Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Women who kill their partners

Assumptions that women who kill their male partners are usually chronic sufferers of domestic abuse, mentally ill and/or intoxicated may not be true. See:

Behav Sci Law. 2012 Sep 27;

Women Who Kill Their Mates.

Bourget D, Gagné P

Spousal homicide perpetrators are much more likely to be men than women. Accordingly, little research has focused on delineating characteristics of women who have committed spousal homicide. A retrospective clinical review of coroners’ files containing all cases of spousal homicide occurring in Quebec over a 20-year period was carried out. A total of 276 spousal homicides occurred between 1991 and 2010, with 42 homicides by female spouses and 234 homicides by male spouses. Differences between homicides committed by female offenders and male offenders are discussed, and findings on spousal homicide committed by women are compared with those of previous studies. Findings regarding offenses perpetrated by females in the context of mental illness, domestic violence, and homicide-suicide are explored. The finding that only 28% of the female offenders in the Quebec sample had previously been subjected to violence by their victim is in contrast to the popular belief and reports that indicate that most female-perpetrated spousal homicide occurs in self-defense or in reaction to long-term abuse. In fact, women rarely gave a warning before killing their mates. Most did not suffer from a mental illness, although one-fifth were acutely intoxicated at the time of the killing. In the vast majority of cases of women who killed their mates, there were very few indicators that might have signaled the risk and helped predict the violent lethal behavior. Copyright © 2012 John Wiley & Sons, Ltd.
Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 23015414
URL – http://www.ncbi.nlm.nih.gov/pubmed/23015414?dopt=Citation

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Filed under: Other Mental Health, Violence, , , , ,

Step-fathers who Kill

Lurking in the shadows

Posted: 09 April 2009 | Community Care Magazine http://www.communitycare.co.uk/Articles/2009/04/09/111233/lurking-in-the-shadows.html

Maria Colwell. Jasmine Beckford. Heidi Koseda. Kimberley Carlile. Leanne White. Lauren Creed. Baby P. These names don’t resonate only with social workers; as some of the UK’s most notorious child deaths they conjure up grim details that are etched on the nation’s collective memory.

And they have something else in common: they all died at their stepfather’s hands. In many cases their mothers received prison sentences for offences ranging from neglect to assault or manslaughter.

Sadly, these are just a few names on the deathly roll call that stretches back to 1973 of young children killed by their stepfather or their mother’s boyfriend.

No matter how good our protective or preventive measures, there will always be parents who will harm or even kill their children. Whether the killer is their biological father or their stepfather may not seem that relevant when it comes to informing preventive policies, but research suggests otherwise.

In 1988, US data showed that children aged up to two are at about 100 times greater risk of being killed by their stepfather than their biological father. Psychologists call this the Cinderella effect. The research went on to look at British data, concluding that it indicated “considerable excess risk at the hands of stepfathers”.

With the rates of remarriage, divorce and cohabitation steadily increasing, giving rise to more stepfamilies, this is a disturbing thought. According to the Office of National Statistics, in 2006 84% of stepfamilies consisted of a stepfather and biological mother living with children from her previous relationship.

Research suggests that whereas genetic fathers often kill their children “more in sorrow than in anger”, out of perceived necessity and/or as part of a suicide, homicides committed by stepfathers tend to be more rage driven, impulsive acts motivated by hostility towards the child and characterised by violently beating or shaking them.

Despite this evidence, some researchers believe that minimal attention has been given to stepfathers – or mothers’ boyfriends – as the perpetrators of these crimes and the reasons behind them.

David Finkelhor, director of the Crimes Against Children Research Center in the US, says: “Sociobiologists point out that these are men who have no genetic stake in this child and see them as competition for attention and time, and their own offspring. Among other primates it’s not unknown for a new alpha male to kill the children of the dominant male when he comes into a group.”

But Finkelhor believes the reasons are simpler than that. “That has some reality to it, but I think it operates through more familiar psychological mechanisms; that these aren’t men who feel a natural affinity or protectiveness about the children of the women they are involved with. These are not men who are nurturing.”

Anger management

This squares with the fact that a child’s inconsolable crying is one of the main triggers for these homicides. “Frequently the dynamics of these cases are common,” says Finkelhor. “The woman leaves the child with the boyfriend or stepfather and when the child starts crying, he doesn’t have the nurturing skills to handle this in a calm way and then hits, throws, or smothers them because he wants them to shut up.

