fMRI Research Update: Spousal abuse causes physical changes in the brains of victims

In many high conflict divorce cases, the pattern of conflict that began as a verbal disagreement escalates in a predictable way until one partner is physically assaulting the other. In a previous post, I reviewed the fMRI research that documented the brain changes in the children from merely witnessing domestic violence (DV) in their families. This post is devoted to the spouse/victims of domestic violence and what we know about the effects of DV and treatments for its symptoms.

Few family lawyers would be surprised to learn that many victims of domestic abuse suffer from post-traumatic stress disorder (PTSD), the same malady that afflicts many combat veterans. The experience of talking with one domestic violence victim is usually enough to sensitize most family lawyers to the resulting anxiety and fear-driven symptoms and behaviors that can result from prolonged exposure to the cycle of abuse (most abusive relationships last an average of 7 years before the victim gets out). What we now know is that the damage is not just emotional--domestic abuse, just like combat, causes identifiable and measurable changes in the brain's structure and function that are evident in fMRI scans of victims. That means the damage is physical and the abuse changes both the physical shape of the brain AND affects the way it functions.

Just as the treatment of combat-related PTSD has proven to be challenging and frequently ineffective, the treatment of domestic violence-related PTSD is less than optimal in its effectiveness. A reasonable summary of the available research, using the latest and most effective cognitive behavior therapy (CBT) for trauma for battered women (CTT-BW) suggests that treatment is about 50% effective. It is this documented lack of treatment success in nearly half the victims that led to the fMRI studies to try to identify underlying brain pathology that was interfering with CBT effectiveness.

What the fMRI scans of these traumatized women revealed was identifiable changes in structure and function of three areas of the brain: the amydala, the insula, and the prefrontal cortex. These 3 regions are the same ones identified in the research of the combat PTSD victims and the kids from violent families, and they are dysfunctional in the same ways in all these victims. Brain centers for identifying danger are hyper-activated, and the brain center responsible for self-control and logical thinking (executive functions, as they are called) is not working like it does in normal people. This latest research noted that other brain areas (the anterior cingulate and posterior cingulate) were more active in people who were successfully treated, suggesting that the CBT was successful in activating these brain areas which led to reducing the fear-driven anticipation of something bad happening to them, leading to reductions in anxiety and other PTSD symptoms.

There are clearly family law implications for this growing body of research. Victims of domestic violence have scientifically verifiable physical brain injuries resulting from their abuse. These brain injuries affect how, and how well, the brains of these people function, and how well state of the art treatments will work to return them to normal functioning.  These findings have both child custody and property division implications which should be considered in cases involving document domestic violence.

Victims of domestic violence, both the adults and the children, are more like the victims of car accidents with head injuries than most of us would like to believe. Domestic violence doesn't just make its victims "nervous"; domestic violence causes brain damage to its victims that is very difficult to repair even with the best available treatments. And by the way, there is NO evidence that this kind of damage will "heal itself" when the victims are removed from the violence.

A number of practice tips come to mind as a consequence of these findings:

1. Longer exposure to abuse means greater brain damage for both the adults and the children. There is no "grace period". Getting away from the abuse is the first step, so the abused spouse and children must either leave or be protected by a protective order--now.

2. Effective treatment for the victim is available, may work, and takes a few (3-4) months. Get the victim into a program which offers CBT or CTT-BW as soon as possible while the litigation proceeds. An effectively treated victim is a much more rational and well functioning client (and parent).

3. Emphasize the physical brain damage effects of DV in settlement discussions about property division and visitation.

4. Insist on treatment for the perpetrator before allowing unsupervised visitation to prevent further "brain damage" to the children. (See my earlier post for details.)

Innovations in services for families: i360life

Many family law cases are complicated by the presence of a mental health issue. Sometimes it's substance abuse by one (or both) spouses; sometimes the drinking or drug use is a problem for one of the children in the family, and it is precipitated or exacerbated by the divorce and litigation. In other cases, a stay at home mom is depressed, anxious, and overwhelmed, and dad is working full time and perhaps traveling regularly for days at a time.

Once the divorce litigation is filed and the case is under way, neither lawyers nor the treating professionals have had many options for providing support to the patient and the family in these challenging cases; usually those choices were counseling or therapy once or twice a week, or inpatient treatment or rehab. Neither of those options provides much support for the children--once a week therapy for mom doesn't really help them at all in the short term, and taking mom away completely for a month or two leaves them abandoned to some relative or unfamiliar caretaker. Until now, there has been nothing in between these two traditional treatment options.

I recently visited with Dr. Kevin Gililand, the CEO and founder of innovation360 to learn more about their unique and innovative services. His rapidly growing company has individually customized and personally designed services to fill the gap between inpatient programs and one hour per week therapy. (See www.i360life.com for more information.)

Innovation360 provides a menu of traditional services but also provides "14 day coming home"  programs for transitions from inpatient programs to home, life management (in home support and structure for self-management, child care supervision, etc.), and ensuring a client's home is safe (and drug free) after returning from rehab. Their "life development"  program is unique in providing in home support by a mental health professional which includes social support, nutrition support, and activity support for as many hours as needed, from a few hours per week to 24/7 care.

As I thought about the most challenging cases I had worked on over the last few years, it became clear to me that this kind of 'in-between' service could have been an immense help to a number of families during their divorces. For many people, having someone with them every day to help them make better decisions and to avoid reverting to old and dangerous behaviors while putting their therapy lessons into practice in their daily lives would have been incredibly valuable and saved the parties a lot of money and grief.

For family law attorneys in this geographic area, this is a new resource for helping in your most challenging cases.

(I am not affiliated with Innovation360 in any way and have NOT been compensated for this article.)