Are batterers different from other criminals? An fMRI study

Intimate partner violence perpetration among veterans: associations with neuropsychiatric symptoms and limbic microstructure

Background

Intimate partner violence (IPV) perpetration is highly prevalent among veterans. Suggested risk factors of IPV perpetration include combat exposure, post-traumatic stress disorder (PTSD), depression, alcohol use, and mild traumatic brain injury (mTBI). While the underlying brain pathophysiological characteristics associated with IPV perpetration remain largely unknown, previous studies have linked aggression and violence to alterations of the limbic system. Here, we investigate whether IPV perpetration is associated with limbic microstructural abnormalities in military veterans. Further, we test the effect of potential risk factors (i.e., PTSD, depression, substance use disorder, mTBI, and war zone-related stress) on the prevalence of IPV perpetration.

Methods

Structural and diffusion-weighted magnetic resonance imaging (dMRI) data were acquired from 49 male veterans of the Iraq and Afghanistan wars (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF) of the Translational Research Center for TBI and Stress Disorders (TRACTS) study. IPV perpetration was assessed using the psychological aggression and physical assault sub-scales of the Revised Conflict Tactics Scales (CTS2). Odds ratios were calculated to assess the likelihood of IPV perpetration in veterans with either of the following diagnoses: PTSD, depression, substance use disorder, or mTBI. Fractional anisotropy tissue (FA) measures were calculated for limbic gray matter structures (amygdala-hippocampus complex, cingulate, parahippocampal gyrus, entorhinal cortex). Partial correlations were calculated between IPV perpetration, neuropsychiatric symptoms, and FA.

Results

Veterans with a diagnosis of PTSD, depression, substance use disorder, or mTBI had higher odds of perpetrating IPV. Greater war zone-related stress, and symptom severity of PTSD, depression, and mTBI were significantly associated with IPV perpetration. CTS2 (psychological aggression), a measure of IPV perpetration, was associated with higher FA in the right amygdala-hippocampus complex (r = 0.400, p = 0.005).

Conclusion

Veterans with psychiatric disorders and/or mTBI exhibit higher odds of engaging in IPV perpetration. Further, the more severe the symptoms of PTSD, depression, or TBI, and the greater the war zone-related stress, the greater the frequency of IPV perpetration. Moreover, we report a significant association between psychological aggression against an intimate partner and microstructural alterations in the right amygdala-hippocampus complex. These findings suggest the possibility of a structural brain correlate underlying IPV perpetration that requires further research.

From childhood maltreatment to intimate partner violence perpetration: A prospective longitudinal examination of the roles of executive functioning and self-esteem

BACKGROUND

Previous research has found that childhood maltreatment predicts increased risk for violence and partner violence and there is some evidence for poorer executive functioning and low self-esteem. To date, there have been no longitudinal studies that have examined the extent to which executive functioning and self-esteem play a role in the relationship between child maltreatment and intimate partner violence (IPV) perpetration.

METHODS

This study aims to fill this gap by utilizing data from a prospective longitudinal study of children with documented court cases of abuse and neglect (ages 0-11 years) from a metropolitan county area in the Midwest (during the years 1967-1971) and demographically matched controls. Both maltreated individuals and matched controls were followed up and assessed over several waves of the study in young and middle adulthood. At mean age 39 years, inhibition and cognitive control were evaluated, while cognitive flexibility and nonverbal reasoning were assessed at mean age 41. Self-esteem was also assessed at mean age 41. Physical IPV perpetration was evaluated at age 47 using two different scoring strategies in separate models: the number of acts and variety of acts, ensuring avoidance of potential score skewness.

RESULTS

Childhood maltreatment predicted lower executive functioning and self-esteem, and both independently predicted intimate partner violence perpetration. Lower executive functioning and self-esteem mediated the relationship between childhood maltreatment and physical IPV perpetration in midlife, irrespective of the scoring method.

