*4.2. Emotional Overload, Emotion Regulation Di*ffi*culties, Impulsivity, and Eating Patterns in Patients with BED*

The second aim of our study was to examine the contribution of emotional overload, emotion regulation difficulties, and impulsivity to eating patterns observed in patients with BED. The evaluated eating patterns were emotional eating and external eating as assessed by the DEBQ [26,27] and the degree of binge eating symptoms and the severity of bingeing and purging behaviors (as defined by their frequency) as assessed by the BITE [25].

Emotional eating was independently associated with age, DERS Non-acceptance subscale score, and UPPS-P Lack of premeditation subscale score. In our study, younger-old adults exhibited more emotional eating compared to older-old ones. This tendency to overeat in response to negative emotions appears to be more frequent in young adults than in older adults and it may be due to an increase in the use of emotion regulation skills with age [40]. The DERS Non-acceptance subscale is related to coping style [11] (p. 337). Coping is generally viewed as an individual's effort (cognitively and/or behaviorally) to adapt to or reduce distress in response to stressful events [41]. Hence, a maladaptive coping style to emotions in patients with BED could trigger an emotional eating pattern. However, in the present study, we did not have the information about what stressful events or negative thoughts patients needed to deal with and what coping styles they usually used. Another dimension contributing to emotional eating was lack of premeditation. This dimension is defined as the tendency to act without thinking and is viewed as presenting deficits in conscientiousness [42]. These deficits could lead to decision-making with little regard to past outcomes or forethought for possible future outcomes. It could also reflect a high tolerance for punishment from maladaptive behaviors (i.e., the negative consequences of these behaviors may not be sufficient to deter individuals with high scores on this dimension) [43].

External eating, corresponding to overeating in response to food-related cues such as the sight and smell of attractive food, was independently associated with the anxiety trait, DERS Impulse control difficulties subscale score, and UPPS-P Negative urgency subscale score. Interestingly, Heeren et al. (2018) found that the trait anxiety can be conceptualized as a single and coherent network system of interacting elements [44]. Noteworthily, they reported that the presence of intrusive thoughts and being unable to get disappointments out of one's mind emerged as the most central features of the trait anxiety network. It could mean that craving induced by food cues and negative affectivity may predispose to this eating style. These features could be linked to the "food addiction" hypothesis [45]. The difficulties maintaining behavioral control when distressed, assessed by the DERS Impulse control difficulties subscale, describe individuals who have very strong feelings that are hard to control [11] (p. 337). Moreover, this subscale specifically focuses on feeling "out of control" in emotionally distressing situations. In our sample, it is another dimension that predisposes patients with BED to eat in response to food-related cues. Negative urgency refers to acting rashly and impulsively when in extreme distress and involves impaired inhibitory control [46]. Patients with BED seem to use palatable food to compensate for negative affect or use food in a comforting fashion to cope with life distress. Taken together, negative affect and cravings induced by food cues increase the likelihood of external eating.

The degree of binge eating symptoms was independently associated with depression score, DERS Non-acceptance subscale score and UPPS-P Lack of premeditation subscale score. Interestingly, two dimensions (i.e., DERS Non-acceptance subscale score and UPPS-P Lack of premeditation subscale score) are the same that for emotional eating. Decision-making with little regard for past outcomes

or forethought for possible future outcomes and a high tolerance for punishment from maladaptive behaviors seem then to also contribute to the likelihood of having a severe binge eating behavior. These results contribute to enriching our understanding of this eating behavior. Moreover, they raise the question of the links between emotional eating and binge eating and of the underlying psychopathology of these eating patterns. Depression severity was also associated with the binge eating behavior as expected based on literature data [22,47].

Finally, the severity of bingeing and purging behaviors was independently associated with the trait anxiety, DERS Impulse control difficulties subscale score, DERS Clarity subscale score, and UPPS-P Negative urgency subscale score. Three dimensions are common with those identified as being associated with External eating (i.e., anxiety trait, DERS Impulse subscale score, and UPPS Negative urgency subscale score). These dimensions are then risk factors for developing a highly disordered eating pattern and a presence of binge eating. However, unexpectedly, there was a reversed link with negative urgency. This may be due to the behaviors assessed by this score. In fact, it provides an index of the severity as defined by the frequency of binge eating and purging behavior. Among the purging behaviors, is the use of fasting. Therefore, we could make the assumption that patients with BED and with low levels of negative urgency may be more prone to using fasting to control their weight. It could be a reason why our two populations of patients (BED vs. wBED) did not differ in current and past BMI. The emotional clarity subscale predicted the severity of bingeing and purging behaviors. This dimension was strongly associated with emotional overeating [39] and could be, in our patients with BED, a risk factor of a high frequency of binge eating. However, this result is to be taken with caution, given the low Cronbach's alpha observed for this dimension in our population.

