Introduction
ompassion is the first manifestation of human relationships [1]. However, some relationships may not be broken but continue unhealthily [2]. Abusive relationships include abuse, disrespect, extreme jealousy, behavior control, or physical violence [3]. Emotional and psychological injuries, physical and sexual injuries, and individual-social injuries are considered abusive  relationships [4, 5]. Many victims do not recognize that they are being abused, and many blame themselves for their relationship problems. In contrast, many people remain in a abusive  relationship for a long time or are often abused physically, psychologically, and sexually in various relationships and suffered from different social, family, economic, and other consequences.
Although a significant number of people have been exposed to abusive  relationships through their lives (psychological violence) or emotionally abused, few are aware of the profound effects of such relationships on their lives [6]. People with abusive  relationships feel more fear, higher depression, anxiety, and irritability, a higher likelihood of suicidal ideation, lower self-esteem, insomnia, and dysfunction. Substance abuse, passivity, and helplessness respond to continuing a relationship is similar to the situation in which one feels helpless and think that any effort seems futile [7, 8].
Various factors prolong the abusive  relationship, such as the history of childhood victimization, lack of financial independence, low self-efficacy, and self-esteem, feel guilty and self-blame, naturalization of the abusive  relationship, lack of social support and having children, cultural factors such as gender roles, belief in fate, the rate of accounting on the connection, the increase in severity and frequency of abuse, and the history of separation before the relationship with the abusive partner [7]. Other factors include returning to father’s home and living a more difficult life, maintaining a family to raise children, fearing losing one’s home and financial resources, and blaming oneself for failing in a marital relationship [9]. Lack of necessary life skills, the severity of the abusive partner’s threat, and the children’s reaction can be the main reasons for continuing the abusive  relationship [10]. 
Statistics indicate that domestic violence as part of a abusive  relationship in developing and developed countries accounts for about 5% and 19% of the total disease burden in women aged 15-44 years. In Germany, one out of four women (25%) has experienced sexual or physical violence by her partner. In the UK, 1% of women have experienced physical violence or threats from their partner at least once in their lifetime [11]. Half of Americans have been abused by a close partner at least once in their lifetime [12, 13]. The prevalence of abusive  relationships in Iran indicates the highest violence rate among women aged 20-30 years with 48.5% and the lowest rate of violence in the age group of 45-50 years with 9.6%. In total, emotional and psychological violence with 52% is the most common type of violence, followed by physical violence with 37% and social violence with 34% against women [14].
Since few studies have been done on the concept of abusive  relationships in Iran, and given that the concept of abusive  relationships is affected by various human, psychological, social, cultural, and environmental aspects [10, 14, 15], conducting such a study provides a more accurate understanding of this problem. It can propose a suitable guide for further studies in Iran. Considering that grounded theory studies can examine the social interactions of the phenomenon’s structures and processes [16, 17], we used this theory to explain the concept of abusive  relationships in psychological clinics in Rasht City, Iran.
2. Materials and Methods
This project is a qualitative study based on the grounded theory approach. The sampling started purposively and continued theoretically [17]. The studied samples included 8 victims of abusive  relationships who, according to themselves, had at least a diploma and were residents of Guilan Province. Also, 8 psychologists participated with a PhD. in psychology working in Rasht and Tehran cities in psychology clinics affiliated to Guilan University and Rasht Azad University.
In this study, the researcher, through a call in cyberspace and flyer distribution in 3 public and non-profit universities and psychology clinics, selected samples that have the experience of abusive  relationships and could present the phenomenon under study [16]. The selection was based on a life history interview and an initial complaint of a abusive  relationship that was not legally registered.
Sampling was continued until the data saturation [18]. According to their statements, other inclusion criteria included being in the age range of 20-40 years, not taking psychiatric drugs, or addicted to drugs. Necessary explanations were provided to the participants, and the time and place of the interview were determined with their consent. The researcher conducted interviews at the psychology clinic in the counseling room. No one was present in the room at the time of the interview, and the individuals’ privacy was fully respected. At the beginning of each interview, the purpose of the interview was mentioned again, and permission was obtained to record the voice while answering the questions. Informed written consent was obtained from the subjects to participate in the study. Participants were also reassured about the confidentiality of the information and the recorded sound. Data were collected using semi-structured interviews, observation, and field notes [19].
