Marriage in Crisis: Uncovering the Psychosocial Profiles of Couples Seeking Help for Marital Discord

Marriage also called matrimony or wedlock is a beautiful bond between two people built on love, trust, and commitment. It’s a union that’s recognized by society and often by law creating a lifelong connection between partners, their families and their loved ones [1]. It is the oldest custom human beings practice, and marital discord, the conflict in married life, is as old as the institution of marriage itself [2]. The reasons for marital discord vary from time to time and from person to person. In the pre-industrial era, men and women who joined in marriage shared cultural values, mutual commitment, trust and faith that subordinated individual interests and resulted in a smooth relationship with family. There was also tension and maladjustment in their marital relationship, but moral and religious beliefs, economic dependence and fear of social disapproval kept them together. In the wake of the Industrial Revolution, marital disagreements gained importance. Men and women who joined in marriage had differences in their knowledge of sexual, psychological, spiritual and social aspects of life, the proper understanding of which alone ensured peace, adaptability and self-control. In the commercial age, the growing independence of married women further separated and changed their concept of marriage. Marital discord represents a breakdown in consensus and cooperation between married couples. Usually, marital discord arises when rivalry develops between partners through internal and external manifestations such as separation, physical violence and defamation. They become distant when they are unable to resolve their issues, leading to tension in their relationship. Usually, marital discord originates when enmity develops among the partners through internal and external manifestations like constant finger-pointing, physical aggression, antagonism, and so on

Marital discord is a lack of adjustment and synchronization in the marriage. It symbolizes a breakdown in the commitment and cooperation of the married couples. It is a process that begins before physical separation and continues even after the marriage is legally ended [3]. Marital discord is a very effective stressor that can prompt individuals to enter mentally disturbed stages and it is a significant predictor of subsequent delinquency and depressive symptoms for married couples. Marital problems are more likely to cause various psychological illnesses ranging from adjustment disorders to more severe depressive episodes and suicidal behaviours.

Marital discord in marriage is also not new to India, and it has existed in all eras of wellknown history. But separation was resorted to only in severe cases where there was intolerable malice, abandonment, mental illness, sterility, and disloyalty. In India, various personal laws and special marriage acts are made to govern the principles of divorce conditions and the procedure [3]. With the increasing trend in divorces in India, more and more couples consult specialists in dealing with their marital issues. For a few couples, it’s a chance to understand their difficulties and reconstitution of their marital life, for others, it’s a mere formality before legal divorce. Personality pathology significantly impacts interpersonal relationships, especially in marriage. Research suggests that personality characteristics can predispose individuals to relationship dissatisfaction [4]. Additionally, Karney & Bradbury’s [5] vulnerability-stress-adaptation model highlights that personality traits, as enduring vulnerabilities, influence couples’ experiences of stress and interaction patterns [5]. Personality disorder symptoms have also been repeatedly linked with more serious forms of marital conflict, including intimate partner violence.

Marital therapy is a limited, though not superficial, form of psychotherapy to help the partners enjoy a more rewarding relationship; or to lessen some of the strains and dissatisfactions in the relationship [6]. Marital therapy has its roots in Germany in the 1920s, where it was part of the eugenics movement. The first institutes for marriage counselling were started in United States in the 1930s. Thus, the concept of Family therapy centres and marital therapy centres has prevailed for a long in the Western world, in India it is still it is in a nascent stage. There is a dearth of research on marital discord and marital therapy in India. Our study is an attempt to focus on various psychosocial aspects, personality profiles, and severity of discord in couples attending our marital therapy centre.

The study is a cross-sectional descriptive study done using the purposive sampling method. 60 consecutive couples attending a marital therapy centre were recruited for this study. Informed consent was taken from all the study participants. After obtaining the approval of Institutional ethics committee the study was conducted at marital therapy centre, Indlas hospital, Vijayawada. A semi-structured proforma was used to collect socio-demographic data (Table 1).

Table 1:Socio-demographic data of study subjects.

Note: S.D.- Standard Deviation, ENRICH- Evaluation and Nurturing Relationship Issues, Communication, and Happiness, ISS- Index of sexual satisfaction.