“They are not all of one sort, but a high proportion [in these cases] are violent, abuse their partners, and tend to have an anger management problem.”

Gathering any deeper psychological profile of these men is hampered by the fact that we know so little about them, and what we do know is usually learned after a child has been killed – which isn’t helped by serious case reviews that mostly focus on the pathology of the mother.

This reflects the continuing failure of agencies to engage properly with men, says David Derbyshire, Action for Children’s head of performance improvement and consultancy, and author of several serious case reviews.

“We probably don’t know a lot because too many times we come across cases where there is no involvement with men. Then there is an incident where the child is injured or dies, the serious case review takes place and we see the intervention is often only all with the woman and the man is not known about, or if he is, there’s no contact.

“If you don’t engage with the man but he is there everyday then the work we are doing is going to have a limited impact.”

Before we can even reach a position where men are properly involved, social workers need to recognise their importance to the whole familial picture and approach them with an open mind, which appears to happen too infrequently.

Research for a book he was writing on gender and child protection led says Jonathan Scourfield, senior lecturer at Cardiff University’s school of social sciences, to interview social workers about how they worked, or didn’t work, with men. He found primarily pejorative views.

“Men were seen as a threat, as no use, as irrelevant and absent – and there was a whole host of reasons given for not engaging with them.”

The dominant theme was of men as a threat, not surprisingly given the kinds of problems that caused referrals to be made to the team. But what worried Scourfield was the number of men that social workers didn’t pick up on. “Often there’s a boyfriend, the mother doesn’t mention it, but he’s hovering in the background, half noticed.”

Even if he is seen or known about, it’s all too common for no real attempt to be made to engage him. “The social work culture is an important part of that, but there’s a huge issue with the actual behaviour of these men. We are talking about men who are very difficult to work with and that needs to be acknowledged,” Scourfield adds.

This leads to questions of how a social worker can confidently decide whether to engage with the individual, or whether they are so dangerous they should be removed from the child’s life. It’s a dilemma that troubles Brid Featherstone, professor of social work and social policy at Bradford University: “We haven’t equipped social workers to work with these men. We haven’t got skills in assessing men generally, so we don’t even get as far as deciding that this man shouldn’t be in the family home.

“There is a problematic absence of an evidence base in the UK about working with men – either those who are a resource for children or a risk. Half the time we don’t know who is in a family. We don’t even record birthfathers if they are not there so how are we going to find others floating around? We tend to rely on the mother but it can be hard to establish living arrangements, as we can see in the Baby P case.”

The need for evidence

Jack Kennedy understands these difficulties. As a consultant in clinical and forensic psychology he compiles psychological reports for courts and parole boards and has worked on some of the most well-known child death cases. “Social workers have a very difficult job because they need evidence to act,” he says. “But it’s very difficult to anticipate or intervene unless there are overt indicators of risk or harm. Society almost expects [social workers] to be a ministry of pre-crime and intervene before these events happen, but to go in and remove a child on a suspicion won’t hold up in court.”

Other than obvious danger signs such as known domestic violence or injuries on a child, Kennedy suggests that where social services are involved with a family they need to be aware of mothers developing new relationships and people visiting the home. “Not least because it can be destabilising for the child having different people coming into the home. And also because they can assist a mother in actively risk managing all the time. But there is a thin line between policing and social care.”

However, any information social workers pull together often comes from the mother and therefore relies on her being honest. This is unlikely to happen if she is witness to her partner abusing her child but feels powerless to do anything about it.

While most of us would find this thought process hard to fathom, the issues behind this “collusion” can be complicated. The personality of these women can form part of the equation. Research into these deaths shows that many women lived in fear of their partners and that violence and abuse against a partner and child often coexisted.

These women can be depressed, overwhelmed or so distracted by their own difficulties that they don’t feel capable of doing anything. Women who are desperate to keep a partner will placate them, or those who are so intimidated by a partner won’t stand up to them.

“These are usually highly vulnerable women who have a confused understanding of relationships,” says Kennedy. “Their backgrounds are characterised by abuse and they are highly dependent on being in a relationship even if it’s dysfunctional because that provides them with the security they are looking for. Many women prize the man they have highly because they believe themselves to be loved in some way. Love and affection become more important to them than the needs of the child.

