Trauma reflections: an interpretive phenomenological analysis of pellet-gun victims' experiences in Kashmir

ABSTRACT

This study explores the lived experiences of pellet gun victimization among individuals in Kashmir using a phenomenological approach. Ten participants directly exposed to pellet gun violence were interviewed. Interpretive Phenomenological Analysis was used for data analysis. Physical injuries led to severe emotional dysregulation, including irritability, aggression, and frustration. Victims reported disrupted eating patterns and psychological trauma. Their self-identity was deeply affected, marked by role reversal, temporal disconnection, guilt, and worthlessness. Economic struggles emerged as a major challenge. Academically, vision loss and trauma-induced distress resulted in diminished motivation and uncertainty about continuing education. Socially, many victims faced victim-blaming, though parental support served as a crucial resilience factor. Spiritual beliefs and religious practices, like prayer, helped individuals cope, avoid self-harm, and stay resilient during hardship. The study highlights the need for trauma-informed interventions, social inclusion programs, and faith-based approaches to support survivors of pellet gun.

Introduction

The region of Kashmir, situated at the crossroads of South and Central Asia, has been a major point of territorial conflict between India and Pakistan, since 1947, leading to wars in 1962, 1965, and 1971–1972 (Ganguly & Brown, 1996; Ganguly, 1997; Wenning, 2003). Today, it is divided among India (Jammu, Kashmir Valley, Ladakh), Pakistan (Gilgit, Baltistan), and China (Shaksgam, Aksai Chin).

The princely state of Jammu and Kashmir, with its diverse religious and ethnic composition, became a focal point of territorial disputes between the two newly formed countries, India and Pakistan, after independence from British rule in 1947. A princely state refers to a territory or region in which a local ruler, often referred to as a prince or maharaja, held significant political power and ruled semi-autonomously under the suzerainty or nominal control of a larger imperial power. During the 1947 partition of India, when India gained independence from British rule and was divided into India and Pakistan, the princely states had to choose whether to join India or Pakistan or remain independent. This led to a complex and often contentious integration process, involving negotiations between the rulers of these states and the leaders of the newly independent countries. The princely states of Jammu and Kashmir are notable examples of this challenging integration process. During the partition, the existing ruler decided to accede to India, leading to the deployment of Indian forces in the region and the subsequent conflict between India and Pakistan over Kashmir.

Historical records indicate that the conflict has remained largely unchanged over the past two decades. Despite numerous submissions, declarations between nations, and mediation efforts by the United Nations, the United States, and the Soviet Union, it remains unresolved. Over the decades, the conflict in Kashmir has manifested in political, social, and economic dimensions, marked by periods of insurgency, military intervention, and political unrest (English, 2015). The territorial dispute has led to a complex and prolonged conflict that has significantly impacted the lives of the local population.

Amidst political struggles and territorial disputes, the civilian population of Kashmir has borne the brunt of the conflict, experiencing widespread human rights violations, displacement, and exposure to violence. The persistent and enduring nature of the conflict has resulted in a population deeply affected by trauma, with individuals and communities grappling with the psychological consequences of prolonged exposure to conflict-related stressors.

Pellet victimization and trauma

The year 2010 was marked by intense conflict in Kashmir between civilians and the military. During this period, the Government of India deployed pellet guns to control violent protests (David, 2017), which. resulted in multiple fatalities, numerous injuries, and severe psychological trauma, including post-traumatic stress disorder (Dar & Iqbal, 2020). Against the backdrop of the longstanding conflict in Kashmir, pellet guns have emerged as a highly contentious and controversial tool for maintaining law and order (David, 2017).

People in Kashmir have reported traumatic experiences during the conflict, which serve as potential risk factors for PTSD. These experiences include losing a family member to death or disappearance, witnessing distressing media coverage of the conflict, and experiencing fear or threats to life (Bhat & Rangaiah, 2015). Women in Kashmir have also faced social exclusion due to the ongoing unrest in the valley (Sarvesh, 2024). A qualitative study found that young adults exhibit psychosomatic symptoms, anxiety, social withdrawal, a sense of loss, stress, and substance abuse as significant consequences of conflict (Bhat & Meenai, 2018). Parents who lost their children during the armed conflict displayed symptoms of distressing illusions – such as hearing, seeing, and sensing the presence of the deceased – and exhibited maladaptive bereavement (Bhat & Gul, 2024). Notably, before the armed conflict, reports of psychiatric issues among them were minimal (Yaswi & Haque, 2008). Research has highlighted the gendered impact of armed conflict (English, 2015; Kazi, 2010; Qayoom, 2014). Women coping with trauma in conflict zones face complex and varied challenges. The conflict has significantly increased the number of Kashmiri women becoming widows (Mir et al., 2023). Their post-loss experiences are marked by stress and violence, often perpetuated by family members (Mir et al., 2023).

Research on the mental health impact of the Kashmir conflict highlights significant psychological distress across various populations. Bereaved parents experience profound traumatic grief and rely on social support and religious practices to cope (Bhat & Gul, 2024). Schoolchildren in Kashmir exhibit a higher prevalence of mental disorders compared to those in other Indian states, with anxiety, mood disorders, and behavioral issues being the most common. These conditions are influenced by ongoing political conflict and a lack of sufficient mental health resources (Paul & Khan, 2019). Among young adults, nearly half display PTSD symptoms, particularly those who have endured severe conflict-related events, emphasizing the urgent need for mental health services in educational settings (Bhat & Rangaiah, 2015). In the general adult population, nearly half experience mental distress, with high rates of depression anxiety, and PTSD – particularly among women, youth, the elderly, and individuals with lower socioeconomic status (Housen et al., 2017; Slovak & Singer, 2001).