The participants were asked to share their experiences regarding a abusive  relationship through questions such as “how has this relationship affected you?”, “did you know during this relationship that it was abusive  to you?”, “What are you doing?” “Did you keep it in these relationships?”, “Is it possible to tell you about other emotional relationships you had?”, “Did you experience abusive  relationships with other people in similar relationships?” and, if necessary, more exploratory questions such as “Would you explain more?”.
Another way to collect data was to interview psychologists. The interviews were conducted with 8 interested and experienced experts in the field of abusive  relationships. The experts were first asked to “recount the important features of abusive  relationships based on what they experienced in their clients” and gradually developed questions such as “what are the primary effects of abusive  relationships on victims?”, “Is there a pattern of repetition in this experience?”, “What do you think are the factors that lead the victims to experience these relationships again?”, “What keeps these clients in such relationships?” and “explain more about your experiences working with these clients”. At the end of each interview, the participant was thanked and asked to add anything they wanted. Each interview was typed word for word, and then the researcher reviewed them and examined the ambiguities that needed attention in subsequent interviews.
Field notes were used to document the observations as part of the data analysis. The researcher wrote down what she saw, heard, thought, or experienced. Field notes were recorded in the appropriate location immediately after the event. She also wrote down any ideas that came to her mind while reviewing the interviews, codes, or classes. After analyzing them, she shared them with the participant to check the accuracy of the material. If necessary, required changes were made to achieve the same understanding between the participants and the researcher. Straus and Corbin’s constant comparative analysis method was used to analyze the data [16]. Word-for-word transcripts of interviews, field notes, recorded items, conceptualization, interpretation, and theorizing processes formed the core of the obtained information.
Each interview underwent open coding, axial coding, and selective coding before the next interview. In open coding, each interview’s text was read several times. The main sentences were extracted and recorded as codes based on the participant’s statement or implicit codes (researcher’s interpretation of the statements). The codes that were conceptually similar to each other were put in one category. In axial coding, the primary codes and categories created in open coding were compared, and while merging similar items, the related categories were arranged around a common axis. This step required constant code comparison. The researcher then compared each category to other ones to ensure that the categories were distinct. Then, by focusing on the conditions that led to the phenomenon in question, the contexts in which the phenomenon occurred, and the strategies used to control the phenomenon, selective coding, and the core variables were identified. The researcher then began to write down the grounded theory of the data as a storyline and introduced the concept of re-experiencing the unhealthy relationships.
The credibility of the data was achieved by reviewing the manuscripts by the member check, the researcher’s prolonged engagement, and contacting and communicating with the participants. The confirmability was peer checked by three faculty members through observing the researcher’s neutrality, agreeing on the codes and themes, reviewing the interview text, codes and categories extracted. The dependability was provided by drafting, using an external check, and double-checking the real data. Transferability or fittingness was also made possible by interviewing different participants, providing direct quotes and examples, and explaining the data.
Results
The personal and social characteristics of the individuals involved in the abusive  relationship and the experts participating in the study are listed in tables 1 and 2. 




The results of open coding from interviews with 8 people with abusive  relationships and 8 psychologists indicated that 47 concepts could effectively design a pattern of re-experiencing abusive  relationships. In the axial coding stage, the concepts were classified into 8 general categories. Finally, in the selective coding stage, the phenomenon of “abusive  relationships” was extracted as a significant category. The central coding paradigm’s eight key characteristics included “perceived violence, psychological symptoms, unhealthy relationship strategies, dark personality traits, emotion regulation problems, retention factors, family trauma, and self-defeating behaviors”, with their subclasses and specific features (Figure 1).  Perceived violence
One of the conceptual classes and main variables found in the study was perceived violence. This category included physical violence, psychological and verbal violence, sexual violence, symbolic violence, and economic violence.
“Economic violence” is one of the subclasses of perceived violence to dominate over the victim for forced control and mistreatment in abusive  relationships. For example: “He did not work and had no money, and I treated him like a mother”. (sample 4, 21 years old); or, “I bought him whatever he wanted. I was at work from morning till night”. (sample 8, 31 years old).