#### *4.3. Limitations*

This study has several limitations. The main limitation is about the power. If we use the number of cases to estimate the a priori power, we estimate that we can study between 2 to 3 variables (epv = 27/9 = 3; 27/10 = 2.7). Calculating the a posteriori power (post hoc) using the IBM SPSS sample Power software, or using simulations, allows us to determine a power at 88% to capture the effect of the three most influential covariates in our multivariable model. Clearly, we lack the power to study the numerous covariates. To check the result of our main endpoint, we have therefore proposed methods suitable for multivariable analyses on databases with a lack of power, such as penalized regression methods like Lasso [48]. These sensitivity analyses confirm our results (Supplementary Materials Tables S1 and S2), but do not exclude, that the other covariates are not significant partly due to a lack of power. Further studies with more power will be needed to estimate the association of the other covariates with our main endpoint. The same results are also confirmed by the use of Bayesian statistical analysis performed by the BRMS package [49] (Supplementary Materials Table S3) and, further, by selecting the covariates by bootstrapping using the rms package according to the methodology previously described [50]. The three most important parameters retained in the model are BITE symptom subscale (78.69%), DERS strategies (46.03%), and Emotional eating (34.92%). A second limitation is related to its cross-sectional nature; therefore, caution is needed in inferring causality. A third limitation is based on the assessment of BED, depression, anxiety, emotion regulation, impulsivity, and eating behavior styles through self-reports, which are subject to possible biases such as desirability or response bias. However, the validity of these questionnaires has been well supported in previous studies and our reliability indices were satisfactory except for DERS Lack of emotional clarity as mentioned earlier. Moreover, in future studies, these limitations could be overcome by using ecological momentary assessments considering patients' natural environment. Such tools are, for example, validated in nutritional epidemiology and in psychiatry (e.g., depression) [51,52].

#### **5. Conclusions**

The results of the present study suggest that obese patients with BED who are seeking bariatric surgery are characterized by a limited global access to the flexible use of adaptive emotion regulation skills to modulate features of emotional responses. Moreover, in this population, many dimensions of emotion regulation are associated with different pathological eating patterns (with sometimes the same dimension associated with varying patterns of eating), which emphasizes the pleiotropic side of these dimensions. The same results are observed for the anxiety trait and impulsivity. Taken together, our results lead us to believe that patients with BED could benefit from the addition of an emotion regulation intervention, which could significantly improve their eating behaviors before surgery. It could also improve the outcomes of bariatric surgery [53]. Further research is needed to confirm our findings, to implement and evaluate emotion regulation interventions, and to characterize better neural correlates of emotion regulation in patients with BED.

**Supplementary Materials:** The following are available online at http://www.mdpi.com/2072-6643/12/10/3099/s1, Table S1: Results of regularized-method LASSO with inference, Table S2: Results of regularized-method LASSO with inference, Table S3: Bayesian approach: Population-Level Effects title.

**Author Contributions:** F.B., F.G. and S.B. designed the study and wrote the protocol. Z.D., F.B. and F.G. conducted the methodology and statistical analyses. F.B. and F.G. wrote the first version of the manuscript. Z.D., S.B., E.B. and A.K reviewed the different versions of the manuscript and all authors contributed to and have approved the final manuscript. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Acknowledgments:** The authors thank the volunteers who made the study possible through their participation and collaboration. This research constitutes part of the Ph.D. thesis of F.B. at the University of Reims.

**Conflicts of Interest:** All the authors declare they have no conflict of interest regarding the publication of this paper.


4. Conclusion

The research on the front-end receiver designs in the unlicensed 60 GHz frequency band has been going on for several years now. Although a multitude of 60 GHz front-end configurations have been published in literature, they are not consequently optimized for low power consumption. In this context, the multi-port technique has been proposed as an attractive solution enabling the design of low-cost and compact wireless communication receivers at microwave and millimeter-wave frequency bands.