Additionally, curfews exacerbate stress, anxiety, and depression by restricting movement, economic activity, and access to essential services, further deteriorating mental health in the region (Bhat & Meenai, 2018).

Pellet gun fire cartridges contain hundreds of small metallic pellets that disperse widely upon firing. While intended to be non-lethal, they can cause significant harm, including blindness and other serious injuries (Mushtaq et al., 2016). Although extensive research has been conducted on the psychological and social impact of the armed conflict in Kashmir – particularly concerning the use of pellet guns – several critical areas remain unexplored. Existing studies primarily document the prevalence of PTSD, stress, social withdrawal, and other psychiatric issues among the general population, with a specific focus on women and young adults (Bhat & Gul, 2024; Bhat & Meenai, 2018; Bhat & Rangaiah, 2015). However, there is a significant gap in qualitative research that captures the personal narratives and lived experiences of pellet-gun victims. People living in conflict zones experience profound trauma, stigma, discrimination, social exclusion, and victimization, all of which deeply impact their lives. Trauma associated with victimization is often intertwined with everyday struggles, including fear, grief, stress, anxiety (Buggs et al., 2022; Leeb et al., 2022), and insecurity. The ongoing violence and insurgency in the valley have far-reaching effects on the population, influencing various aspects of their daily lives. Over the decades, the conflict has progressively deteriorated living conditions, disrupting generations and eroding the once-peaceful environment of the valley.

In the volatile landscape of Indian-administered Kashmir, the haunting echoes of trauma resonate through the lives of pellet victims – each injury telling a story of pain and resilience. While global attention remains fixed on the political dynamics of the conflict, this study delves into the personal narratives of individuals whose lives have been permanently altered by pellet injuries. Through a phenomenological approach, it explores the intricate and nuanced aspects of their experiences. The primary aim of this study was to examine the lived experiences of pellet gun victimization among individuals in Kashmir, with a particular focus on understanding the physical, emotional, social, and economic impacts of such experiences.

Methods

Interpretative phenomenological analysis (IPA) (Smith, 1996) was chosen as the qualitative approach to explore the meaning of pellet victimization among those who had directly experienced the incident. This method specifically focuses on the personal experiences (Shinebourne, 2011) of individuals directly affected by pellet-gun fire – meaning those who were hit by the pellets. This approach does not include the experiences of bystanders or passive observers.

Through interviews, IPA enables researchers to deeply explore the lived experiences and personal interpretations of victims who suffered gunshot wounds. The interpretative process in IPA employs double hermeneutics, wherein participants make sense of their own experiences, and the researcher, in turn, interprets these meanings (Smith et al., 2003). IPA integrates elements of symbolic interactionism (Denzin & Brown, 1995), hermeneutics, and theoretical commitment (Smith et al., 2003). Symbolic interactionism, a sociological theory, suggests that people's actions are shaped by the meanings they attach to things, which emerge from social interactions and are continuously constructed and modified through an interpretive process. These meanings are dynamic, evolving over time. IPA acknowledges that research is inherently interpretative, involving both the researcher and participants in meaning-making processes (Shinebourne). Grounded in phenomenology, IPA seeks to describe lived experiences from an individual's perspective while avoiding the imposition of pre-existing theoretical assumptions (Smith & Osborn, 2015). By integrating these elements, IPA provides a comprehensive framework for understanding the complex and deeply personal experiences of pellet-gun victims in Kashmir, making it a well-suited methodology for this research.

Sample

A total of ten participants were recruited for this study, consisting of eight males and two females. During the recruitment process, 16 individuals were approached, of whom six declined to participate due to personal reasons or unwillingness to discuss their traumatic experiences. There is no definitive guideline regarding the sample size for interpretative phenomenological analysis (IPA) research (Pietkiewicz & Smith, 2012; Smith, 2011). In this study, the sample size was determined based on the number of cases that would allow for a comprehensive examination of both the similarities and differences among pellet gun victims and an in-depth understanding of the personal significance of the event for each participant. Participants' ages ranged from 18 to 36 years, with an average age of 25. Additional demographic details, such as occupation, education, and marital status, are provided in Table 1. The inclusion criteria were: (a) being 18 years or older. (b) Having been directly exposed to and injured by pellet gun violence. (c) Having completed at least a high school education.

Table 1.

Shows the details of the participants.

Serial No.	Name	Age	Gender	Educational qualification	Marital status
1	Masrat	22	Female	Graduate	To be married
2	Amir	20	Male	Post Secondary	Unmarried
3	Suhail	18	Male	12th grade	Unmarried
4	Ashraf	35	Male	10th Grade	Married
5	Shafi	18	Male	10th Grade	Unmarried
6	Omer	25	Male	12th Grade	To be married
7	Hanan	18	Male	10th class	Unmarried
8	Zeba	18	Female	10th Grade	Unmarried
9	Waseem	36	Male	Graduate	Married
10	Rouf	19	male	Post Secondary	Unmarried

The rationale for focusing specifically on pellet gun violence, rather than including participants with other types of traumatic experiences, lies in the distinct nature of the injuries and psychological outcomes associated with pellet gun use. Pellet guns, frequently deployed in conflict zones like Kashmir, cause unique injury profiles, such as ocular trauma leading to partial or complete blindness. These injuries are linked to severe and lasting psychological consequences, including PTSD, anxiety, and depression (Bhat & Rangaiah, 2015; Dar & Iqbal, 2020; Yaswi & Haque, 2008). By isolating the impact of pellet gun injuries, this study aims to more accurately assess the specific mental health outcomes associated with this form of violence. This targeted approach ensures that the findings are directly attributable to pellet gun violence, facilitating the development of specialized therapeutic interventions and public health strategies. Furthermore, this focus enables a more precise examination of the social, economic, and emotional burdens affected individuals face – burdens that may differ significantly from those experienced by victims of other types of traumas.