Assessment tools used in the study are:

A. Depression Anxiety and Stress Scale - 21 Items (DASS-21). Developed by researchers Lovibond at the University of New South Wales, the Depression Anxiety Stress Scale (DASS-21) is a well-established, self-administered instrument with 21 statements that help people define, understand, and measure clinically significant emotional states. This assessment tool contains three scales that separately measure the emotional states of depression, anxiety and stress. The scales of the DASS- 21 have been proven to have high internal consistency and high discriminative, concurrent and convergent validity [7].
B. International Personality and adaptation of the Personality Disorder Examination- (IPDE). This scale was an outgrowth disorder examination developed by Loranger AW [8]. It is a semi-structured clinical interview originally designated to assess the personality disorders in the ICD- 10 and DSM-III-R classification systems, and subsequently modified for compatibility with DSM-IV and DSM-5. The IPDE was designated for international use and has been translated into multiple languages to facilitate its use in various cultural settings [8].
C. Index of Sexual Satisfaction (ISS) by Hudson, is a 25-item scale completed by subjects rated from 0 to 7 Likert scale. There are two cut off scores for the scale. The first is a score of 30(+5). Scores below this indicate an absence of clinically significant problem. Scores above 30 indicate the likelihood of a clinically significant problem. The second cut off score is 70. Scores above this point nearly always indicate that clients are experiencing a severe problem in their sexual life [9].
D. ENRICH Marital Satisfaction scale by Fowers and Olson. It is a 15-item scale compromising the idealistic scale (5 items), and marital satisfaction scale (10 items). The EMS has good internal consistency and test-retest reliability (Cronbach alpha of 0.86). Higher score indicates greater marital satisfaction [10].

Data entry and analysis were performed using Microsoft excel (2019) and R environment version 3.4.4 (Vienna, Austria). Descriptive statistics Continuous variables were reported as mean with Standard Deviation (SD) and categorical variables were reported as a number with the percentage of the total.

In inferential statistics

The Pearson correlation coefficient test was used to study the relationship between marital satisfaction and sexual satisfaction, whereas the paired samples t-test was used to find the differences in stress, anxiety and depression levels between wives and husbands. For all analyses, the probability level considered to indicate statistical significance was set at P<0.05.

Socio-demographic characteristics

In our study the mean age of the husband was 35.52 years (SD+5.40) and the wife 32.35 years (SD+4.34). The average duration of marriage was 6.78 years (SD+5.08). Among husbands more than two-thirds and half of the wives were graduates. Most of the couples belong to the nuclear family (73.33%, n=44). Half of them (50%, n= 30) belong to middle low socio-economic status, the rest belong to either upper or lower class. Almost all husbands were working except one. When it came to wives, one-third (38.33%, n=23) were homemakers and the rest of them were working class. Majority (70%, n=42) of the marriages were love marriages, and a few were arranged by elders. 43.33% (n=26) couples consulted us on their own decision whereas elders, legal authorities or police suggested psychiatric consultation in other cases.

Personality profiles

20% (n=12) husbands and 10% (n=6) wives had cluster A personality. More than half of the husbands (60% n=36) and twothirds (70% n= 42) of wives shown cluster B personality. 20% of husbands (n=12) and 20% (n=12) of wives had shown cluster C personality.

Depression, anxiety and stress (DASS 21) scores

41.67% (n=25) husbands and 15% (n=09) wives had reported no depressive symptoms. 20% (n=12) husbands and 23.33% (n=14) wives reported severe to extremely severe depression. Most of the couples denied any anxiety symptoms (83.33% n=50 husbands and 73.33% n=44 wives). Only 25% of wives (n=15) reported mild to moderate anxiety.

DASS-21 stress scores showed an entirely different picture. Nearly two-thirds (71.67% n=43) of husbands reported no significant stress even when their marriage was under discordance whereas more than two thirds (76.67% n=46) reported some level of stress. Nearly half of the wives (48.33% n=29) reported severe to extremely severe stress. On the t-test test there was a statistically significant difference seen in depression (P=.002) and stress scores (P<.001) when compared between the husbands and wives (Tables 2 & 3).

Table 2:DASS 21 scores.

Note: DASS 21- Depression Anxiety and Stress Scale-21 Items.

Table 3:Comparison of DASS 21, ISS & ENRICH mean scores between husbands & wives.

Note: S.D.-Standard Deviation *P <0.05. DASS 21-Depression Anxiety and Stress Scale- 21 items ENRICH- Evaluation and Nurturing Relationship Issues, communication, and happiness, ISS- Index of sexual satisfaction.