This chapter describes in detail the design of a low-power 60 GHz direct conversion front-end receiver based on the multi-port (six-port) concept, using a less costly MHMIC fabrication process. The demodulation performances of the proposed front-end receiver structure have been experimentally proven through various M-PSK/M-QAM demodulated signals. The obtained demodulation results, demonstrating the ability of the proposed 60 GHz six-port front-end receiver to directly demodulate PSK or QAM millimeter-wave signals to baseband, or even to down-convert them in quadrature to a given intermediate frequency (IF), create a real expansion opportunity to the future compact, low-power, and low-cost 60 GHz wireless communication systems.


**6. Conclusions**

68 Bioinformatics

cell cycle.

7165]

7154]

48518]

65007]

[GO-ID: 7242]

[GO-ID: 51244]

[GO-ID: 6796]

[GO-ID: 6793]

networks a.

Signal transduction [GO-ID:

Cell communication [GO-ID:

Positive regulation of cellular process [GO-ID: 51242]

Biological regulation [GO-ID:

Intracellular signaling cascade

Regulation of cellular process

Phosphate metabolic process

phosphorus metabolic process

**b**. p-Value calculated as an exponential function.

Regulation of biological process [GO-ID: 50791]

Positive regulation of biological process [GO-ID:

in metabolic process and DNA repair process.

could be further classified into two major groups; cell function regulation and signaling of biological process. In contrast HIV-1 infected macrophage gene network was enriched with 10 significant functional categories of a total of 40. The significantly overrepresented categories indicated that this emergent new gene network was composed by genes involved

In this study we simulated at systemic level, the alterations of cellular pathways when HIV provirus integrates into genes by turning them off and produce dysregulation of several local signaling pathways. One of the target gene associated with HIV-1 integration was AKT3, also called PKB, which is a serine/threonine protein kinase family member. It is involved in a wide range of biological processes including cell proliferation, differentiation, apoptosis, stimulating cell growth, and regulating other biological responses (59, 60). Also, it have been identified playing important roles of regulation in the G2/M transition of the

**Normal Network p-value b HIV-1 infected Network p-value b**

3,90E-123 Biopolymer biosynthetic process [GO-ID: 43284]

1,39E-95 Macromolecule biosynthetic process

1,45E-88 alcohol metabolic process [GO-ID:

2,65E-84 Furaldehyde metabolic process [GO-

3,01E-80 Age-dependent response to reactive

cell aging [GO-ID: 1320]

1,40E-86 Maintenance of fidelity during

[GO-ID: 45005]

ID: 33859]

**a**. The description of the gene ontology biological processes and the corresponding gene ontology identifiers are given.

**Table 2.** The top 10 of significant biological process of normal and HIV-1 infected macrophages

[GO-ID: 9059]

6066]

4,63E-120 Metabolic process [GO-ID: 8152] 8,00E-05

1,93E-92 Biosynthetic process [GO-ID: 9058] 2,43E-03

DNA-dependent DNA replication

2,29E-85 Mismatch repair [GO-ID: 6298] 6,24E-03

oxygen species during chronological

3,01E-80 oxidation reduction [GO-ID: 55114] 6,90E-03

6,27E-05

1,40E-03

3,19E-03

6,24E-03

6,68E-03

6,68E-03

We can conclude that a general effect of HIV-1 integrations in macrophages DNA is to disrupt several signaling pathways that control the normal cell homeostasis. Comparison between normal and infected macrophages of top 10 GO function categories showed the dramatic change of one non-infected macrophage whose main cellular functions are devoted to maintain a cell signaling crucial functions, to one infected in which the most important function are macromolecular biosynthetic process, maintenance of fidelity during DNAdependent DNA replication, mismatch repair, age-dependent response to reactive oxygen species during chronological cell aging and oxidation reduction. As HIV infected macrophage is an abnormal reservoir in which the metabolic cascades are altered, it is possible to propose that the metabolism of macrophage adapt to perform survival functions where the apoptotic process is interrupted and a SOS metabolism make that the macrophage change of its life style

*In silico* studies are based upon statistical calculations which permit the drawing of generalizations about a biological process; however since some variables could affecting the *in toto* process, in order to get a real history of Lentivirus integration it would be important to consider that there is another factors, including physiological process and cellular compartments that would be influencing the *in vivo* integration site selection. Some of these are cell-cycle phase, the transcriptional state of the cell, the topology of chromosomal DNA, cell type infected, and presence of co-helper molecules during the PIC complex conformation

By providing these new testable hypotheses we hope that our results will accelerate experimental efforts to define a reliable disturbing in the gene complex relationship by lentivirus integration in PBMC and macrophages which are critical immune cells responsible for a wide range of immune functions and play multifaceted roles in HIV pathogenesis

Systemic Approach to the Genome Integration Process of Human Lentivirus 71

[7] United Nations AIDS Program on HIV/AIDS (2008). Report of the Global AIDS.