Procedure

Prior to data collection, ethical clearance was obtained from the Institutional Review Board of the Pellet Victims Welfare Trust, Kashmir. A formal letter detailing the study’s objectives was submitted to the Head of the Trust to ensure a clear understanding and secure the necessary assistance. Upon approval, the authors prepared a pamphlet to recruit participants voluntarily. Interested individuals were provided with an overview of the study, and those who provided written consent participated in the interviews.

A semi-structured interview schedule with open-ended questions was used to encourage participants to share their experiences (see Appendix). Each interview, lasting between 60 and 90 min, was conducted after obtaining both written and audio-recorded consent. The first author facilitated the interviews by asking questions and providing prompts, while the second author recorded the sessions and took field notes to ensure a smooth flow without disruptions. For participants unable to sign, a stamp pad ink alternative was provided. Confidentiality was strictly maintained, and participants were assured that the collected data would be used solely for academic purposes, ensuring ethical integrity throughout the research process. Participants received a remuneration of 500 INR. The participants' responses were transcribed verbatim for analysis (Figure 1).

Figure 1.

Shows the conceptual framework of the study.

Measure

The initial interview questions were developed by the first author, who designed a semi-structured interview schedule to explore the lived experiences and psychological impact of pellet victimization (see Appendix). The first author has extensive academic and research experience in qualitative methodologies, particularly in interpretative phenomenological analysis (IPA).

The development of the interview schedule followed these steps:

• Literature review: The researchers conducted a comprehensive review of existing literature on trauma, victimization, and specifically pellet gun violence. This review helped identify key themes and gaps in the current knowledge, which informed the development of the interview questions.

• Conceptual framework: Based on the literature review and research objectives, the researchers established a conceptual framework. This framework guided the formulation of interview questions to ensure alignment with the study’s goals. It included aspects such as physical and emotional experiences, changes following the incident, coping with life demands, social relationships, and financial impacts.

• Developing open-ended questions: The interview schedule was designed to be semi-structured, allowing for flexibility and depth in responses. Open-ended questions were crafted to encourage participants to share their personal experiences and narratives. These questions aimed to elicit detailed and rich descriptions of their experiences.

• Creating prompts for each question: To ensure comprehensive coverage of each topic, specific prompts were developed for each main question. These prompts helped guide the conversation and ensured that all relevant aspects of the participants’ experiences were explored. For example, Main Question: What was the experience of a pellet attack like for you? Prompt: What physical and emotional experiences has a pellet attack had on you?

• Pilot testing: The interview schedule was pilot-tested with a small group of individuals who had similar experiences but were not part of the main study. These pilot participants were recruited through community organizations on a voluntary basis. They were screened for eligibility, provided with detailed information about the pilot test, and gave informed consent. Researchers administered the interview schedule during the pilot test, observed any issues, and collected participant feedback. This feedback was then used to refine the questions, ensure clarity, and adjust the prompts, enhancing the overall quality and reliability of the interview schedule for the main study.

• Finalizing the interview schedule: The interview schedule was finalized based on the pilot testing and feedback. It included five main questions, each with several prompts to guide the conversation. The questions covered various aspects of the participants’ experiences, including physical trauma, psychological reactions, changes in interpersonal relationships, and economic impacts.

• Conducting the interviews: Conducting the interviews in person allowed the interviewer to observe non-verbal cues and build rapport with the participants, enhancing the quality of the data collected.

Analysis

Initially, both authors closely read the transcripts and listened to the audio recordings multiple times independently. This data immersion process helped recall the interview atmosphere and setting, providing deeper insights into the participants' experiences. Detailed notes were taken on observations, reflections, and significant thoughts, focusing on content, language use (such as metaphors, symbols, repetitions, and pauses), context, and initial interpretative comments. Next, the semantic content and language use were examined at an exploratory level. This process fostered a growing familiarity with the transcripts and enabled the identification of specific ways in which participants articulated, understood, and reflected on their victimization experiences. Following this step, both authors cross-checked their notes to reach a consensus. Discrepancies in initial notations were resolved through a systematic process of discussion and negotiation. In cases of disagreement, the original transcript was revisited to reassess the initial notes. The goal was to develop a comprehensive and detailed set of notes and comments on the data, identifying abstract concepts and patterns of meaning. Subsequently, the notes were transformed into emergent themes through collaborative analysis. This stage involved prioritizing the notes over the transcripts to formulate concise thematic phrases at a higher level of abstraction while ensuring they remained grounded in the participants' accounts. This approach exemplified the hermeneutic circle, wherein understanding was developed iteratively. The primary task was translating the notes into themes that encapsulated both the participants' original words and the researchers' interpretations. Relationships between themes were then explored, and themes were clustered based on conceptual similarities, with descriptive labels assigned to each cluster. Themes that did not align with the emerging structure or lacked a strong evidential base were excluded. This process included developing a visual representation, such as a thematic chart or map, to illustrate the interrelated themes and reassess their significance within the broader research question.