“They are not resilient enough to say ‘that is wrong, this is over,’ because they think they will not get anyone else. This is not about excusing their behaviour, it’s about helping us understand more about what sort of situation an individual may be in.”

Featherstone goes further, saying there are women who are terrified, and other more complex women who don’t acknowledge their ambivalence to their child. “We are hamstrung by the assumption that all mothers love their children or, if they don’t, they can be helped to. But we have to acknowledge maternal ambivalence. Hate can become the more dominant feeling. I have worked with a small number of women who were sadistic themselves. While you are not going to get lots of these women, sometimes you have to think the unthinkable.”

In 2007-8 there were 45 homicides of children aged up to four, according to the Home Office. But these figures don’t include death by neglect or cases which, although were not classified as murder, were not accidents either. Some analysts in the US believe that, there, the actual figure for child homicides may be double the official one because they can resemble deaths resulting from accidents or other causes; for example, a child who has been thrown or intentionally dropped will have similar injuries to those of one who died after an accidental fall.

The so-called Cinderella effect has no fairytale solution. Evidence of the prevalence of deaths caused by stepfathers is there, though the connection is not always made. But we owe it to the memories of all those children from Maria Colwell to Baby P to make sure we know who is present in a child’s life and whether they are a resource or a risk, so we can prevent as many children as possible from ending up on the same list.

RESOURCES

* Crimes Against Children Research Center

* Men who Murder Children Inside and Outside the Family, K Cavanagh, R Dobash.

Filed under: Violence, , , , , ,

Northern Ireland Doctors Raise Concerns Over Domestic Abuse

Article Date: 01 Apr 2009 – 4:00 PDT

The BMA(NI) highlighted its concerns about domestic violence to local Assembly members in advance of the motion put forward by Sinn Fein MLAs Sue Ramsey and Jennifer McCann.

Commenting on recent Policing Board figures which indicated that police officers in Northern Ireland respond to a domestic incident every 23 minutes, Dr Brian Patterson, Chairman of the BMA’s Northern Ireland Council said,

“The BMA supports the range of efforts being made by the police, the DHSSPS and by individual MLAs in both raising awareness and tackling the unacceptable levels of domestic violence in Northern Ireland.

“As doctors, we are well placed to help victims and their families and it is important that we support our patients when they come forward to discuss this.”

1 The BMA(NI) briefing note on Domestic Abuse (March 2009) suggests that the Northern Ireland Executive should:

a. Raise general awareness of domestic abuse, including its prevalence, manifestation and available support for victims.

b. Ensure strategies to address domestic abuse, such as ‘Tackling violence at home – a strategy for addressing domestic violence and abuse in Northern Ireland’, are highlighted.

c. Develop a structured and statutory basis for addressing domestic abuse at a local level.

d. Recognise that men are also victims of domestic abuse and this needs to be taken into consideration when developing policy.

e. Work to identify and combat the barriers to reporting incidents of domestic abuse.

f. Promote a ‘zero-tolerance’ attitude to domestic abuse.

g. Ensure that information about support services is readily available in healthcare settings such as GP surgeries, A&E units and maternity departments.

h. Raise awareness of the scale of domestic abuse among Section 75 groups, and break down the barriers for such individuals to access the services and protection they need.

i. empower victims to report the abuse to the police.

2 Please contact the BMA(NI) Press Office for a copy of the briefing note

3 Further information is contained in the BMA report ‘Domestic Abuse’ (published 2007).

4 The Policing Board’s Human Rights and Professional Standards Committee published its first Human Rights Thematic Inquiry on 24 March 2009 examining how effectively the PSNI are tackling domestic abuse in Northern Ireland http://www.nipolicingboard.org.uk/news/article.htm?id=9536.

Source
Sara Morrow
Public Affairs Officer
British Medical Association Northern Ireland
16 Cromac Place
Cromac Wood, Ormeau Road,
Belfast BT7 2JB

Filed under: Violence, , ,

When A Violent Marriage Ends, Is Co-parenting Possible?

ScienceDaily (Mar. 17, 2009) — When a marriage that has included violence ends, is co-parenting possible? It depends on whether intimate terrorism or situational violence was involved, says a new University of Illinois study published in Family Relations

“There’s a tendency to treat all violence as if it’s the same, but different types of violence require different interventions,” said Jennifer Hardesty, a U of I assistant professor of human and community development.