[8] Simon V, Ho DD.and Karim QA (2007) HIV/AIDS Epidemiology, Pathogenesis,

[9] Inciardi J.A. and Williams M.L Editor's introduction: (2005) The global epidemiology of

[10] Balakrishnan S (2009) Alternative paths in HIV-1 targeted human signal transduction

[11] Wang YJ, McKenna PM, Hrin R, Felock P, Lu M, Jones KG, Coburn CA and Grobler JA (2010) Assessment of the susceptibility of mutant HIV-1 to antiviral agents. J. virol

[12] Hanson K and Hicks C (2006) New antiretroviral drugs. Current HIV/AIDS Rep. 3: 93-

[13] Moore J.P. and Stevenson M : New Targets for Inhibitors of HIV-1 Replication. Nature

[14] Cereseto A, and Giacca M (2004) Integration site selection by retroviruses. AIDS Rev 6:

[15] Coffin J.M: Retroviridae and their replication In Virology, ed. B.N. Fields et al., Raven

[16] Sierra S, Kupfer B and Kaiser R (2005) Basics of the virology of HIV-1 and its

[17] Hindmarsh P, Leis J (1999) Retroviral DNA integration. Microbiol mol. biol. rev. 63: 836-

[18] Van Maele B, Busschots K, Vandekerckhove L, Christ F, and Debyser Z (2006) Cellular

[19] Bushman F, Lewinski M, Ciuffi A, Barr S, Leipzig J, Hannenhalli S. and Hoffmann C (2005) Genome-wide analysis of retroviral DNA integration. Na.t rev. microbiol. 3: 848-58. [20] Ciuffi A, Llano M, Poeschla E, Hoffmann C, Leipzig J, Shinn P, Ecker JR and Bushman F (2005) A role for LEDGF/p75 in targeting HIV DNA integration. Nat. med. 11: 1287-9. [21] Ciuffi A (2008) Mechanisms governing lentivirus integration site selection. Curr. gene.

[22] Lewinski M, Yamashita M, Emerman M, Ciuffi A, Marshall H, and Crawford G (2006) Retroviral DNA Integration: Viral and Cellular Determinants of Target-Site Selection.

[23] Ferris AL, Wu X, Hughes CM, Stewart C, Smith SJ, Milne TA, Wang GG, Shun MC, Allis CD, Engelman A and Hughes SH (2010) Lens epithelium-derived growth factor fusion proteins redirect HIV-1 DNA integration. Proc. natl. acad. sci. USA. 107: 3135-40 [24] Jordan A, Defechereux P, Verdin E (2001) The site of HIV-1 integration in the human genome determines basal transcriptional activity and response to Tat transactivation.

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**4. Results**

This section presents the results of the qualitative data collection. All of the women who participated in the research said that they had chosen their own partners and all had experienced intimate partner violence within their personal relationships. Only two had remained with their partners. All participants experienced complex negotiation and di fficulties in leaving their partners; rooted in their decision to choose their partners and their fear of the consequences of their decisions. Three themes emerged from the thematic analysis of the interview transcripts. These were women's sense of personal responsibility in choosing their partners; women stayed in relationships longer due to going against social norms; and their relationship with their parents. The themes highlight the many di fferent barriers to leaving the relationship faced by these women. The women carried the "burden" of choosing their partners, which manifested when they looked to leave the abusive relationships. Women also stayed in the relationships longer because of this weight they carried. Women placed huge emotional investment in their relationship with their families, in particular their parents, whether their relationships had broken down with their parents or not. Each of these themes are explored in more detail below:

### *4.1. Women's Sense of Personal Responsibility in Choosing Their Partners*

All research participants expressed a sense of a "burden" they were carrying because of their decision to marry or to be in a long-term relationship with a partner of their choice. This was a decision in conflict with the cultural expectations and norms of their family and community. Jazmin, a 24-year-old British born Muslim woman of Pakistani heritage who was in a long-term relationship with a Muslim man of Iranian descent, blamed herself for her decision and she blamed her partner for the breakdown of her relationship with her family.

### *"Oh, it's like my fault because I chose him, and I wanted to be with him and cos of him I've been disowned"* —Jazmin

Nirvair, a 29-year-old British born Sikh woman who married her husband, a Sikh Indian national, with her family's full support referred to the implications of the fact that the decision to marry her husband was hers solely.