After this, the process of abstraction was applied to identify patterns among emergent themes, leading to the development of superordinate themes. This step entailed recognizing higher-order relationships and distilling overarching themes that encapsulated the essence of the participants’ experiences. Once one case was analyzed, the process was repeated for subsequent cases, with each case analyzed independently to maintain its integrity. This bracketing approach ensured that themes were not imposed prematurely across cases. Finally, cross-case analysis was conducted to identify connections and refine the overall thematic structure. Themes were reconfigured and relabeled as needed to maintain consistency with the participants’ verbatim accounts. This iterative and rigorous process reinforced the reliability and depth of the analysis. By adhering to these steps, the researchers provided a thorough and nuanced interpretative phenomenological analysis of the trauma experiences of pellet-gun victims in Kashmir.

Robustness and validity

The final coding of themes was established through a collaborative process. Both authors independently analyzed the data before cross-checking each other's notes to reach a consensus on the themes. This process involved regular discussions and negotiations to resolve any discrepancies. In cases of disagreement, the authors revisited the original transcripts to reassess their initial notes and interpretations, ensuring that the final themes accurately reflected the participants' experiences. Discrepancies in coding were systematically addressed through structured discussions. Specifically, when disagreements arose, the authors returned to the original data to verify and refine their initial interpretations.

Positionality statement

We acknowledge that our personal experiences and professional backgrounds may influence our perspectives and interpretations. While we have no direct experience with trauma and violence, our understanding has been shaped by media coverage and academic discourse. We have maintained a reflexive stance throughout the research process, engaging in regular discussions and peer debriefings to examine our assumptions and interpretations critically. Our approach prioritizes understanding how individuals perceive and discuss their experiences rather than categorizing phenomena based on predetermined frameworks or scientific criteria. This process involves ‘bracketing’ our preconceptions and allowing the participants' lived realities to emerge organically. We strive to authentically represent their experiences without imposing our own assumptions. We are deeply committed to amplifying the voices of the participants, ensuring their narratives are conveyed accurately and respectfully. By focusing specifically on pellet gun violence, we aim to provide a nuanced understanding of the psychological and social challenges faced by victims. Both authors have expertise in qualitative methods, particularly interpretative phenomenological analysis (IPA). They have conducted and analyzed in-depth interviews using IPA to explore lived experiences and meaning-making processes across various research contexts.

Results

Physical trauma

Emotion dysregulation

Participants who have experienced pellet victimization exhibit significant signs of emotion dysregulation, highlighting the profound emotional impact of physical trauma. Many struggle with increased irritability and aggression, often becoming short-tempered and easily frustrated, indicating difficulties in managing emotions. Feelings of helplessness and frustration further underscore their emotional distress. Additionally, changes in appetite – such as a loss of interest in food, alternating between not eating and overeating, or perceiving food as tasteless – reflect the deep connection between emotional turmoil and physical well-being. Some participants report an inability to eat, experiencing nausea at the sight of food, and a preference for liquids, further illustrating the somatic manifestations of their distress. Intense feelings of pain, unhappiness, and profound anguish are prevalent, emphasizing the severe emotional burden they endure.

‘I have noticed that I have become short-tempered since this incident. I get irritated and react aggressively over small things, only to realize it later. My eyes remain red most of the time. I feel helpless, frustrated, and irritated because of this disability.’ (Participant 1)

‘Earlier, my appetite was normal. However, after this incident, I remember not being able to eat for two days. I consulted my doctor about this issue, but the medicine had little effect. I still don’t feel like eating.’ (Participant 3)

‘There are days when I don’t feel like eating, and other times I overeat.’ (Participant 4)

‘My parents often force me to eat, but food tastes bland to me.’ (Participant 7)

‘I feel immense pain and anguish in my heart. I am unhappy with my condition.’ (Participant 9)

‘I don’t feel like eating. The moment I see food, I feel nauseous. I only consume liquids.’ (Participant 10)

‘Several bullets hit my face, abdomen, and chest; blood oozed from my eyes. I lost my balance and fell—I felt as if I were dead. The pain was unbearable because these guns fired unpredictably, with no clear path. My right eye has lost vision.’ (Participant 5)

‘The pain in my body takes me back to the moment I was hit. I try not to think about it, but I can't stop myself from remembering that incident.’ (Participant 2)

‘When I’m in pain and alone, I start recalling that incident.’ (Participant 4)

Identity confusion and role reversal

Participants experienced a profound impact of physical trauma on their sense of identity, leading to significant confusion and a sense of role reversal. Many struggled to recognize themselves due to disfigurement and vision loss, creating a disconnect between their past self-image and present reality. The noticeable changes in their physical appearance often reinforced this struggle. Additionally, the transition from independence to relying on family members for support further highlighted the reversal of roles and its impact on their sense of self.