CONCLUSION

Findings suggest that executive functioning and self-esteem play a role in the cycle of violence. Implications and suggestions for future directions are discussed.

Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps

Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.

Intrinsic neural network dynamics underlying the ability to down-regulate emotions in male perpetrators of intimate partner violence against women

Research has pointed to difficulties in emotion regulation as a risk factor for perpetrating intimate partner violence against women (IPVAW). While efforts have been made to understand the brain mechanisms underlying emotion regulation strategies such as reappraisal, little is known about the intrinsic neural dynamics supporting this strategy in male perpetrators. Resting-state functional magnetic resonance imaging was used to characterise the network dynamics underlying reappraisal. Spectral dynamic causal modelling was performed to examine the effective connectivity (EC) within a predefined reappraisal-related brain network. 26 men convicted for an IPVAW crime [male perpetrators] were compared to 29 men convicted of other crimes [other offenders] and 29 men with no criminal records [non-offenders]. The ability to down-regulate emotions in response to IPVAW stimuli was used as a covariate to explore its association with male perpetrators' EC. The analysis revealed that (1) compared to non-offenders, both convicted groups exhibited increased EC within prefrontal areas, enhanced EC from prefrontal to temporoparietal regions and decreased EC in the opposite direction; (2) male perpetrators compared to other offenders showed increased EC from temporoparietal to prefrontal regions and, increased EC from the supplementary motor area to frontal areas; (3) connections involving dorsolateral prefrontal cortex were found to be potential predictors of the ability to down-regulate emotions. The study provides a deeper characterisation of the brain architecture of the processes that underlie IPVAW. This knowledge could inform the work of adaptive emotion regulation strategies in intervention programmes for male perpetrators in order to reduce the high recidivism rates.

Psychological Tasks Used in Neuroimaging with Male Perpetrators of Intimate Partner Violence against Women: A Systematic Review

This bibliographic review analyses the utility for psychologists of using neuroimaging tests and psychological or neuropsychological tests at the same time for studying the functioning of the brain in male abusers condemned for intimate partner violence against women (IPVAW). So as to be able to find an answer, we reviewed the available studies that investigated the structure or functioning of the brain. The results of these reviewed works of research show the benefits of using neuroimaging applied to male abusers, together with the use, either simultaneously or not, of other types of psychological, neuropsychological, or observational tests to complement and/or amplify the results of the neuroimaging techniques, as this can help us to advance in the knowledge of neuroscience as concerns the mind of the male abuser.

Resting-state functional connectivity and socioemotional processes in male perpetrators of intimate partner violence against women

Intimate partner violence against women (IPVAW) is a serious and overwhelming public concern. Neuroimaging techniques have provided insights into the brain mechanisms underlying IPVAW perpetration. The purpose of this study is to examine the resting-state functional connectivity (rsFC) involving the process of social decision-making of male perpetrators. Twenty-six male perpetrators convicted for an IPVAW crime were compared to 29 men convicted for crimes other than IPVAW (other offenders) and 29 men with no criminal records (non-offenders) using a seed-based approach. Seeds were located in areas involved in reflective (prefrontal), impulsive (amygdala and striatum) and interoceptive (insula) processing. Then, as an exploratory analysis, the connectivity networks on male perpetrators were correlated with measures of executive functions and socioemotional self-report measures. Male perpetrators in comparison to other offenders and non-offenders, presented higher rsFC between prefrontal, limbic, brainstem, temporal and basal ganglia areas. Also male perpetrators showed higher rsFC between insula, default mode network and basal ganglia, while lower rsFC was found between prefrontal and motor areas and between amygdala, occipital and parietal areas. Exploratory correlations suggest that the specific rsFC in male perpetrators might be more related to socioemotional processes than to executive functions. These results showed that male perpetrators present a specific rsFC in brain systems that are essential for an adaptive social decision-making.