“In intimate terrorism, the goal is to control the other person, and the abuser may use not only physical violence but also psychological and financial abuse to dominate his spouse. This calls for rigid, formal post-divorce safety measures, including supervised visitation of children and treatment approaches, such as a batterer’s intervention group or alcohol or substance abuse treatment,” she said.

“Situational violence is more likely a result of poor conflict management rather than a desire to control a partner. There may have been a heated argument about finances that ended with a shove. These fathers can probably learn new ways to manage their anger, and they do have the potential to safely co-parent their children,” she said.

Hardesty’s study used in-depth interviews with 25 women to explore differences in their co-parenting relationships with their abusive ex-husbands.

Role differentiation was a big problem for fathers who had engaged in intimate terrorism, said the researcher. “These men had difficulty separating their role as a father from their desire to hold onto their relationship with the mother. And because they weren’t able to differentiate those roles very well, control issues and abuse of the women tended to continue after the separation.”

According to Hardesty, renegotiating boundaries after divorce poses unique challenges and risks for abused women. “Separating from an abusive partner does not necessarily end the violence. Instead, separation may threaten an abuser’s sense of control and instigate more violence,” she said.

Risk may continue if former partners co-parent after divorce because abusers still have access to their former wives, she said. “Women in the study who had been victims of intimate terrorism all continued to be afraid that their ex-husbands would hurt them or their children,” she said.

In contrast, women who had experienced situational violence in their marriages often described safe co-parenting relationships characterized by respect for each other’s boundaries.

Currently the legal system assumes it’s in a child’s best interests to maintain relationships with both parents after a divorce, Hardesty said. “As a result, women’s attempts to protect their own and their children’s safety are often undermined or overlooked,” she noted.

Parent education classes that help participants redefine boundaries around their parental and spousal roles and teach conflict resolution and anger management skills may help persons who have engaged in situational couple violence, she said.

Different approaches for mothers and fathers work best when intimate terrorism has occurred, she said. For mothers, the course should contain information on coercive control, safety planning, risk assessment, and the legal and social benefits available to them and their children. For fathers, the classes should reinforce a rigid and enforced separation between them and their children and their access to mothers.

“In cases of intimate terrorism, parent education would ideally be part of a set of programs aimed at prioritizing safety and assessing risk over time if children’s relationships with fathers are to continue,” she said.

“Eventually we hope the courts will be able to screen for different types of violence and target interventions, but we’re not yet able to put this into practice. More research is needed to tease out these difficulties. Until we can, I think we have to err on the side of safety,” she added.

Co-authors of the study are Lyndal Khaw of the University of Illinois, Grace H. Chung of Montclair State University, and Jennifer M. Martin of the Bedford-Stuyvesant Family Center, Brooklyn Bureau of Community Services, in Brooklyn, New York. Funding was provided by the Cooperative State Research, Education, and Extension Service, U.S. Department of Agriculture.


Journal reference:

  1. Jennifer L. Hardesty, Lyndal Khaw, Grace H. Chung, Jennifer M. Martin. Coparenting Relationships After Divorce: Variations by Type of Marital Violence and Fathers’ Role Differentiation*. Family Relations, 2008; 57 (4): 479 DOI: 10.1111/j.1741-3729.2008.00516.x
Adapted from materials provided by University of Illinois at Urbana-Champaign, via EurekAlert!, a service of AAAS.

Filed under: Violence, , ,

Does Biology Play a Role in Domestic Violence?

TUCSON—Between 20% and 30% of all men and women in the US will be victims of domestic violence in their lifetime. Domestic violence accounts for 20% of all emergency department visits, 50% of police calls, and about 30% of murdered women. While considerable research into understanding the perpetrator’s mindset has focused on learned behaviors and psychosocial issues, comparatively little effort has been devoted to exploring possible biological causes of the problem, according to David George, MD.

“Most people look at domestic violence from a psychodynamic/psychosocial perspective,” said Dr. George, Section Chief of Clinical and Translational Studies at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland. “These people believe that perpetrators feel inadequate and try to control other people by their behaviors or that they grew up in homes where they were exposed to violence, and, therefore, they’ve learned these patterns. I was particularly interested in the fact that there has been so little emphasis given to any biological understanding of what might be taking place.” Dr. George made his presentation at the 18th Annual Meeting of the American Neuropsychiatric Association.