‘After my recovery, I could not recognize myself when I saw my face in a selfie. I partially lost my eyesight, and my vision is so poor that I cannot see small objects on the floor of my room, often stepping on them by mistake.’ (Participant 6)

‘I want to die; my face is severely disfigured. I have lost my beauty. Why should I live? After losing my beauty and my eyesight… the world feels dark.’ (Participant 7)

‘No, I cannot drive anymore, so I sold my car. I am completely dependent on my parents, wife, and brothers. I can no longer support myself; instead, they have to support me. It has affected my entire family. Pellet shots destroyed my dreams and hopes. This disability has made me feel helpless.’ (Participant 4)

‘At this age, I should be taking care of my parents, but instead, the situation is reversed—I am dependent on them. I never imagined this would happen. I always thought I would support my parents, but now I feel like I am good for nothing.’ (Participant 6)

Perceived dependency

Pellet victims experience a profound sense of dependency because of their severe physical injuries. This dependency manifests in multiple ways. (1) Physical dependency: many victims struggle to perform daily activities independently due to their injuries. Vision impairments and mobility challenges make navigation and task completion difficult, often requiring assistance from others. (2) Emotional dependency: victims rely on others for emotional support to cope with trauma and distress. The need for companionship becomes essential in fostering a sense of safety and reassurance. (3) Financial dependency: the inability to work due to injuries forces victims to depend on family members for financial support, adding to their sense of helplessness. The following narratives illustrate the physical, emotional, and financial dependency experienced by pellet victims.

‘No, I can no longer drive, so I sold my car. Now, I am entirely dependent on my parents, wife, and brothers.’ (Participant 4)

‘My vision is so poor that I cannot see small objects on the floor of my room, and I often step on them by mistake.’ (Participant 6)

‘Since the incident, I am afraid to go outside. I cannot stay alone in a room—I need someone with me at all times.’ (Participant 5)

‘When I am in pain and alone, I start recalling that incident.’ (Participant 4)

‘I can no longer support myself. Instead, I am completely dependent on my family, and this has affected them as well.’ (Participant 4)

‘At this age, I should have been taking care of my parents, but instead, I am dependent on them.’ (Participant 6)

Loss of educational aspirations and occupational independence

This theme emerged prominently in participants' narratives. Pellet victimization significantly impacted students’ educational aspirations, causing doubts about their ability to continue their studies or maintain their occupations. While some participants expressed a desire to resume their education, parental concerns about their safety often acted as a barrier. Additionally, a lack of academic motivation, financial instability, and feelings of guilt emerged as key sub-themes.

Lack of academic motivation

Victims' statements highlight the significant impact of pellet injuries on their educational aspirations and life goals. They express deep concerns about their future and struggle with self-doubt regarding their ability to continue their studies after experiencing vision loss due to the injury.

‘I was hit in the face and lost my vision. I worry about my future. I was a brilliant student, but now I doubt whether I can continue my studies. This disability has taken me away from my aspirations.’ (Participant 1)

‘I was in 10th grade when I got injured, and after that, I dropped out. Sometimes, when I get bored at home, I pick up my books and try to read, but I struggle to see the letters clearly—everything looks blurred.’ (Participant 5)

‘Before the injury, I had planned to go abroad for management studies. But now, I feel my parents won’t allow me to leave. They are so scared that they don’t even let me step outside the house.’ (Participant 5)

‘I was working hard to be successful in life, but now I feel helpless. The doctors told me my head contains countless pellet wounds. I was a topper in my class, aspiring to become an IAS officer and working to fulfill my parents' dreams. This disability has robbed me of my goal and left me with painful, lasting wounds.’ (Participant 7)

‘Accepting this reality is both shocking and painful. With my lifeless eyes, my academic career has come to an end. My life’s ambition has been shattered into pieces. It saddens me to think that my friends still go to school while I remain confined to my home. We used to play together on our way to school—now, that world is lost to me.’ (Participant 3)

Financial instability and guilt

Participants' narratives revealed the severe economic struggles they faced due to their injuries, leading to financial instability and difficulty in meeting both personal and family needs. The disruption of their livelihoods caused by pellet injuries resulted in feelings of helplessness, guilt, and uncertainty about the future.

‘Before the incident, I used to earn between 10,000 to 15,000 a month. But I haven't made a single penny for the past four years. I once had my own money to support myself, my wife, and my children. Now, I feel helpless and guilty. I can't fulfill their desires and needs. I find asking for money from anyone difficult—it’s not in my habit. I am uncertain about my future.’ (Participant 4)

‘I was the eldest among my siblings. Before the injury, I ran a fruit business in Kashmir and also worked part-time as a driver. I was responsible for my sister's education, but for the past three years, I have faced severe economic hardship. Her education had to be discontinued.’ (Participant 6)

‘I underwent three surgeries to remove the pellets from my head. I have not earned a single rupee in the past three years since this happened to me. How will I fulfill my child's educational needs? A child requires so many things for school—a good uniform, a pair of shoes, textbooks, notebooks, and more.’ (Participant 9)

Changed interpersonal relationships

Following victimization, participants have experienced significant changes in their interpersonal relationships. Their accounts indicate that, beyond dealing with physical injuries, they also face social stigma related to gender roles and ostracization. However, some participants reported increased parental support after the incident. This superordinate theme is divided into two subthemes, described below:

Social expectations and victim blaming

The accounts of pellet victims reveal the harsh reality of social expectations and victim-blaming that often follow such traumatic incidents. After experiencing pellet gun violence, victims notice a shift in how their relatives and neighbors treat them, reflecting societal attitudes that place undue blame on them rather than offering support.