Marital satisfaction and sexual satisfaction scores

Almost all husbands (96.67, n=58) and nearly two-third of wives (76.67%, n=46) reported less marital stasfaction.95 % (n=57) of couples had low couple agreement scores. No statistically significant difference was found between couples in marital satisfaction (P=0.11). Coming to sexual satisfaction, more than half of the wives (56.67% n=34) did not report any significant sexual satisfaction issues, 26.67% (n=16) reported probable sexual dissatisfaction and 16.67% (n=10) reported definite sexual dissatisfaction. Among husbands, 36.67% (n=22) reported no issues with sexual satisfaction.41.67% (n=25) reported probable sexual dissatisfaction and rest of the 21.67% (n=13) reported definite problems in the area of sexual satisfaction. No statistically significant difference found between couples in sexual satisfaction (P=0.11). On Pearson correlation, there was no statistically significant correlation between years of marriage, marital satisfaction and sexual satisfaction (Tables 4 & 5).

Table 4:Correlation between Marital satisfaction and years of marriage (Pearson correlation coefficient).

Note:Enrich- Evaluation and nurturing relationship issues, communication, and happiness.

Table 5:Correlation between sexual satisfaction and marital satisfaction (pearson correlation coefficient).

Note: ENRICH- Evaluation and Nurturing Relationship Issues, communication, and happiness, ISS- Index of sexual satisfaction.

The current study is a descriptive study looking at the different variables seen in couples attending a marital therapy centre. Marital therapy has been the form of help most widely studied and previous research suggests that couples who seek marital therapy tend to be upper middle class, Caucasian, and college educated [11]. Here in this study, we have compared our findings with the previous studies.

Age and duration of marriage

A study by Whisman et al. [12] found that couples seeking therapy tend to be in their mid-to-late 30s, consistent with our findings. The average duration of marriage in our study (6.78 years) is slightly lower than some earlier studies, which reported averages ranging from 8-12 years. Karney and Bradbury [5] found that the effect of duration of marriage on marital satisfaction was negative or U-shaped (it decreases in the beginning and increases after sometime [5].

The relationship between education and marital satisfaction is complex, with varying findings across studies. While Janssen et al. [13] ‘s study in the Netherlands found that highly educated women experienced less marital satisfaction, Ziaee et al. [14] ‘s study reported a positive correlation between education level and marital satisfaction among married women employees Janssen PF [13] & Ziaee T [14]. A study done by Goud et al. [15] in India found no significant relationship between education and marital discord severity. In our study, more than two-thirds of husbands and half of wives were graduates, and they have very low marital satisfaction which might be influenced their marital dynamics which requires further research. The finding that almost all husbands were working, while one-third of wives were homemakers, is consistent with some earlier studies highlighting the impact of gender roles on relationship dynamics.

While Amato et al. [16] suggested that couples from nuclear families tend to have better relationship quality, our study yielded different results, with 73.33% of couples from nuclear families reporting lower marital satisfaction [16]. The distribution of socioeconomic status in our study, with half of the couples belonging to the middle-low class, might influence the stressors and challenges faced by these couples. The results could be attributed to the absence of a support system, financial pressures, and evolving roles within the family.

While Epstein et al. [17] found that love marriages were associated with better relationship quality and less discord compared to arranged marriages, our study yielded contrasting results, with 70% of love marriages experiencing severe discord [17]. This could be due to sampling differences, self-reporting bias or cultural factors. In some cultures, particularly countries like India arranged married couple might seek guidance from elders to resolve conflicts or more likely to compromise to maintain family harmony. The fact that 43.33% of couples consulted us on their own decision, while less number of couples was suggested by elders, legal authorities, or police, highlights the complex factors influencing couples’ decisions to seek therapy.

