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.)

Exposure to Family Violence and Brain Changes in Children--A Research Update

My last post highlighted the neural structures and processes involved in the development of parental alienation. This note summarizes some recent research about the connection between exposure to family violence and changes in brain functioning in children.

Researchers in the UK had noted that fMRI scans of combat veterans showed increased activation (when compared to veterans with NO combat exposure) in two areas of the brain: the amygdala and the anterior insula. These are two deep brain structures known to be active in the detection of threats, fear, survival responses, (amygdala) and of feelings of disgust or empathy, (anterior insula). These two deep brain structures have mirror neuron connections as well, leading to internal brain representation of external events, just like those noted in the post about parental alienation from last week.

This latest research compared the brains of two groups of children, neither of whom had any symptoms of mental health problems. One group of children came from families with documented histories of family violence; the other group of children had no such history. On a task that involved identifying faces as either male or female while in the fMRI scanner, the children with a history of "exposure to family violence" showed brain activation patterns similar to those of the veterans with combat experience--that is, activation of the two brain areas--the anterior insula and amygdala. The children with NO history of such exposure did NOT show similar activation on their fMRI scans.

This ground breaking research suggests that merely witnessing family violence leads to changes in children's brain function similar to those experienced by combat veterans. It is well known that post-traumatic stress disorder, PTSD, is characterized by "hyper-vigilance",  and the chronic over activation of the neural processes involved in detecting threats and reacting to them. PTSD sufferers experience chronic fear and anxiety as a result of the over-activation of these same two brain structures (and some others).

What is not currently known is how much "exposure" is needed to result in these neural changes, nor why some children seem to avoid the long term consequences of anxiety and hypervigilance and distrust that other children experience from their exposure to family violence.

What is clear, even at this early stage, is that children are highly susceptible to measurable changes in brain function from exposure to family violence. The implications for family lawyers and courts would seem to include:

1. Children don't have to be physically injured by family violence to be adversely affected--just witnessing family violence is sufficient to cause adverse brain effects.
2. Intervention in escalating family violence at the early stages and removing potential for children being exposed to such scenes can prevent the emergence of those changes in brain function that increase the risks of development of anxiety  and other maladies.
3. Leaving divorcing spouses together in the same house raises these risks for children since other divorce research has documented that nearly 100% of divorces involve at least one episode of physical violence between spouses. It is in the best interests of the children that their exposure to family violence be prevented.

Divorce-Related Trauma in Children: Exposure to Family Violence Leads to Changes in Brain Function

My last post highlighted the neural structures and processes involved in the development of parental alienation. This note summarizes some recent research about the connection between exposure to family violence and changes in brain functioning in children.

Researchers in the UK had noted that fMRI scans of combat veterans showed increased activation (when compared to veterans with NO combat exposure) in two areas of the brain: the amygdala and the anterior insula. These are two deep brain structures known to be active in the detection of threats, fear, survival responses, (amygdala) and of feelings of disgust or empathy, (anterior insula). These two deep brain structures have mirror neuron connections as well, leading to internal brain representation of external events, just like those noted in the post about parental alienation from last week.

This latest research compared the brains of two groups of children, neither of whom had any symptoms of mental health problems. One group of children came from families with documented histories of family violence; the other group of children had no such history. On a task that involved identifying faces as either male or female while in the fMRI scanner, the children with a history of "exposure to family violence" showed brain activation patterns similar to those of the veterans with combat experience--that is, activation of the two brain areas--the anterior insula and amygdala. The children with NO history of such exposure did NOT show similar activation on their fMRI scans.

This ground breaking research suggests that merely witnessing family violence leads to changes in children's brain function similar to those experienced by combat veterans. It is well known that post-traumatic stress disorder, PTSD, is characterized by "hyper-vigilance",  and the chronic over activation of the neural processes involved in detecting threats and reacting to them. PTSD sufferers experience chronic fear and anxiety as a result of the over-activation of these same two brain structures (and some others).

What is not currently known is how much "exposure" is needed to result in these neural changes, nor why some children seem to avoid the long term consequences of anxiety and hypervigilance and distrust that other children experience from their exposure to family violence.

What is clear, even at this early stage, is that children are highly susceptible to measurable changes in brain function from exposure to family violence. The implications for family lawyers and courts would seem to include:

1. Children don't have to be physically injured by family violence to be adversely affected--just witnessing family violence is sufficient to cause adverse brain effects.
2. Intervention in escalating family violence at the early stages and removing potential for children being exposed to such scenes can prevent the emergence of those changes in brain function that increase the risks of development of anxiety  and other maladies.
3. Leaving divorcing spouses together in the same house raises these risks for children since other divorce research has documented that nearly 100% of divorces involve at least one episode of physical violence between spouses. It is in the best interests of the children that their exposure to family violence be prevented.