Symbolic violence was identified with fearful behaviors to threaten and control the victim in the subclass of perceived violence in abusive  relationships. For example: “He suddenly slams the car door”. (sample 5, 22 years old); “If I did not answer the phone, a few minutes later he would park his car under the window of my room” (sample 1, 22 years old).
Another variable was sexual violence. Sample 5, 22 years old, said: “I cried and asked him not to do that! (sex), but it happened, and it was a horrible experience. I did not understand anything about it (loss of virginity)” (sample 7, 24 years old).
The examination of the narratives showed that almost all of the victims had experienced psychological and verbal violence. For example: “He did something that cut me off from my best friend (sample 7, 24 years old)”. “He always insulted me” (sample 8, 31 years old). “He shouted all the time” (sample 3, 22 years old). “Bothered me, why not answering the phone? Why did you look at that man?” (sample 8, 31 years old).
After examining the evidence, the data showed that the samples had repeatedly been physically abused: “We fought”. (sample 1, 22 years old). “He hit me to death”. (sample 2, 25 years old). “There is also physical violence. He may beat the victim”. (expert 1). “The abuser deprives the victim of freedom”. (expert 2). “Forces the partner to do sex”. (expert 8)”. “They are financially abusive and also control the income and expenses of the other party” (expert 5).
Among the types of violence mentioned, psychological and verbal violence were the most common types, and the participants believed that it had many psychological consequences for them: “He hurt me psychologically”. (sample 1, 22 years old). “I am still under stress” (sample 3, 22 years old).
Psychological symptoms
One of the conceptual classes, whose subclasses are the main variables in conditional contexts, consequences, and strategies in experiencing abusive  relationships, was psychological symptoms. This category included low mood, perceived stress, physical pain, vigilance, nightmares, loneliness, low self-esteem, irritability, chronic guilt, and addiction. This category included low mood, perceived stress, physical pain, vigilance, nightmares, loneliness, low self-esteem, irritability, chronic guilt, and addiction. 
Feeling lonely seems to be one of the essential variables obtained from contextual conditions that cause people to experience abusive  relationships and not leave them; even one of the consequences of abusive  relationships is loneliness. For example: “At night, when my parents were asleep, I cried what to do if I woke up in the morning and missed them”. (sample 1, 22 years old). “To avoid being alone, I prefer to establish a relationship with someone”. (sample 8, 31 years old). “I became very lonely”. (sample 7, 24 years old). “Some are so afraid of being alone that start the next relationship again” (expert 5).
Low self-esteem was one of the main variables in causal conditions. Also, low self-esteem caused the person to remain in a abusive  relationship: “I wished everyone accept me”. (sample 5, 22 years old). “I would like to be seen”. (sample 2, 25 years old). “They have low self-esteem” (expert 8).
 Feeling guilty was another subset of psychological symptoms. The victims expressed a strong sense of guilt that foreshadowed staying in a abusive  relationship. “I owe a lot to myself and my family (sample 5, 22 years old). “I felt guilty (sample 1, 22 years old). “s/he feels guilty” (expert 2).
Irritability was one of the minor variables in psychological symptoms and was the primary variable in the intervening condition: “When I get nervous, I tell him everything I have in mind”. (sample 6, 22 years old). “I say things I should not say”. (sample 1, 22 years old). “I have no control”. (sample 8, 31 years old). “They have high arousal” (expert 7).
Addiction was one of the main variables of strategies: “I smoke”. (sample 8, 31 years old); “I smoke if I am in a group with my friends”. (sample 7, 24 years old); “I started to smoke since then”. (sample 5, 22 years old). Addiction seems to have intensified the mental and physical stress of this relationship. “They consumed something (drug)”. (sample 2, 25 years old). “They usually consume drugs”. (expert 3).
The three variables of “nightmare”, “physical pain”, and “vigilance” were reported by victims less frequently than other subclasses, respectively: “I see his nightmare” (sample 1, 22 years old). “I have chest pain” (sample 7, 24 years old). “They turn into physical pain and shorten their life” (expert 1).