‘I feel that my relatives' and neighbors' behavior has changed. They often taunt me, questioning what I was doing when the incident occurred. They repeatedly say that if I had stayed home that day, this would not have happened. A girl is expected to remain at home.’ (Participant 1)

‘Many of my relatives and neighbors often tell me that I should stay at home now and not go outside.’ (Participant 3)

Supportive relationships

The narratives shared by some pellet victims highlight the crucial role of social support from significant others in their journey of healing and resilience. The participants acknowledge the positive impact of parental and sibling support.

‘My parents' support makes me feel better. They always encourage me not to feel sad.’ (Participant 1)

‘My parents are kind; they do everything for me, and they are my real support.’ (Participant 2)

‘They encouraged me and helped me resume my education. Sometimes I behave aggressively towards them, but they never resent it.’ (Participant 6)

‘I am fortunate to have loving parents and supportive siblings. They keep encouraging me about life.’ (Participant 8)

‘They always motivate me to be optimistic in every battle of life. They give me the freedom to do whatever I want and never deprive me of my rights, including education. They push me toward my goals and help me overcome the fear of that incident.’ (Participant 3)

‘I want to live for my family. Despite the obstacles, I am determined to overcome this challenge in life… Maybe this is a test of my patience from God.’ (Participant 2)

Faith-based coping

Religious and spiritual expressions provide pellet victims with a framework for understanding and coping with the traumatic event. Through prayer, gratitude, and trust in divine guidance, participants find strength, comfort, and resilience in their faith, enabling them to face adversity with hope and perseverance.

Religious beliefs

Despite experiencing immense difficulties and contemplating suicide, participants ultimately decide against it because of their religious beliefs, which prohibit taking one's own life. This adherence to religious teachings serves as a moral compass, guiding their actions and decisions even in moments of despair.

‘Many times, I have thought of ending my life, but I know it is against my religion. My faith in God stops me from taking such a step.’ (Participant 4)

‘Sometimes, when I feel hopeless, I turn to prayer. It gives me peace and helps me believe that everything happens for a reason.’ (Participant 7)

‘Once, I thought of committing suicide because it is very difficult to live a life like this. But my religion does not allow one to take their own life. So, I listen to lectures by religious scholars and try to trust in God. It makes me feel better.’ (Participant 1)

‘God is testing my patience. I believe He will reward me for enduring this suffering.’ (Participant 2)

‘Even though my life has changed forever, I remind myself to be grateful for what I still have.’ (Participant 5)

Spiritual practices

The statements below illustrate how spiritual practices serve as anchors for individuals facing adversity, providing comfort, strength, and a sense of connection to something greater than themselves. Through prayer, gratitude, and rituals, participants find ways to navigate life's challenges with faith and resilience.

‘When I feel hopeless, I try to remember that the Almighty has blessed me with such caring parents. They have supported me all the time. It was all God's plan. Whenever I feel low, I offer a prayer.’ (Participant 2)

‘Both hardships and ease come from God. Maybe He is testing me. I listen to religious talks that preach holding onto hope in tough times. I pray to God and ask Him to restore my eyesight.’ (Participant 6)

‘I listen to the Holy Book on my cell phone. This helps me maintain trust in God in every situation in life. When I feel low or frustrated when my heart is heavy… I perform wudu (ablution) and offer nafl (supererogatory) prayers. While in sajda (prostration), I cry a lot. The connection I feel with God during prostration helps me clear negative thoughts.’ (Participant 10)

Discussion

This study contributes to the growing body of research on trauma in politically volatile regions by identifying a distinct profile of psychological and functional impairments among victims of pellet gun injuries in Kashmir. Unlike other forms of trauma, these injuries create a complex interplay between physical disfigurement (Bhat et al., 2017), emotional dysregulation, and social stigma, necessitating a multidimensional approach to trauma care.

A key finding is the pronounced emotional dysregulation among victims, characterized by heightened irritability, impulsivity, and aggression (Cricenti et al., 2022; Slovak & Singer, 2001). While emotional and behavioral dysregulation are common trauma responses (Finkelhor & Turner, 2022; Sharkey & Schwartz, 2022), the findings suggest that the chronic visibility of injuries – particularly facial disfigurement and vision loss – may intensify these reactions. The persistent physical reminders of trauma reinforce feelings of victimization and social exclusion, exacerbating psychological distress.

Another critical implication of these findings is the role of faith-based resilience as a coping mechanism. Many participants relied on religious beliefs to navigate distress, emphasizing the need for culturally and contextually relevant interventions. While trauma-informed therapy is widely recommended for victims of violence (Harris et al., 2011), integrating faith-based support systems could enhance treatment efficacy in this population.

Additionally, this study highlights the long-term impact of pellet injuries on functional outcomes, including occupational limitations and dependency. Reports of appetite disturbances and reduced social engagement suggest broader disruptions in daily functioning that warrant targeted rehabilitation efforts. Future research should explore the intersection of psychological trauma and economic marginalization among survivors, as financial insecurity may compound distress and hinder recovery. By situating these findings within the broader trauma literature, this study underscores the need for holistic, culturally responsive interventions that address the complex psychological, social, and economic consequences of pellet gun injuries.