The first step in determining whether biological abnormalities may lead to acts of domestic violence is to closely examine who the perpetrators are, according to Dr. George. The incidence of domestic violence is approximately equal in men and women, and about 70% of perpetrators abuse alcohol, he noted. Based on interviews with several hundred people who have committed acts of domestic violence, as well as their spouses and significant others, Dr. George has observed several recurring patterns. One of these patterns is that perpetrators are likely to have been in multiple fights during their childhood. “They are going to push their teachers,” noted Dr. George. “They fight with their siblings and with the kids down the street. As they grow older, most of them tend to limit their violence to the home and direct it toward their spouse or significant other.”

Perpetrators also have little insight into why they become violent, and most acts of domestic violence are impulsive, said Dr. George. “There are those with a predatory side, but I do not see it often. Alcohol plays an important role in domestic violence. Alcohol is a two-edged sword. Perpetrators are going to use alcohol to calm down, but often the alcohol contributes to the likelihood of violence.”

Typical behavioral symptoms in perpetrators include racing thoughts, supersensitivity to environmental stimuli, and mood swings that range from shutdown to flight, fight, and stalking. “I had one person tell me, ‘If you ever got in my mind, you would probably lock me up. You would think I was crazy.’ This is something that is going on inside of them,” said Dr. George. “Little things are going to set them off—spilled milk at the dinner table, dirty dishes that aren’t taken care of in the sink, the dinner that’s late. The most interesting thing was that they feel afraid at the time of the aggression. That was very difficult for me to comprehend, because so often we are working with large and aggressive perpetrators whose victims are smaller in stature. Fear just doesn’t look like it should be a significant factor.”

ANXIETY, PERSONALITY DISORDERS, AND SUBSTANCE ABUSE

Dr. George has conducted a number of studies regarding domestic violence. One trial included perpetrators of domestic violence with alcohol dependence, nonviolent alcoholics, and healthy controls. The researchers found that violent alcoholics had a higher incidence of major depression, panic attacks, social phobia, obsessive-compulsive disorder, generalized anxiety, and certain personality disorders than did nonviolent alcoholics.

In a double-blind, placebo-controlled trial involving the administration of sodium lactate to participants, Dr. George and colleagues found that behavioral symptoms such as speech, breathing, facial grimacing, and motor activity in the arms and legs were much more accentuated in the perpetrators, as was their sense of fear, panic, and rage, compared with nonviolent controls. “These results were instrumental in changing my thinking about perpetrators of domestic violence,” commented Dr. George. “It moved me from seeing them as offensive individuals to seeing them as defensive individuals. This was extremely important to me, because it directed my attention to the neuropathways that have been shown in animals to mediate defensive aggression.”

PSYCHOPATHOLOGY AND FEAR RESPONSE

Dr. George devised a basic model for understanding the psychopathology of perpetrators of domestic violence. “Perpetrators frequently misinterpret environmental stimuli, which gives rise to a perceived sense of threat,” he explained. “Sensory stimuli enter the thalamus, and from there are processed by both the cortex and the amygdala. The processing of the sensory stimuli in the amygdala is extremely fast and serves as an early warning system. The processing of the sensory stimuli in the cortex is going to be much slower and much more detailed than in the amygdala…. The cortex and the amygdala talk to each other. In certain situations, these sensory stimuli give rise to defensive behavior, autonomic arousal, and hypoalgesia…. If you talk to these people and ask them what it is like when they are hitting someone, they will tell you, ‘It feels like my hands and arms are like feathers. I have no feeling in my hands. I don’t feel as though I’m doing anything.’”

In formulating a theory for the etiology of domestic violence, Dr. George reasoned that threats trigger a conditioned fear response in perpetrators that is out of proportion to the stimulus, which may result in fear-induced aggression. “This misinterpretation arises from the abnormality in structures and pathways that mediate fear-induced aggression,” he said.