Social mentalizing in male perpetrators of intimate partner violence against women is associated with resting-state functional connectivity of the Crus II

Social mentalizing refers to the ability to understand the intentions, causes, emotions and beliefs of another person or the self and is crucial for interpersonal understanding. Disturbances in this process may lead to aggressive and violent behaviors. Literature has shown that male perpetrators convicted for intimate partner crime (IPVAW) present alterations in different measures related to social mentalizing, in particular, they present more irrational thoughts toward women and difficulties in emotional recognition and empathy processes. However, the brain mechanisms underlying this process are still unknown. The aim of this study is to examine the resting-state functional connectivity of the cerebellar Crus II area, as a core component of social mentalizing in male perpetrators, and to explore if this connectivity is associated with social mentalizing processes. To achieve these objectives, we compared the resting-state connectivity of 25 men convicted for an IPVAW crime (male perpetrators) with 29 men convicted for other crimes (other offenders) and 28 men with no criminal records (non-offenders) using a seed-based whole brain analysis. Subsequently, correlations were performed to explore the association between the significant connectivity networks and social mentalizing measures only in male perpetrators of IPVAW. Analyses showed that male perpetrators of IPVAW exhibit hyperconnectivity between Crus II and posterior areas of the default mode network, frontoparietal and limbic areas compared to other offenders and non-offenders. In addition, the greater connectivity found between the Crus II and the posterior default mode network was related to a greater number of distorted thoughts about women and less affective empathy in male perpetrators of IPVAW. These results show that connectivity between the cerebellum and the default mode network may underlie the social processes that are at the basis of intimate partner violence perpetration.

Emotional Regulation in Male Batterers When Faced With Pictures of Intimate Partner Violence. Do They Have a Problem With Suppressing or Experiencing Emotions?

Emotional regulation is crucial to psychological functioning and mental health. Studies of male batterers indicate the critical role that emotional processing plays in the violence they exert upon their partners or ex-partners. The aim of this study was to investigate the neural bases of emotional regulation in male batterers-both in experiencing and suppressing emotions-when faced with pictures of intimate partner violence (IPV). We conducted a fMRI study to compare brain functioning when emotions were experienced or increased with the case in which emotions were suppressed or reduced in response to IPV pictures and unpleasant pictures. The sample consisted of three groups: Male Batterers Group (MBG, n = 26), that is, men convicted for IPV; Other Offenders Group (OOG, n = 27), men convicted of crimes other than IPV; and a Non-offenders Group (n = 29), that is, men without a criminal history. The results reveal that in MBG, the brain areas that previous studies have related to suppression and experience processes were activated when faced with unpleasant pictures. However, a different pattern of functioning was found when experiencing IPV pictures. That could be explained by a low capacity to empathize with their partners or ex-partners and by the use of maladaptive emotional regulation strategies. In addition, MBG showed activation in brain areas previously related to suppression but did not modulate their emotions, showing a similar emotional state after suppression and experience. The results of this preliminary study suggest that in psychological treatments for male batterers, it is important to promote empathy towards partners or ex-partners, along with adaptive strategies of emotional regulation.

"Would You Allow Your Wife to Dress in a Miniskirt to the Party"? : Batterers Do Not Activate Default Mode Network During Moral Decisions About Intimate Partner Violence

Moral convictions consist of assessments based on perceptions of morality and immorality, of right and wrong. There are people who, based on morality, commit crimes. For instance, social and moral norms based on inequality appear to play an important role in the batterer's behavior to commit violent acts. Research shows that batterers consider themselves to be moral persons, are defenders of their beliefs, and, if necessary, are self-delusional, enjoying a "feeling" of moral worth. The main aim of this work was to uncover the brain mechanisms underlying moral decision making related to intimate partner violence (IPV) against women. We conducted a functional magnetic resonance imaging (fMRI) study comparing moral decisions related to IPV and general violence (GV) in a sample of convicted Spanish men. The two groups of our sample were recruited from the Center for Social Insertion (CSI; Granada, Spain): batterers (BG, n = 21), people convicted for IPV, and other criminals (OCG, n = 20) convicted of violating other legal norms without violence against people. Greene's classical dilemmas were used to validate IPV and GV dilemmas. First, our results showed that IPV and GV dilemmas activate the same brain areas as those activated by Greene's dilemmas, primarily involving the default mode network (DMN), which suggests that IPV and GV dilemmas are both moral dilemmas. Second, our results showed that other criminals activated the DMN during both types of dilemmas. Nevertheless, batterers activated the DMN during the GV dilemmas but not during the IPV ones, suggesting that decisions about their female partners do not entail moral conflict. Thus, these preliminary results showed that batterers do not activate moral areas during IPV dilemmas specifically, but do so during GV dilemmas. These results suggest that intervention programs for batterers should aim to specifically modify the value system held by the abuser toward his female partner and not toward other people.

