10


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