In a study using PET (18FDG) imaging to examine the neural structures and pathways involved in fear conditioning and fear-induced aggression, Dr. George’s group found that mean CMRglc in the right hypothalamus was significantly lower in perpetrators with alcohol dependence, compared with nonviolent alcoholics and healthy controls. “At rest, when you compare the activities in the left amygdala with various cortical and subcortical structures like the thalamus and cingulate, you see a strong correlation in the nonviolent alcoholics between these structures and the amygdala, whereas in the perpetrators, you had decreased correlations,” said Dr. George. “We are interpreting this to mean that the ability of the cortex to modulate the amygdala in these people is reduced. Similarly, we compared perpetrators with healthy controls. We found the same kind of finding here, decreased correlations [with the left and right amygdala]. And the nonviolent alcoholics had an increased correlation between the left thalamus and left posterior orbitofrontal cortex.”

Such findings may indicate different motivations to drink alcohol for nonviolent alcoholics and alcoholic perpetrators. “Basically, we arrived at two different possibilities,” Dr. George said. “The increased correlation found in nonviolent alcoholics maybe makes them more susceptible to environmental cues that trigger drinking. Whereas, I think alcoholic perpetrators are more prone, at least in the initial stages of the disease, to drink in order to decrease anxiety.”

In another study, Dr. George and colleagues performed lumbar puncture in the left lateral decubitus position in alcoholic perpetrators of domestic violence, nonalcoholic perpetrators, and healthy controls. The researchers found that the nonalcoholic violent group had lower 5-HIAA [5-hydroxyindoleacetic acid] concentrations than did the other two groups, which was “not particularly surprising, given the huge literature that’s out there saying that 5-HIAA is involved with impulsive types of aggression,” noted Dr. George. “It is unclear as to why the alcoholics didn’t have it. We then looked at testosterone, and there we found that [alcoholic perpetrators] did have higher levels of testosterone. So we have at least two neurotransmitter systems that theoretically could be involved, that could be modulating the way they process sensory information. We are looking at a number of other transmitter systems at this time.”

CAN DOMESTIC VIOLENCE BE TREATED?

Dr. George’s current research is focusing on fMRI, genotyping, and potential treatments. To date, he emphasized, “Treatments for domestic violence are often ineffective.” In one ongoing trial, he has been comparing fluoxetine with placebo regarding their effect on measures of aggression, anxiety, and depression in those who commit acts of domestic violence. “What is really interesting is when you look at what serotonin does, it modulates sensory information,” noted Dr. George.

Dr. George believes that it is possible to piece together some of these findings to understand domestic violence on the basis of a biological pathway. “This is such a primitive pathway,” he commented. “Defensive aggression is present throughout the whole animal kingdom and promotes survival. With reduced cortical connection to the amygdala, perpetrators process sensory information very quickly. Based on fMRI studies, this processing of sensory information by the amygdala is out of the conscious awareness. I think that’s why therapy has been so ineffective in these individuals. They are responding so quickly to sensory information that they don’t even have time to think about it.”

Ultimately, Dr. George believes that further studies linking conditioned fear and fear avoidance with behaviors and psychiatric diagnoses will help change the way researchers and clinicians perceive and treat perpetrators of domestic violence.           

—Colby Stong

Suggested Reading
Fils-Aime ML, Eckardt MJ, George DT, et al. Early-onset alcoholics have lower cerebrospinal fluid 5-hydroxyindoleacetic acid levels than late-onset alcoholics. Arch Gen Psychiatry. 1996;53:211-216.
George DT, Phillips MJ, Doty L, et al. A model linking biology, behavior and psychiatric diagnoses in perpetrators of domestic violence. Med Hypotheses. 2006;67:345-353.
George DT, Umhau JC, Phillips MJ, et al. Serotonin, testosterone and alcohol in the etiology of domestic violence. Psychiatry Res. 2001;104:27-37.
Umhau JC, Petrulis SG, Diaz R, Rawlings R, George DT. Blood glucose is correlated with cerebrospinal fluid neurotransmitter metabolites. Neuroendocrinology. 2003;78:339-343.

Filed under: Violence, , , , , , , , ,

The Dangerous Behaviour Masterclass 4 – Reading: The Biology of Violence

For this Masterclass, instead of continuing with my own discourse, I’d like you to read the following article taken from Neuropsychiatry Reviews, Vol .8, N0. 5, May 2007. Later on, I will expand upon how understanding the interplay between brain function and violence can highlight effective strategies for responding to imminent violence.

Does Biology Play a Role in Domestic Violence?

TUCSON—Between 20% and 30% of all men and women in the US will be victims of domestic violence in their lifetime. Domestic violence accounts for 20% of all emergency department visits, 50% of police calls, and about 30% of murdered women. While considerable research into understanding the perpetrator’s mindset has focused on learned behaviors and psychosocial issues, comparatively little effort has been devoted to exploring possible biological causes of the problem, according to David George, MD.