Strategies for keeping a abusive  relationship
 Strategies to keep a abusive  relationship were one of the conceptual categories that persuaded the victims to continue with the abusive  relationship, including emotional blackmail and financial ransom. Emotional blackmail is one of the strongest forms of control and intervention. For example: “He proposed to have sex, and I rejected! so, he broke up for 10 days and sent me sad songs”. (sample 3, 22 years old). “If you refuse sex, I will end the relationship”. (sample 4, 21 years old).
Financial ransom is known to be a means of protecting an emotional partner in a traumatic relationship. For example, “I often sent gifts for his family to have a good relationship with them (sample 2, 25 years old). “Insults and beatings were compensated with money and gifts”. (sample 1, 22 years old). “Anyway, not being understood creates a feeling of guilt in the person”. (expert 8).
Dark personality traits
One of the main variables in the study was dark personality traits, which included pessimism, deception, and exploitation, profit motives, emotional instability, emotional turmoil due to parental rejection, domination, trying to blame others, difficulty in moral judgment, and right and wrong, and perfectionism.
Victims’ reports showed that dark personality traits as inflexible traits contributed to greater involvement in abusive  relationships and justified the abusive  relationship in a repetitive cycle. The following examples from the experiences of the subjects indicate pessimism: “I was doubtful”. (sample 8, 31 years old). “He always slanders”. (sample 6, 22 years old). “It’s as if everyone wants to abuse me”. (sample 5, 22 years old). “They are always living with doubt”. (expert 1).
Deception and abuse were also examined with examples from the research samples: “I usually satisfied him by buying gifts and other things”. (sample 8, 31 years old). “He said: do not be afraid I’ll stay with you, but very soon his behavior changed”. (sample 3, 22 years old). “They do not like the person that they are living with start a relationship with anyone else”. (expert 8).
Profit motives is another subclass of dark personality traits. For example: “How good it is to find a person who listens to everything I say”. (sample 8, 31 years old). “They are constantly plotting”. (expert 2). Emotional instability in reports from one of the samples was as follows: “One day he was good; the next day he pushed me and screamed”. (sample 4, 21 years old).
Emotional turmoil due to parental rejection, as a subset of dark personality traits, has been identified as a factor in entering into a abusive  relationship: “My relationship with my family is not good” (sample 8, 31 years old).
The following examples from the experiences of the subjects indicate a sense of “dominance”: “I threatened him”. (sample 8, 31 years old). “I bullied him”. (sample 1, 22 years old). “They have the pattern of a lord and a serf”. (expert 7). 
In dark personality traits, “perfectionism” was examined as a means of further control and humiliation. For example, “I always have a problem with my partner”. (sample 1, 22 years old); “Blames the person for all the violence”. (expert 8).
The problem of distinguishing right from wrong is exemplified by the example of the dark character in sample 4, 21 years old: “Maybe I would have been more cautious if I had gone back”. “They lack foresight”. (expert 4).
In addition to these categories, experts added another category to dark personality traits called “lack of proper social and interpersonal functioning”. “Lack of communication skills”. (expert 5). “Insulting behavior towards attitudes that are against their will”. (expert 7). “The one who hurts has not formed his identity or is in his early stages of formation of identity”. (expert 2). “Lack of will to say ‘no.’” (expert 5).
Problems with emotion regulation
One of the conceptual categories and intervention factors in the phenomenon of abusive  relationships was the problems related to “emotion regulation”. One of the subcategories of this collection is rumination. For example: “I think about him without wanting to”. (sample 1, 22 years old). “Some people have mental rumination problem”. (expert 3).
Another concept in this category was self-blame. For example: “I betrayed myself”. (sample 3, 22 years old). “S/he blames himself or herself”. (expert 2).
Another problem with “emotion regulation” was emotionlessness. For example, sample 7, 24 years old, said: “He suddenly becomes indifferent”. “They become indifferent”. (expert 6).
The last subclass in this category is to avoid and blame others. The reports of some of the participants, including the victims and the experts, were as follows: “I do not want any man to be around me since I’m not ready mentally now”. (sample 3, 22 years old). “I see all the problems through the eyes of my family”. (sample 2, 25 years old). “Every problem is because of my behavior”. (sample 1, 22 years old). “Some people get frustrated with the relationship and no longer experience it”. (expert 5).