One of the most salient indicators of emotion dysregulation among participants was its impact on appetite. While the American Psychological Association has documented the relationship between trauma and eating disturbances (APA, 2019), these findings suggest that trauma from state violence may produce a distinctive pattern of appetite disruption. Some victims experienced food aversion, while others alternated between extreme hunger and complete disinterest in eating. Participant 3 shared, ‘Earlier, my hunger was quite normal. However, I remember that I could not eat for two days after this incident.’ Similarly, Participant 4 described a fluctuating pattern of not eating followed by binge-eating episodes. The sensory experience of eating was also affected, with Participant 7 noting, ‘Often my parents force me to eat something. But food seems tasteless.’ More severe cases included nausea at the sight of food, as described by Participant 10: ‘I do not feel like eating. The moment I see food, I start nauseating. I take only liquid.’ These findings align with broader research on trauma and appetite dysregulation. Psychological distress following traumatic events has been associated with altered eating behaviors, often mediated by heightened anxiety and depressive symptoms (Finkelhor & Turner, 2022). However, the connection between state-inflicted trauma and appetite disturbances remains underexplored. This study underscores the need to investigate how trauma from politically motivated violence may uniquely affect physiological responses, including eating behaviors, and suggests that psychological counseling should incorporate nutritional guidance.

Another critical dimension of participants' experiences was the disruption of self-image. Many participants reported feeling disconnected from their past selves due to disfigurement, reinforcing feelings of alienation and social withdrawal. The distress associated with not recognizing one's reflection or struggling with a changed physical identity aligns with prior research on post-traumatic body image disturbances (Cash & Smolak, 2011). Studies on individuals with facial disfigurement or vision impairment have similarly shown that changes in physical appearance can profoundly impact self-esteem and personal identity (DeSousa, 2010; Thompson & Kent, 2001). The loss of perceived attractiveness and functional ability further exacerbated psychological distress, echoing research on the effects of facial trauma, where individuals frequently experience anxiety, depression, and diminished self-worth (Rumsey & Harcourt, 2005). The emotional burden of disfigurement, particularly in cultures where physical appearance holds social significance, exacerbates the impact on mental health and self-perception. A recurring concern among participants was the shift from independence to dependency, highlighting the theme of role reversal. Many victims, who were previously self-sufficient and caretakers in their families, found themselves reliant on others for daily activities. This shift was perceived as a loss of agency and dignity, reinforcing feelings of helplessness and social isolation. Previous research on acquired disabilities supports these findings, suggesting that the transition to dependency often leads to feelings of uselessness, frustration, and social withdrawal (Papadimitriou & Stone, 2011). The inability to contribute financially and emotionally to their households intensified their psychological distress. This aligns with existing studies on disability and social roles, which highlight how the loss of independence can disrupt an individual’s sense of purpose and societal value (Shakespeare, 2006).

These findings suggest that trauma from pellet gun violence presents unique challenges beyond those observed in other forms of violence-related trauma. Unlike survivors of interpersonal violence, victims of pellet gun injuries may experience an added layer of social alienation, making reintegration and psychological recovery particularly complex. This study advances the discourse on trauma and violence exposure by contextualizing these findings within existing research while emphasizing their novel contributions.

The results also revealed a loss of academic motivation and aspirations among victims (Lepore & Kliewer, 2013). Before the incident, these individuals were self-sufficient, but the sudden loss of income has led to financial instability, leaving them unable to support their families. This inability to provide for their loved ones fosters deep guilt over their perceived inefficiency. Semenza et al. (2024) found that such traumatic experiences are linked to feelings of hopelessness and a diminished sense of self-worth due to reduced employment and wealth-generation opportunities.

Participants experienced significant changes in interpersonal relationships post-trauma. Instead of receiving empathy or support from neighbors and relatives, they faced judgment. Many were questioned about their whereabouts during the incident, reflecting cognitive biases in victim-blaming, particularly hindsight bias. Hindsight bias occurs when individuals believe an event was predictable after learning its outcome, leading them to overestimate their ability to foresee and prevent it (Roese & Vohs, 2012). This bias influenced post-trauma interactions, with relatives and neighbors assuming victims could have avoided the attack, thereby shifting blame onto them.

The phrase ‘A girl is expected to stay at home’ further underscores societal gender norms that confine women to domestic spaces. Female victims, in particular, were implicitly held responsible for not adhering to these expectations, reinforcing gendered victim-blaming.

Despite these challenges, some participants highlighted the critical role of social support from significant others in coping with trauma. Faith-based resilience emerged as a key coping mechanism among pellet survivors. Spiritual beliefs provided comfort and strength, reinforced through listening to Holy Books and engaging in practices such as ablution and extra prayers. Prior research has shown that religious beliefs serve as a coping mechanism and a means of finding meaning among Kashmiris (Bhat & Gul, 2024). Prostration, in particular, was described as a practice that helps release negative thoughts and fosters a sense of solace through connection with a higher power. More broadly, spirituality – whether tied to organized religion or not – has been shown to promote resilience in trauma survivors (Peres et al., 2007).

The distinct injury profiles and psychological consequences associated with pellet gun violence in conflict zones like Kashmir are likely mirrored in other regions experiencing similar forms of violence. Therefore, the mental health outcomes identified in this study may be applicable to other conflict-affected populations, emphasizing the need for culturally relevant trauma interventions.

Implications

While the study focuses on pellet gun violence in the Shopian district of Kashmir, the unique injuries and psychological impacts associated with pellet gun use in conflict zones could apply to other regions experiencing similar conflicts. The prevalence of pellet guns as non-lethal weapons used by security forces in civil unrest situations could have indicated that the psychological outcomes found in this study may also apply to other global regions where pellet guns are employed. The study results could be generalized to populations facing similar injury types, such as ocular trauma, whether caused by pellet guns or other mechanisms. The psychological consequences of such injuries – particularly blindness and disfigurement – are likely to transcend the specifics of the weapon involved, making the findings relevant to broader trauma research. The insights gained from our study can inform the development of specialized therapeutic interventions and public health strategies relevant to Kashmir and other regions facing similar challenges. The targeted approach of our study provides a framework that can be adapted and applied to different settings.