*"It was me who went to them [her parents] and said, "I want to marry him". It wasn't them saying "You have to marry him" and I think for me personally it did. It was quite a big influence on everything."* —Nirvair

Women participants also spoke about how they alone had to resolve the situation because of their decision to choose their intimate partner. Krishna, a 45-year-old Hindu woman with two children, felt it was her responsibility to resolve the situation with her abusive husband.

*"I chose it. I'm the one who, who got myself into this and it's my job to put up with it not everybody else's job to get me out."* —Krishna

All the women expressed a huge sense of responsibility. This reflects an understanding of the wider implications they faced as a result of transgressing the social norm of arranged marriage and choosing their own partner. The women blamed themselves. They felt they would be judged and they had to resolve the situation without asking for any help from their families or others. The family did not play any role in choice of partner and so the women, now facing di fficulties, did not feel they had the right to ask for protection (Mohee 2011).

### *4.2. Women Stayed in Relationships Longer*

Choosing their own partners was a significant factor in understanding the consequences and deciding on whether to leave the partner they had chosen. Many women described how they stayed in abusive relationships longer than they wanted to and made special e fforts to make the relationship work. Some women felt judged by society, felt that they were in the "wrong" and the fear of judgement led them to place importance on staying in their relationship over their own safety. Harjit is a 57-year-old British born Sikh woman who married a Sikh man. Harjit talked about her concerns about the personal costs of her decision to leave him. Harjit explains:

*"* ... *so, part of me thought "No I've got to stick it out and prove that I was right" or I won't be able to deal with erm, almost that, that personal shame of I went through all of that, did that, put my family through that and now I end up with this."* —Harjit

Other women felt that by choosing their partner themselves they had created the situation they found themselves in and so had to continue enduring the abuse from their partners. Their e fforts to make the relationship work had the opposite e ffect. Jazmin stated

*"I thought I can't [leave the relationship], I have to make it work so it's like that saying that they say, "you make your own bed, you lie in it" (laughs). So that's what I tried to do but it—the situation got way out of hand."* —Jazmin

Sara, a 36-year-old British born Muslim woman who was in a relationship with a man of Black Caribbean heritage also spoke about why she endured her partner's violence towards her.

*"I chose to be with him and now I'm in this situation. I have to put up with it. I have to try and make it work."* —Sara

Women endured emotional, financial and physiological abuse as well as physical violence because they regarded their decision to choose their partner outweighed everything else. They reflected on their actions and accountability.

*"I think choosing my own partner* ... *made me feel like I had a responsibility to make that marriage work* ... *I think if he didn't physically abuse me, I think I would have stuck it out* ... *I tolerated it cos I just thought "You know you made the decision to be here"* ... *and I think that influenced a lot of my poorly judged decisions at the time"* —Nirvair

Most of the participants endured one abusive intimate partner relationship. Four women experienced two such relationships where their first intimate relationships were forced marriages and then chose their own partners in the subsequent relationship. Two women experienced intimate partner violence in two relationships, where the perpetrators were partners they had chosen. This factor became significant, especially in the second relationship. Krishna explains.

*"I felt ashamed of myself and especially when it happened second time, that's even worse you feel because then that's the reason I put up with it for eight years because I thought people won't believe me, again. "The story repeats again" that's what I said and now I joke around, and I said "You know what "One time wasn't enough, so I had to dive into a big sea again to feel the water"* —Krishna

Women stayed in the relationships longer to prove to their families and communities that their decisions were correct despite their departure from the social norm of arranged marriage. They put energy into making the relationships work because they did not want to be judged by society a second time for rejecting expectations of them to remain in the relationship. The women's accounts show the depth and influence of valuing success in relationships at all costs (Anitha and Gill 2009). The women's sense of honour and shame enforced such pressures to remain in the relationships at all costs (Siddiqui 2013). The gendered expectations and influence of honour and shame on women who have chosen their intimate partners, when negotiating whether to leave the abusive relationship are hitherto rarely explored within the academy.

### *4.3. Relationship with Parents*

An emerging theme centred on how the women's relationships with their families fared as a result of their rejection of social norms to be in an intimate relationship with a person of their choice. All the women participants talked about the significance of their relationships with their families. The parents of six women were supportive throughout. Parental relationships broke down for the remaining nine, and of these four women were still isolated from their parents at the time of the fieldwork. Their relationships with their parents and siblings were important to them, the bond they had with their families and the personal costs of strong ties with families being severed because of their decision to be in an intimate relationship with a person of their own choosing was devastating to them. Harjit referred to the fear that her family would spurn her on finding out her relationship had broken down.