Characteristics of Childhood Family Violence Experiences in Spanish Batterers

Intimate Partner Violence (IPV) constitutes a major public health problem worldwide. The existing links between childhood family violence experiences and perpetration of IPV during adulthood suggest that violence is transmitted across generations. The aims of this study were to provide new insights into characteristics of the history of childhood family violence in a sample of Spanish convicted male batterers and to examine what typology of batterer (specialist or generalist) is more likely to have had different types of childhood experiences of violence in the family context. Participants were 740 men convicted of IPV whose ages ranged from 18 to 71 years old (M = 39.74; SD = 10.01). Of them, 305 men were classified as specialist batterers, and 391 men were classified as generalist batterers. Participants completed a questionnaire made ad hoc regarding family of origin violence and sociodemographic aspects. Results showed that, in comparison with generalist batterers, specialist batterers had higher likelihood of having experienced child abuse or maltreatment during their childhood, having experienced physical punishment and child neglect, having their father as the aggressor of such experienced situations of abuse, or maltreatment. Likewise, specialist batterers had higher likelihood of having been witnesses of family violence, having witnessed physical and psychological violence in the family, having witnessed their mother and siblings being the victims and their father being the aggressor when family violence occurred. This study emphasized the need for identifying children exposed to direct and indirect family violence because they could be a vulnerable group for future IPV perpetration. Moreover, variables related to childhood family violence must be considered when developing intervention treatment programs focused on male specialist batterers.

Brain Injury and Mental Health Among the Victims of Intimate Partner Violence: A Case-Series Exploratory Study

Intimate partner violence (IPV) survivors frequently report face, head, and neck as their injury site. Many mild traumatic brain injuries (TBIs) are undiagnosed or underreported among IPV survivors while these injuries may be linked to changes in brain function or pathology. TBI sustained due to IPV often occurs over time and ranges in severity. The aim of this case-series study was to explore risk factors, symptoms, and brain changes unique to survivors of intimate partner violence with suspicion of TBI. This case-series exploratory study examines the potential relationships among IPV, mental health issues, and TBI. Participants of this study included six women: 3 women with a history of IPV without any experience of concussive blunt force to the head, and 3 women with a history of IPV with concussive head trauma. Participants completed 7T MRI of the brain, self-report psychological questionnaires regarding their mental health, relationships, and IPV, and the Structured Clinical Interview. MRI scans were analyzed for cerebral hemorrhage, white matter disturbance, and cortical thinning. Results indicated significant differences in resting-state connectivity among survivors of partner violence as well as differences in relationship dynamics and mental health symptoms. White matter hyperintensities are also observed among the survivors. Developing guidelines and recommendations for TBI-risk screening, referrals, and appropriate service provision is crucial for the effective treatment of TBI-associated IPV. Early and accurate characterization of TBI in survivors of IPV may relieve certain neuropsychological consequences.