“Most people look at domestic violence from a psychodynamic/psychosocial perspective,” said Dr. George, Section Chief of Clinical and Translational Studies at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland. “These people believe that perpetrators feel inadequate and try to control other people by their behaviors or that they grew up in homes where they were exposed to violence, and, therefore, they’ve learned these patterns. I was particularly interested in the fact that there has been so little emphasis given to any biological understanding of what might be taking place.” Dr. George made his presentation at the 18th Annual Meeting of the American Neuropsychiatric Association.

The first step in determining whether biological abnormalities may lead to acts of domestic violence is to closely examine who the perpetrators are, according to Dr. George. The incidence of domestic violence is approximately equal in men and women, and about 70% of perpetrators abuse alcohol, he noted. Based on interviews with several hundred people who have committed acts of domestic violence, as well as their spouses and significant others, Dr. George has observed several recurring patterns. One of these patterns is that perpetrators are likely to have been in multiple fights during their childhood. “They are going to push their teachers,” noted Dr. George. “They fight with their siblings and with the kids down the street. As they grow older, most of them tend to limit their violence to the home and direct it toward their spouse or significant other.”

Perpetrators also have little insight into why they become violent, and most acts of domestic violence are impulsive, said Dr. George. “There are those with a predatory side, but I do not see it often. Alcohol plays an important role in domestic violence. Alcohol is a two-edged sword. Perpetrators are going to use alcohol to calm down, but often the alcohol contributes to the likelihood of violence.”

Typical behavioral symptoms in perpetrators include racing thoughts, supersensitivity to environmental stimuli, and mood swings that range from shutdown to flight, fight, and stalking. “I had one person tell me, ‘If you ever got in my mind, you would probably lock me up. You would think I was crazy.’ This is something that is going on inside of them,” said Dr. George. “Little things are going to set them off—spilled milk at the dinner table, dirty dishes that aren’t taken care of in the sink, the dinner that’s late. The most interesting thing was that they feel afraid at the time of the aggression. That was very difficult for me to comprehend, because so often we are working with large and aggressive perpetrators whose victims are smaller in stature. Fear just doesn’t look like it should be a significant factor.”

ANXIETY, PERSONALITY DISORDERS, AND SUBSTANCE ABUSE

Dr. George has conducted a number of studies regarding domestic violence. One trial included perpetrators of domestic violence with alcohol dependence, nonviolent alcoholics, and healthy controls. The researchers found that violent alcoholics had a higher incidence of major depression, panic attacks, social phobia, obsessive-compulsive disorder, generalized anxiety, and certain personality disorders than did nonviolent alcoholics.

In a double-blind, placebo-controlled trial involving the administration of sodium lactate to participants, Dr. George and colleagues found that behavioral symptoms such as speech, breathing, facial grimacing, and motor activity in the arms and legs were much more accentuated in the perpetrators, as was their sense of fear, panic, and rage, compared with nonviolent controls. “These results were instrumental in changing my thinking about perpetrators of domestic violence,” commented Dr. George. “It moved me from seeing them as offensive individuals to seeing them as defensive individuals. This was extremely important to me, because it directed my attention to the neuropathways that have been shown in animals to mediate defensive aggression.”

PSYCHOPATHOLOGY AND FEAR RESPONSE

Dr. George devised a basic model for understanding the psychopathology of perpetrators of domestic violence. “Perpetrators frequently misinterpret environmental stimuli, which gives rise to a perceived sense of threat,” he explained. “Sensory stimuli enter the thalamus, and from there are processed by both the cortex and the amygdala. The processing of the sensory stimuli in the amygdala is extremely fast and serves as an early warning system. The processing of the sensory stimuli in the cortex is going to be much slower and much more detailed than in the amygdala…. The cortex and the amygdala talk to each other. In certain situations, these sensory stimuli give rise to defensive behavior, autonomic arousal, and hypoalgesia…. If you talk to these people and ask them what it is like when they are hitting someone, they will tell you, ‘It feels like my hands and arms are like feathers. I have no feeling in my hands. I don’t feel as though I’m doing anything.’”