 You're the one who erm, decided it". or whatever and I certainly missed being able to share what was going on, but I didn't feel that I could for fear of being told "well, no it was your decision"* —Harjit

The close ties of family relationships also manifested in women's reflections of disclosing the abuse to their parents. Samia expressed how momentous an occasion it was:

*"I think it was actually one of the hardest things was to tell my mother what had been happening because I had, I'd chosen him"* —Samia

Samia felt the size and the gender of her family members factored into how she weighed up the risks and consequences of choosing her partner and the consequences of how many family members she had to tell.

*"* ... *I mean for me in a way I only had my mother with whom I wasn't getting on. I had no other family really. I had nothing. All I had was rubbish. I mean I don't mean that—it's just bad you know and to lose my mother was erm was bad* ... *but I've talked to other women who are in similar situation and they couldn't make the choices"* —Samia

In addition to the size of the family, women found their mothers and fathers responded di fferently.

*"So, I do speak to my mum and she's really humble, really. She's forgiven me. She's, she's okay and I'm quite relieved but my father, no, no, no, no for him* ... *still my father is, I think, is very angry* ... *He (Pania's father) says to him[self] I'm a dead person. He doesn't wanna know anything about me* ... *It's like I've killed everything in him,"* —Pania

Some women felt a sense of betrayal and were angry at their parents' lack of support and the subsequent isolation they felt from their families. As their o ffspring, women felt they deserved support. Kiran describes how she regarded her parents' response to her situation and her expectations of them:

*"My parents may not have wanted to support me but to completely remove contact? ... my situation was so bad, it's because of that, that I left and thought they would come round. My husband was hitting me, and it wasn't that they came and cried that their daughter is being treated so badly. Support is about "this is my daughter. She's our blood and we'll care for her and help. So, she made a mistake, never mind." But no "she made a mistake so leave her. She made a mistake, leave her." That's what they said to me. The whole blame is on me."* —Kiran

Women also experienced isolation from their wider community. Krishna describes the comments people made when she attended local community events after splitting up from her husband.

*"I was blacklisted in the whole Indian community. No one would talk to me. I was a bad person and they'll start saying in the public places* ...  What woman is going through deep down"* —Krishna

As well as the community, partners also exploited women's isolation and estrangement from their families further entrenching women's sense of being completely alone. Sara gave an example of the verbal abuse she received from her partner, which became a factor in her staying in the relationship longer.

*""Your family didn't care about you. They didn't support you." Basically, I had to put up with whatever was thrown at me* ... *It was my choice, I did this. I chose to be with him and now I'm in this situation. I have to put up with it. I have to try and make it work."* —Sara

Not all of the participants' relationships with their parents had deteriorated. Some women described the emotional support and response they received from their parents. Renaisha is a 38-year-old woman of Indian heritage who has two children aged 14 and 12. She described her parents' response to her when she told them about the domestic violence she had su ffered for 17 years.

*"* ... *my parents didn't know for seventeen years but when they realised they were extremely supportive. "No, you don't deserve a life like this. You need to leave* ... *This is not a marriage. This is not what marriage is."* ... *Amazingly, (starts crying) I think that the first thing I, I was expecting to hear from my mum and dad that "we had told you" and I was shocked and to this day they have never mentioned it."* —Renaisha

Renaisha was not expecting the reaction she received from her parents. Other women such as Krishna and Anita received mixed messages from their parents and overall found their parents to be supportive:

*"I cried so much to my mom over the phone and I said "Mom, I don't know what to do." I didn't go into details with my mom. I said, "Mom I can't live in this abuse anymore" and my mom goes "I told you not to go." She said "It doesn't matter I'm still here for you, we're all here for you. Why did you put up with it second time? We told you not to put up with any abuses"* —Krishna

Others simply did not want to o ffer an opportunity for their parents to add to abuse their partners. Anita, a 31-year-old woman of Pakistani heritage explained.

*"I never told my parents about that relationship because erm it was—there was nothing in that relationship worth telling my parents for* ... *actually the last thing you want is someone to sit there and slag o*ff *your partner to you"* —Anita

Parental involvement regardless of level of participation remains significant within the arranged marriage practice (Pande 2015). The women in this study did not involve their parents in their decision-making. However, the women's responses show that both they and their parents are socialised in the practice of arranged marriage and both are negotiating changes to this cultural norm as a

consequence of the women choosing their own partners. The power imbalances within families remain, illustrated by the way women expected their parents to behave, wanted them to behave, or were surprised by their responses. There is a gap in the literature that looks at the relationship between women and their parents when women have chosen their own partners and their subsequent experiences of domestic abuse within the intimate relationship.