Retention factors
One of the conceptual categories in the abusive  relationships was the retention factors, which included material aspects, loss of hymen, family and community pressures, dependence and fear of loneliness, and lack of awareness. The reports of some of the participants, both victims and experts in the current category, were as follows: “I stayed because of his social status”. (sample 1, 22 years old). “We had sex, now I insist on getting married”. (sample 2, 25 years old). “Everyone in the family knew, and that was very important to me”. (sample 2, 25 years old). “When a woman has no job, she has no power and is forced to choose violence or abused”. (expert 1). “There is no opportunity of mistakes for girls”. (expert 2). “Divorce is not common in my family; I have to stay”. (expert 2). “They have a dependent personality”. (expert 7).
Family harms
One of the conceptual classes and contextual conditions was family harm. Parental strictness and control, sexual abuse in childhood, extramarital affairs, psychological problems of the parents, domestic violence, and marital disputes cause the family harm and affect its positive functions. For example: “They forced me to choose someone for me”. (sample 8, 31 years old).
One of the essential concepts underlying the abusive  relationship in this article is child sexual abuse. For example, “My cousin touched me”. (sample 4, 21 years old). “They were abused by aunts, uncles, cousins, etc”. (expert 3).
The extramarital affairs of the parents were reported by one of the samples: “My father was unfaithful”. (sample 4, 21 years old).
Parental psychological problems seem to be another critical finding in this research. For example, “My mother is an aggressor”. (sample 1, 22 years old). “Parents have psychological disorders”. (expert 3).
Other family traumas included marital disputes. For example, “They were always disputing”. (sample 4, 22 years old). “My mom is calm, and my dad is all complaining”. (sample 5, 22 years old). “They have wrecked families”. (expert 2).
Self-defeating behaviors
One of the conceptual classes of abusive  relationships is self-defeating behaviors such as postponement, self-disability, and self-destructive. For example: “I always postponed my study”. (sample 5, 22 years old). “My mother raised us irresponsible”. (sample 5, 22 years old). “He does not have the patience to come to counseling sessions”. (expert 1). “They consider the problems as their destiny”. (expert 2). “They become members of groups who have many high-risk relationships”. (expert 3).
Discussion
Applying grounded theory revealed the critical concepts in explaining the concept of abusive  relationships, including “perceived violence, psychological symptoms, unhealthy relationship strategies, dark personality traits, emotion regulation problems, retention factors, family harms, and self-breaking behaviors”. Each of these classes includes subclasses with specific characteristics. Simultaneously, being in a thematic model with several features such as contextual conditions, causal conditions, retention factors, strategies, and consequences explained the intervening factors of the abusive  relationship’s re-experience cycle.
Domestic violence, abusive  relationship patterns in parenting experiences, controlling, family unfaithfulness, past affairs, rejection and loneliness, and mental disorders in parents had provided influential factors in creating the conditions for people to enter into a destructive relationship.
The study of Repič Slavič and Gostečnik shows that childhood abuse is so involved in a person’s chemical-hormonal system that even if he or she consciously and healthily feels love, belonging, and natural, s/he subconsciously attracts unhealthy people to feel and pursue the same sense of security, familiarity, and naturalness as the experiences s/he had as a child in adulthood [20].
Balaban’s study also showed that emotional and sexual abuse has numerous negative consequences for children and adolescents and is useful in communication in adulthood [21]. Rostami et al. also showed in a study that there was a relationship between experiences of child abuse with personality traits, high-risk behaviors, creating schemas, and subsequent experiences in thinking, feeling, and communicating with others [22]. Lindquist reported about Pakistani Muslim immigrant women’s experience in abusive relationships of rejection and loneliness and past abusive experiences with essential people in the lives of women victims of abuse [9]. The study of Cervantes and Sherman also showed that the habit of abuse prepares the individual for the next abuse in intimate relationships [23]. Ahmadi et al. showed that the “obligation to repeat” compels the person to motivate others in the current relationship so that the same patterns of parental behavior be repeated with her or him [24].