In formulating a theory for the etiology of domestic violence, Dr. George reasoned that threats trigger a conditioned fear response in perpetrators that is out of proportion to the stimulus, which may result in fear-induced aggression. “This misinterpretation arises from the abnormality in structures and pathways that mediate fear-induced aggression,” he said.

In a study using PET (18FDG) imaging to examine the neural structures and pathways involved in fear conditioning and fear-induced aggression, Dr. George’s group found that mean CMRglc in the right hypothalamus was significantly lower in perpetrators with alcohol dependence, compared with nonviolent alcoholics and healthy controls. “At rest, when you compare the activities in the left amygdala with various cortical and subcortical structures like the thalamus and cingulate, you see a strong correlation in the nonviolent alcoholics between these structures and the amygdala, whereas in the perpetrators, you had decreased correlations,” said Dr. George. “We are interpreting this to mean that the ability of the cortex to modulate the amygdala in these people is reduced. Similarly, we compared perpetrators with healthy controls. We found the same kind of finding here, decreased correlations [with the left and right amygdala]. And the nonviolent alcoholics had an increased correlation between the left thalamus and left posterior orbitofrontal cortex.”

Such findings may indicate different motivations to drink alcohol for nonviolent alcoholics and alcoholic perpetrators. “Basically, we arrived at two different possibilities,” Dr. George said. “The increased correlation found in nonviolent alcoholics maybe makes them more susceptible to environmental cues that trigger drinking. Whereas, I think alcoholic perpetrators are more prone, at least in the initial stages of the disease, to drink in order to decrease anxiety.”

In another study, Dr. George and colleagues performed lumbar puncture in the left lateral decubitus position in alcoholic perpetrators of domestic violence, nonalcoholic perpetrators, and healthy controls. The researchers found that the nonalcoholic violent group had lower 5-HIAA [5-hydroxyindoleacetic acid] concentrations than did the other two groups, which was “not particularly surprising, given the huge literature that’s out there saying that 5-HIAA is involved with impulsive types of aggression,” noted Dr. George. “It is unclear as to why the alcoholics didn’t have it. We then looked at testosterone, and there we found that [alcoholic perpetrators] did have higher levels of testosterone. So we have at least two neurotransmitter systems that theoretically could be involved, that could be modulating the way they process sensory information. We are looking at a number of other transmitter systems at this time.”

CAN DOMESTIC VIOLENCE BE TREATED?

Dr. George’s current research is focusing on fMRI, genotyping, and potential treatments. To date, he emphasized, “Treatments for domestic violence are often ineffective.” In one ongoing trial, he has been comparing fluoxetine with placebo regarding their effect on measures of aggression, anxiety, and depression in those who commit acts of domestic violence. “What is really interesting is when you look at what serotonin does, it modulates sensory information,” noted Dr. George.

Dr. George believes that it is possible to piece together some of these findings to understand domestic violence on the basis of a biological pathway. “This is such a primitive pathway,” he commented. “Defensive aggression is present throughout the whole animal kingdom and promotes survival. With reduced cortical connection to the amygdala, perpetrators process sensory information very quickly. Based on fMRI studies, this processing of sensory information by the amygdala is out of the conscious awareness. I think that’s why therapy has been so ineffective in these individuals. They are responding so quickly to sensory information that they don’t even have time to think about it.”

Ultimately, Dr. George believes that further studies linking conditioned fear and fear avoidance with behaviors and psychiatric diagnoses will help change the way researchers and clinicians perceive and treat perpetrators of domestic violence.           

—Colby Stong

Suggested Reading
Fils-Aime ML, Eckardt MJ, George DT, et al. Early-onset alcoholics have lower cerebrospinal fluid 5-hydroxyindoleacetic acid levels than late-onset alcoholics. Arch Gen Psychiatry. 1996;53:211-216.
George DT, Phillips MJ, Doty L, et al. A model linking biology, behavior and psychiatric diagnoses in perpetrators of domestic violence. Med Hypotheses. 2006;67:345-353.
George DT, Umhau JC, Phillips MJ, et al. Serotonin, testosterone and alcohol in the etiology of domestic violence. Psychiatry Res. 2001;104:27-37.
Umhau JC, Petrulis SG, Diaz R, Rawlings R, George DT. Blood glucose is correlated with cerebrospinal fluid neurotransmitter metabolites. Neuroendocrinology. 2003;78:339-343.

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