The neural correlates of intimate partner violence in women

Abstract

IntroductionIntimate partner violence (IPV) is a global public health problem. Population-based surveys from developed countries indicate that 1 in 4 women have experienced IPV in their lifetime, and 1 in 10 are current victims. 1-2 Similarly, a cross-sectional survey from South Africa found that the lifetime prevalence of women experiencing IPV was 24.6%, and 9.5% in the last year. 3 The high prevalence of adverse physical and mental health outcomes related to IPV, is well established in the research literature. [4][5][6] In a review of mental health outcomes of women with IPV, victims of partner violence were up to 5 times more likely to develop major depressive episode (MDE), suicidality, posttraumatic stress disorder (PTSD) and substance abuse compared to non victims. 7 There is growing interest in determining the neurobiological correlates of trauma exposure and its sequelae. A number of neurobiological studies of PTSD in women have specifically recruited subjects with IPV exposure. [8][9][10][11] In one such study, women exposed to IPV displayed deficits in executive functioning, working memory and visuoconstruction. 11 In another, women with IPV were found to have smaller supratentorial cranial vault volumes, largely due to reduced mesial temporal grey matter particularly in the parahippoocampal region, and reduced frontal and occipital grey matter regions. 10 Taken together, these findings suggest that IPV may be associated with deficits in cognitive tasks, which are in turn associated with a range of neural circuitry abnormalities.It is unclear whether these findings are due to the trauma exposure, or to the sequelae of trauma exposure (eg PTSD, MDE). In a series of meta-analyses of hippocampal volume in PTSD, persons exposed to trauma (not exclusively IPV) without PTSD had reduced hippocampal volumes compared to healthy non-trauma exposed controls. In the same series, a meta analysis (12 studies, N=379) of persons with trauma exposure and PTSD compared to trauma exposed non-PTSD subjects found a significant reduction in the left hippocampal volume in the PTSD group. 12 There are few studies that have specifically investigated hippocampal volume in IPV exposed subjects. One such study reported no difference in hippocampal volume in women with IPV and PTSD compared to women with Method: Nineteen women with IPV exposure in the last year, and 21 women without IPV exposure in the last year underwent structural magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) sequences. Additional data on alcohol use and presence of psychiatric disorder was collected. Differences in fractional anisotropy (FA) between the two groups were examined, using a statistical model that included demographic measures, alcohol use and psychiatric disorder. Results: IPV subjects did not demonstrate significantly different hippocampal volumes compared to subjects without recent IPV. FA was, however, significantly reduced in the body of the corpus callosum of IPV subjects. Adjusting for age, alcohol use, smoking an...

Non-communicable diseases among women survivors of intimate partner violence: Critical review from a chronic stress framework

“…However, no evidence for a reduced hippocampus volume was observed in either IPV PTSD-or IPV PTSD+ when compared to control participants. Two other studies in IPV women without PTSD supported a lack of effect of IPV on the hippocampus (Flegar et al, 2011;Roos, Fouche, & Stein, 2017).…”

“…Interestingly, in the study by Flegar and colleagues where no differences in hippocampal volume were found in IPV exposed women (Flegar et al, 2011), authors used diffusion tensor imaging (DTI) to explore white matter integrity among these women. FA values were reduced in the body of the corpus callosum.…”

Bridging Intimate Partner Violence and the Human Brain

“…However, all these studies included both participants who had experienced abuse-related trauma, and also those who had been exposed to other trauma, such as wars, combat, accidents, and disasters. Neuroimaging studies conducted in abused women showed no significant difference in the hippocampal volume between abused and nonabused women (Fennema-Notestine, Stein, Kennedy, Archibald, & Jernigan, 2002; Flegar et al, 2011), rendering the findings on the effect of IPV on women’s hippocampal volume inconclusive. There are two explanations for such inconsistent findings.…”

A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group

“…There is evidence, which has emerged over the past decade, that exposure to IPV impacts neuronal structure and function. For example, women who experience IPV show reduced cortical thickness in both frontal and occipital brain regions (Fennema-Notestine, Stein, Kennedy, Archibald, & Jernigan, 2002), as well as reduced white matter integrity in the body of the corpus callosum compared to women with no history of IPV (Flegar et al, 2011). Furthermore, alterations in global and regional functional connectivity of regions involved in cognitive-emotional control have been shown in women who have experienced IPV (Roos, Fouche, & Stein, 2017).…”

“…There is a growing structural and functional neuroimaging literature in the study of IPV. Women who experience IPV show alterations in brain volume (Fennema-Notestine et al, 2002), white matter microstructure (Flegar et al, 2011), and global and regional functional connectivity (Roos et al, 2017).…”