### **5. Discussion—"Should I Stay, or Should I Go?"—Barriers to Leaving**

Black Feminism provides the lens to understand and analyse the complexity of South Asian women's decision making when faced with a violent intimate relationship when they have chosen their own intimate partners. It is through the centring of women's voices and deconstructing their responses that an understanding of the context of their lives comes about (Cho et al. 2013). The angle of vision spotlights the lack of protection the women experience from families and face ostracism and isolation as a consequence of transgressing the cultural norm of arranged marriage (Bano 2010; Siddiqui 2016; Thiara 2013). Black feminists have highlighted the cultural and gendered contexts of honour and shame that situate South Asian women's experiences of both familial and intimate partner violence as violations of human rights (Patel 2013; Siddiqui 2014, 2016).

The women's responses suggest that the agentic act of choosing a partner became the key influencing factor in their decisions whether to remain or leave the violent and abusive intimate relationship. Women referred to having to "prove" to their families they had made the "right" decision and could make the "right" decision by enduring many more years of the abusive relationship than they would have done in a relationship approved and sanctioned by their family. Their agency in forming the intimate relationship became the very barrier to exercising agency to leave the violent relationship; a paradox. An arranged marriage would have been seen as a collaborative decision with responsibilities shared between the woman and her family and with familial support if the relationship faltered (Gill and Harvey 2017, p. 85). In her study of South Asian Muslim women negotiating marriage and their identities, (Mohee 2011) found that some women did not choose their own partners because they would lose the protection of their families if those marriages did not work out and also they could not attach blame to their parents. In contrast, the women in this study did not have this "safety net" because their intimate relationships were not a collaborative family decision but an individual choice. The connection between family support and arranged marriage shows how the barrier to leaving the violent relationship comes about and how women's vulnerability stems from not having complied with social norms.

The women remained in relationships for longer periods in order to try to convince themselves and their families that they were originally justified in forming the intimate relationship of choice and thus transgress the cultural norms of arranged marriage. Fearing a second rejection, staying in the relationship longer, and fearing judgement from the community and family, all point to a desire to prevent further experiences of conflict with the family, stemming from pressures to maintain patriarchy through the gendered nature of dishonour and shame. Thus demonstrating the pressure women continued to feel to conform to social constructs of honour and shame despite transgressing social practice of arranged marriage; another paradox.

The women themselves considered their agentic act of choosing their own partners as one of transgression. They could not separate out the act of choosing a partner from the socialisation of arranged marriage and associated honour and shame. Having chosen their partners they continued to be enmeshed in the sense of dishonour and shame they had brought onto their family as a result of their rejection of cultural norms concerning intimate relationships (Sen 2005). Furthermore, the breakdown of the relationships gave credence to the belief that choosing partners outside of arranged marriage is flawed. Such violation of patriarchal power in turn gave legitimacy to the domestic violence against them by both their families and their partners (Siddiqui 2013). The belief systems are so entrenched that the women, despite being victims, punish and blame themselves for the domestic abuse they experienced (Kelly 1988). Thus, the threats of losing respectability in the community (Siddiqui 2013) and being ostracised from the family (Bano 2010) are just as powerful when leaving a relationship, especially an abusive one, as when forming it.

The women chose their partners amidst power imbalances within their families. Power relations within the family, including parents, siblings, and extended family members, and community pressure can leave women vulnerable and with no or little power as agentic subjects (Anitha and Gill 2009; Wilson 2006). Harjit's phrase "I went through all of that, did that, put my family through that and now I end up with this" reflects multiple, complex and contradictory layers of agency and negotiation of cultural norms (Anitha and Gill 2009; Wilson 2006). Such differential power portrays how women can perceive a mother's power over them as well as that of their partners (Yuval-Davis 2011). Women's responses to power varied depending on whether their mothers or intimate partners were exercising power over them. They applied a differential factor; they were still beholden to their mothers in a way they were not to their partners. A socially constructed trait of expected behaviour on women is to put their family's interests above their own (Gill and Harvey 2017). Fear of rejection from a mother was greater than from a partner.