Neural mechanisms of intimate partner aggression

People sometimes hurt those they profess to love; yet our understanding of intimate partner aggression (IPA) and its causes remains incomplete. We examined brain activity using functional magnetic resonance imaging (fMRI) in an ethnically and racially diverse sample of 50 female-male, monogamous romantic couples as they completed an aggression task against their intimate partner, a close friend, and a different-sex stranger. Laboratory and real-world IPA were uniquely associated with altered activity within and connectivity between cortical midline structures that subserve social cognition and the computation of value. Men's IPA most corresponded to lower posterior cingulate reactivity during provocation and women's IPA most corresponded to lower ventromedial prefrontal cortex activity during IPA itself. Actor-partner independence modeling suggested women's IPA may correspond to their male partner's neural reactivity to provocation. Broadly, these findings highlight the importance of self-regulatory functions of the medial cortex and away from effortful inhibition subserved by dorsolateral cortices.

Intimate Partner Aggression Committed by Prison Inmates with Psychopathic Profile

Psychopathy and intimate partner aggression (IPA) are two concepts that usually appear concomitantly. Male violence toward women is often considered a psychopathic trait that sometimes involves the woman's homicide by her partner and, at other times, attempted homicide. This phenomenon has been studied by conducting interviews following Hare's model with 92 men incarcerated under a compliance regime in a Spanish prison (Córdoba). The results detected six explanatory factors of IPA as a result of attempted homicide or homicide: criminal past and delinquency, impulsivity, the need to stand out from others, lack of empathy, manipulation of others, and instability in partner relationships. The first two factors predict a occurrence of high scores on Hare's Psychopathy Checklist. The results are discussed, and future lines of research are presented, especially focused on the concept of dehumanization and revenge.

Translational Application of a Neuro-Scientific Multi-Modal Approach Into Forensic Psychiatric Evaluation: Why and How?

A prominent body of literature indicates that insanity evaluations, which are intended to provide influential expert reports for judges to reach a decision "beyond any reasonable doubt," suffer from a low inter-rater reliability. This paper reviews the limitations of the classical approach to insanity evaluation and the criticisms to the introduction of neuro-scientific approach in court. Here, we explain why in our opinion these criticisms, that seriously hamper the translational implementation of neuroscience into the forensic setting, do not survive scientific scrutiny. Moreover, we discuss how the neuro-scientific multimodal approach may improve the inter-rater reliability in insanity evaluation. Critically, neuroscience does not aim to introduce a brain-based concept of insanity. Indeed, criteria for responsibility and insanity are and should remain clinical. Rather, following the falsificationist approach and the convergence of evidence principle, the neuro-scientific multimodal approach is being proposed as a way to improve reliability of insanity evaluation and to mitigate the influence of cognitive biases on the formulation of insanity opinions, with the final aim to reduce errors and controversies.

Increased Amygdala Activations during the Emotional Experience of Death-Related Pictures in Complicated Grief: An fMRI Study

Complicated grief (CG) is associated with alterations in various components of emotional processing. The main aim of this study was to identify brain activations in individuals diagnosed with CG while they were observing positive, negative, and death-related pictures. The participants included 19 individuals with CG and 19 healthy non-bereaved (NB) individuals. Functional magnetic resonance imaging (fMRI) scans were obtained during an emotional experience task. The perception of death-related pictures differed between the CG group and the NB group, with a greater activation in the former of the amygdala, putamen, hypothalamus, middle frontal gyrus, and anterior cingulate cortex. Amygdala and putamen activations were significantly correlated with Texas Revised Inventory of Grief scores in the CG group, suggesting that the higher level of grief in this group was associated with a greater activation in both brain areas while watching death-related pictures. A significant interaction between image type and group was observed in the amygdala, midbrain, periaqueductal gray, cerebellum, and hippocampus, largely driven by the greater activation of these areas in the CG group when watching death-related pictures and the lower activation when watching positive-valence pictures. In this study, individuals with CG showed significantly distinct brain activations in response to different emotional images.