Personality profiles and marital discord

Pathology in personality is strongly linked with interpersonal relationships, more so in intimate relationships like marriage. According to Terman et al. [4] personality characteristics predispose individuals to experience dissatisfaction within their relationships [4]. Certain personality traits like neuroticism and agreeableness, can predict marital satisfaction. Changes in personality traits over time can also influence marital satisfaction. According to Karney & Bradbury’s [5] vulnerability-stress-adaptation model of marital quality, the enduring vulnerabilities of each spouse, including personality traits, are hypothesized to affect both the stressful events that couples encounter and the types of behavioural exchanges that occur between spouses [5]. Personality disorders particularly borderline and antisocial personality symptoms have also been repeatedly linked with more serious forms of marital conflict, including intimate partner violence. In our study we found most of the couples had cluster B personality traits, particularly wives having more borderline traits. This replicates the findings of an early study done by Ayirolimeethal et al. [18] of their study done on Marital adjustment in patients with an emotionally unstable personality disorder [18]. Unstable relationships, fear of abandonment, emotional instability, and impulsivity in this population create a cycle of conflict and marital discord.

Marital satisfaction and sexual intimacy

Our study’s findings indicate a pronounced disparity in marital satisfaction among couples, with nearly all husbands and over twothirds of couples exhibiting low satisfaction levels. These results converge with prior research conducted in Western contexts and select Indian studies, which have consistently demonstrated the efficacy of couple therapy in enhancing relationship satisfaction. The cross-cultural consistency of these findings underscores the imperative for developing tailored therapeutic interventions that account for diverse socio-cultural factors, thereby optimizing treatment outcomes [15,19,20].

As a relationship begins, intimacy is low, but it quickly increases. In a successful relationship, intimacy will continue to increase, maybe at a slower rate. Like intimacy, passion will have a rapid increase in the beginning, but later it will level off. Commitment is the slowest to increase, but would reach the peak at last. All the studies previously conducted have proved that sexual intimacy has an important role throughout a relationship [15,18]. Surprisingly, in our study, sexual intimacy did not show a significant role in marital satisfaction. Here, cultural factors and values of the society might have been intervened. Indeed, physical attraction has its role in its first few years. After that, the main role is for non-sexual intimacy, which includes emotional, social, recreational and intellectual aspects of life.

Depression and stress

Trillingsgaard et al. [21] in their study done on Danish couples found that in couples attending couple therapy, women were having more depressive symptoms [21]. Whisman et al. [22] in their study found that marital dissatisfaction worsens depressed mood in both the husbands and wives more so in wives with depression [22]. Our study echoes these findings, revealing statistically significant differences in depression and stress scores between the wives and husbands with wives scoring higher in both. This could be possibly explained due to the gender roles and, societal expectations of women leading to more stress and reporting differences. Overall, the findings in our study are in agreement with those of earlier studies done in India and abroad except for certain differences which could be attributed to different study methodologies and cultural variations.

Strengths

A. Unique population: The study focuses on couples attending a marital therapy centre, providing valuable insights into the challenges faced by these couples.
B. Comprehensive assessment: The study evaluates various aspects, including socio-demographic characteristics, personality profiles, depression, anxiety, stress, marital satisfaction and sexual satisfaction.
C. Comparison between husbands and wives: The study highlights the differences in experiences and perceptions between husbands and wives, which can inform tailored therapeutic approaches.
D. Cultural context: The study provides insights into the cultural factors influencing marital relationships in the Indian context.

a) Small sample size: The study’s sample size (n=60 couples) may limit the generalizability of the findings.
b) Selection bias: The study only includes couples attending a marital therapy centre, which may not be representative of all couples in the community.
c) Cross-sectional design: The study’s cross-sectional design limits the ability to establish causal relationships between variables.
d) Self-reported measures: The study relies on self-reported measures, which may be subject to biases and social desirability effects.
e) Limited exploration of cultural factors: While the study mentions cultural factors, it could benefit from a more indepth exploration of these factors and their impact on marital relationships.

This study examines the psychosocial profiles of couples attending marital therapy at a tertiary care centre. The study’s key findings highlight the complexities of marital relationships, particularly among couples seeking therapy. Notably, a high prevalence of Cluster B personality traits, especially borderline traits in wives, was observed. Despite of being in love marriages, majority of the couples reported low marital satisfaction, with almost all husbands and over two-thirds of wives expressing dissatisfaction in their marriages. Furthermore, significant differences were found in depression and stress scores between husbands and wives, with wives experiencing higher levels of distress. Interestingly, no significant correlation was found between years of marriage, marital satisfaction and sexual satisfaction. These findings underscore the importance of tailored therapeutic approaches that address the unique challenges faced by couples, including personality traits, marital satisfaction and mental health.