Women participants recognised that only having women members of the family to answer to was safer than where there were both men and women family members.  This can also be extended to the women's expectations towards their fathers as the patriarchal head of the family—an internalisation of gendered norms. Such gendered differences amongst parents reflect power imbalances between mothers and fathers and the expected gendered norms of marriage (Patel 2003b). Fathers, as patriarchs, are conduits of those expectations and have the power to decide who, and who is not, part of the family. By ostracising and isolating their daughters, as though they never existed and had no right to be part of the family because of shame they had brought on the family, fathers redeem honour in the community (Sen 2005). The ultimate consequence for a daughter and the show of power by the father is to cut the daughter off from her family.

The conformity to socially constructed traits of gender meant that Harjit put her family's interests above her own, in the negotiation to leave the abusive relationship (Gill and Harvey 2017). Harjit's choice of partner was both inside and outside culturally expected norms. Marrying someone of the same religious and cultural background placed her within cultural and gendered expectations. However, marrying someone outside of the arranged marriage practice and in extreme public defiance of her mother placed Harjit and her mother outside of cultural and gendered norms. Mothers are held responsible for their daughters' transgressions in the eyes of the community (Bhopal 2011). As well as the acts themselves, it is the public knowledge of such violations of "izzat" that causes families to experience "sharam" and dishonour in the face of the community (Toor 2009). With the community knowing about the women's perceived transgressions and the women's fear of being judged by their community, the women stayed in the relationships longer than they would have had they had an arranged marriage. The women had been judged once already. They remained in the abusive relationship longer because they feared further ostracism, shame, and stigma within the family and community (Thiara 2013) in addition to the ostracism, shame and stigma they were experiencing because they had formed intimate relationships. Control and power over the women extended into the public sphere (the community) as well as the private sphere (family and intimate partner). Women feared shame both within the family and outside of it. The women may have broken social norms by marrying their partners of choice but they were still tied to cultural beliefs of codes of honour and were punished by others (Chakravarti 2005; Coomaraswamy 2005; Siddiqui 2005) and at the same time castigated themselves. Their penalty, along with their admonishment, was to stay in the relationship longer. The women felt they did not deserve the support of their families; but were also resisting social norms, beholden to and influenced by them at the same time (Mahmood 2005).

The women's resilience was realised in surviving the everyday realities of domestic violence from their chosen intimate partner and convincing themselves to remain within the relationship. Leaving the relationship (and thereby resisting intimate partner domestic violence) in many cases led to further isolation and abuse from their parents, siblings, and extended family, as well as the intimate partner. Responses to domestic violence and abuse within di fferent relationships and at di fferent times can seem contradictory in nature. The context of women's survival and their negotiation within and in relation to violent relationships is complex (Patel 2003b). Leaving one oppressive relationship can be exploited and lead to further subjugation from a subsequent oppressive relationship. Intimate partner perpetrators can subjugate women, who have left previous violence and abusive familial or intimate partner relationships.

Parental support of women in itself also became a barrier to women disclosing the abuse to their parents. Renaisha stayed in her marriage for 17 years, experiencing domestic violence and abuse, before finally telling her parents. The enforcement of honour carried out by families can be pervasive in nature and result in severe consequences for women (Patel 2003b). The opposite is the redemption of honour, saving women from the "sin" of transgressing social norms where families "forgive" the women and are supportive. This too became a barrier to women leaving the relationship. Renaisha's prolonged hesitancy to disclose the violence she was experiencing to her family illustrates the deep entrenchment of the socialisation of arranged marriage and honour and shame. She feared that by admitting that her relationship was a "failure", she would evidence her poor decision making in the eyes of her family and community.

By choosing their own intimate partners, the women rejected the societal objective to secure and preserve status within the family, kinship, and communities (Bhopal 2011). However, the women were not immune to the social constructs of honour and expectations on them to preserve family honour, respect and pride (Gill and Brah 2014; Toor 2009) even after contravening the social norm of arranged marriage. Faced with consequences such as ostracism from family and community (Gill and Brah 2014; Sen 2005; Siddiqui 2013) they stayed in abusive relationships longer. Women's experiences of patriarchal constraints within families showed how contested the area of intimate relationships are within families to ultimately control women's bodies and lives (Anitha and Gill 2009; Wilson 2006). The result was that the very act of choosing their own intimate partner became the barrier to leaving the abusive relationship. This paper has added to the literature on domestic violence to show how gendered norms and expectations of South Asian women when forming an intimate relationship also apply to when they leave a violent relationship, despite transgressing social norms.