The neuromoral theory of antisocial, violent, and psychopathic behavior

The neuromoral theory of antisocial behaviors argues that impairment to the neural circuitry underlying morality provides a common foundation for antisocial, violent, and psychopathic behavior in children, adolescents, and adults. This article reviews new findings in two research fields since this theory was first proposed: brain mechanisms underlying moral decision-making, and brain systems subserving antisocial behaviors. The neuromoral theory is updated to take into account new empirical findings. Key areas implicated in both moral decision-making and the spectrum of antisocial behaviors include fronto-polar, medial, and ventral prefrontal cortical regions, and the anterior cingulate, amygdala, superior temporal gyrus, and angular gyrus / temporoparietal junction. It is hypothesized that different manifestations of antisocial behavior are characterized by differing degrees of neuromoral dysfunction, with primary psychopathy, proactive aggression, and life-course persistent offending being more affected, and secondary psychopathy, reactive aggression, and crimes involving drugs relatively less affected by neuromoral dysfunction. Limitations of the current model, social contextual factors, neural remediation interventions, ascertaining whether the affective or cognitive component of empathy is most implicated, and directions for future research are outlined. One forensic implication of the model is that significant impairment to the neuromoral circuit could constitute diminished criminal responsibility.

Techniques of Neutralization: A Brain Network Perspective

Sykes and Matza introduced neutralization theory in 1957 to explain how juvenile delinquents retain a positive self-image when engaging in delinquent acts. Since then, aspects of neutralization theory have been incorporated into sociological and criminological theories to explain socially deviant behavior. Functional brain mapping research utilizing advanced magnetic resonance imaging techniques has identified complex, intrinsically organized, large-scale brain networks. Higher order operations commonly attributed to three brain networks (default mode network [DMN], central executive network [CEN], salience network [SN]) align closely with neutralization theory. This article briefly discusses brain networks in general and the DMN, CEN, and SN specifically. It also discusses how these networks are involved when engaging in the use of techniques of neutralization and offers implications for future research.

Structural brain differences in emotional processing and regulation areas between male batterers and other criminals: A preliminary study

Poor emotion processing is thought to influence violent behaviors among male batterers in abusive relationships. Nevertheless, little is known about the neural mechanisms of emotion processing in this population. With the objective of better understanding brain structure and its relation to emotion processing in male batterers, the present study compares the cortical grey matter thickness of male batterers to that of other criminals in brain areas related to emotion. Differences among these brain areas were also compared to an emotional perception task. An MRI study and an emotional perception assessment was conducted with 21 male batterers and 20 men convicted of crimes other than Intimate Partner Violence (IPV). Results demonstrated that batterers' had significantly thinner cortices in prefrontal (orbitofrontal), midline (anterior and posterior cingulate) and limbic (insula, parahipocampal) brain regions. The thickness of the dorsal posterior cingulate cortex in the batterer group correlated with scores on the emotional perception task. These findings shed light on a neuroscientific approach to analyzing violent behavior perpetrated by male batterers, leading to a better understanding of the underlying mechanisms involved in IPV.

Anger provocation in violent offenders leads to emotion dysregulation

Anger and anger regulation problems that result in aggressive behaviour pose a serious problem for society. In this study we investigated differences in brain responses during anger provocation or anger engagement, as well as anger regulation or distraction from anger, and compared 16 male violent offenders to 18 non-offender controls. During an fMRI adapted provocation and regulation task participants were presented with angry, happy and neutral scenarios. Prior research on violent offenders indicates that a combination of increased limbic activity (involved in emotion), along with decreased prefrontal activity (involved in emotion regulation), is associated with reactive aggression. We found increased ventrolateral prefrontal activity during anger engagement in violent offenders, while decreased dorsolateral and ventrolateral prefrontal activity was found during anger distraction. This activity pattern was specific for anger. We found no exclusive pattern for happiness. In violent offenders, this suggests an increased need to regulate specifically during anger engagement and regulation difficulties when explicitly instructed to distract. The constant effort required for violent offenders to regulate anger might exhaust the necessary cognitive resources, resulting in a risk for self-control failure. Consequently, continuous provocation might ultimately contribute to reactive aggression.