Among the factors that maintain abusive  relationships in the present study are the well-off status of the abuser, sexual harm, the parents’ awareness of the relationship, and the family and community pressure. Among the unique findings in the present study compared to other similar studies, we can mention the pressure of girls’ cultural and social factors in premarital maintaining chastity by maintaining the hymen. The lack of awareness of the family about creating the right time to gain premarital knowledge and insisting on formalizing the relationship early certainly plays a vital role in continuing the abusive  relationship. Paying particular attention to the financial ability of the abuser is also one of the factors that lead to the victim trying to keep on the abusive  relationship for a relatively long time. This finding is in line with the results of some other identical studies [9, 10, 12, 25].
Causal conditions found in the study include fear of loss, skepticism about one’s observations and perceptions, tendency to justify people’s behavior, tendency to believe in love, emotional blackmail, low self-esteem, and feel guilty. People who engage in abusive  relationships seem to feel guilty, doubtful aptly, and non-belief of abuse. They have a false hope of changing the behavior of the emotional partner. They are skeptical of their perceptions of the persistence of abuse, regardless of the situation, and they believe that love and forgiveness can improve their emotional relationship.
The results of some studies have reported similar findings of skepticism about one’s perceptions, a tendency to justify one’s behavior, low self-esteem, and feeling guilty and blame [7, 8, 9]. The present study results showed that victims’ strategies for the challenges posed by the abusive  relationship were as follows: sticky, passive, and obedient behaviors, give-and-take reactions, abuse, overeating, self-defeating behavior, passivity, self-criticism, disconnection and reconnection, and seeking trust.
Findings of many other studies have also shown the substance abuse, self-criticism, self-defeating and suicidal behaviors, passivity, and helplessness in the victims of abusive  relationships [7, 8, 12, 26]. The consequences of experiencing a abusive  relationship in the present study were as follows: decreased social, academic, and executive functions, relationship replacement, becoming abusive, thought-provoking, angry, anxious, low mood, and avoidant. Each time entering in the relationship cycle, the victim may prolog this abusive  relationship. This finding is in line with the results of some studies that have reported negative consequences such as anger, anxiety, low mood, and avoidance [25, 26, 27].
Another result of the present study was a pattern called intervening conditions. The circumstances that increase the experience of harm in this category include disobedience, friends and family intervention, aggression and violence, mistrust, and resolving the issue of emotion. The findings of the study of Beig-Rezaei et al. confirmed the intervention of friends and family and violence and aggression [14]. The tension is an influential factor in the repetitive pattern of the abusive  relationships in women [28]. These study findings showed that the re-experience of abusive  relationships is dynamic, complex, continuous, correlated, and affected by the factors influencing abusive  relationships.
The current study presents hypotheses about perceived violence, psychological symptoms, unhealthy relationship maintenance strategies, dark personality traits, emotion regulation problems, holding factors, family trauma, and self-defeating behaviors in re-experiencing abusive  relationships. Also, it explains the process of re-experiencing abusive  relationships under the influence of the characteristics of the primary variable “phenomenon of abusive  relationships”.
The results of this research can be helpful to individuals, communities, and organizations, especially health, treatment, and medical education. Besides, it is used in other studies, especially studies related to the prevention, treatment, and rehabilitation of people involved in a abusive  relationship. The findings can also be useful for clients of psychological clinics, universities, welfare organizations to treat people at risk of abusive  relationships and holding specialized workshops to train psychologists interested in this area. 
The participants were mostly females, which was a limitation of the study, while it was not possible to express the experiences of male participants equally. Therefore, it is suggested that in future studies, two groups of men and women with equal volume in the sample be examined. Also, the present study was conducted with individuals in unregistered legal relationships, so it is suggested that individuals registered in legal relationships be studied in quantitative research.

Ethical Considerations
Compliance with ethical guidelines
The study were approved by the Deputy of Research and Technology of Islamic Azad University of Tonekabon branch (Ethics Code: IR.IAU.TON.REC.2020.026).
A signed written consent form was obtained from the participants before the study.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors contributions
Conceptualization and Data analysis: Zinat Sadat Mirpour, Mohammadali Rahmani, and Shohreh Ghorbanshiroodi; Writing the original draft and Data collection: Zinat Sadat Mirpour; Reviewing the final edition: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgements
We appreciate the Deputy of Research and Technology of Islamic Azad University, Tonekabon branch. The authors also express their gratitude to all participats.


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