Future research should investigate how religious and cultural frameworks interact with psychological healing in conflict zones. Future research should explore how such trauma intersects with social stigma, victim-blaming, and systemic marginalization. Moreover, intervention strategies must address both the psychological and functional consequences of these injuries, integrating trauma-informed therapy with rehabilitative care, such as vision loss adaptation programs and community-based social reintegration efforts. Future inquiries should examine long-term psychological and social outcomes among victims of state violence and identify culturally and politically informed interventions that promote holistic recovery.

Limitations

We acknowledge that the use of snowball sampling may be a limitation of our study (Parker et al., 2019). Future research could benefit from employing alternative sampling methods, such as stratified random sampling, to enhance the sample's representativeness. Despite this limitation, we believe that our study provides valuable insights into the specific mental health outcomes associated with pellet gun trauma, which can inform the development of specialized therapeutic interventions and public health strategies. One significant limitation of this study is that the findings may not be generalizable to individuals who have experienced other types of traumas. The study specifically focuses on the unique psychological and physical impacts of pellet gun trauma, which often results in distinct injury profiles such as ocular trauma and associated psychological consequences like PTSD, anxiety, and depression. These specific experiences and outcomes may differ significantly from those of individuals who have endured other forms of trauma, such as domestic violence, natural disasters, or other types of conflict-related injuries. Therefore, caution should be exercised when attempting to apply these findings to broader trauma populations, as the unique context and nature of pellet gun victimization may not fully capture the diverse experiences and needs of other trauma survivors.

We acknowledge that power dynamics can influence the resolution of discrepancies. Both authors were committed to maintaining an equitable partnership, ensuring that each had equal opportunities to express their opinions and make decisions collaboratively. Despite these efforts, we recognize that implicit biases and power imbalances can still occur, which is a limitation of our study.

Future research suggestions

Future studies could explore understudied aspects of pellet gun victimization, such as the impact on family members, community dynamics, and the role of cultural factors in shaping victims’ experiences and coping strategies. Future research should explore the effectiveness of various therapeutic interventions and support systems for individuals affected by pellet gun violence. This can help develop evidence-based practices for mental health professionals working with this population. Comparative studies involving victims of different types of violence can help in identifying the unique and common psychological outcomes associated with pellet gun injuries. This can inform the development of targeted interventions for different forms of trauma. Furthermore, the prevalence data on pellet victimization is currently unavailable. It would be valuable for future researchers to explicitly acknowledge this gap in the existing literature, as it highlights an important area for further investigation and underscores the need for more targeted studies in this context.

Appendix: Interview schedule for pellet victims

Introduction: Thank you for agreeing to participate in this interview. The purpose of this interview is to understand your experiences and the impact of the pellet gun incident on various aspects of your life. Your responses will be kept confidential and contribute to a better understanding of individuals' challenges in similar situations.

Interview questions:

• What was the experience of a pellet attack like for you?

  • •(a) What physical and emotional experience has a pellet attack had on you?
  • •(b) How have you been coping with the aftermath of being shot by a pellet gun?
  • •(c) In what ways has the experience affected your well-being and daily life?
• 2.What changes does the incident bring in you?
  • •(a) Can you discuss changes in your thoughts, emotions, or behaviors following the pellet gun incident?
  • •(b) How has your perception of safety and security been altered since the incident?
  • •(c) Have there been any shifts in your relationships or personal identity due to the trauma?
• 3.How are you dealing with the demands of life after the incident?
  • •(a) How have you been managing the challenges of daily life, such as work, relationships, or personal responsibilities, after the incident?
  • •(b) What coping mechanisms or support systems have you found helpful in adjusting to life post-incident?
  • •(c) Have you encountered any specific difficulties or obstacles while trying to resume normal activities?
• 4.How is the behavior of others with you after the incident?
  • •(a) Have you noticed any changes in how people interact with or treat you since the pellet gun incident?
  • •(b) How do you feel about the reactions or responses you receive from others regarding your experience?
  • •(c) Has the incident significantly affected your relationships with friends, family, or colleagues?
• 5.How does being able to survive affect financial affairs?
  • •(a) Can you describe the financial impact of being differentially able due to the pellet gun incident?
  • •(b) Have there been any challenges or limitations in accessing employment opportunities or financial resources due to your disability?
  • •(c) How has the financial strain of medical expenses or rehabilitation affected your overall economic stability and well-being?

Author contributions

F.N.: Planned and wrote manuscripts, prepared interview schedules, and performed data collection and analysis.

I.W.: Data collection and analysis. Also wrote the initial draft. The data are available upon request from the second author.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data is available within the study.

Ethical standards and informed consent

The study was approved by an Institutional Review Board/Ethics Committee of the Pellet Victims Welfare Trust, Kashmir. The study was conducted in accordance with the Declaration of Helsinki (World Medical Association, 1964). To obtain informed consent, we explained the study’s purpose and emphasized its aims. We clearly outlined what participation would involve, including the nature and duration of the interview. We also assured participants that their involvement was entirely voluntary. Confidentiality measures were highlighted, such as using pseudonyms instead of their real names to protect their identity. Lastly, we ensured that participants understood they could withdraw from the study at any time without any consequences.