No More Drama

No more pain (no more pain)
No more pain (no more pain)
No drama (no more drama in my life, no ones gonna make me hurt again)
No more in my life

No More Drama
-----Mary J. Blige

Women who are victims of intimate partner violence (IPV) can suffer from post-traumatic stress disorder (PTSD), cognitive impairments (Twamley et al., 2009), and alterations in brain activity when anticipating aversive or threatening events (Simmons et al., 2008).

In a neuroimaging study, 15 women with IPV-related PTSD were compared to 15 non-traumatized control women in a task that cued the presentation of either positive or aversive images (Simmons et al., 2008). The authors hypothesized that the women with PTSD would show exaggerated neural responses in the insula in anticipation of negative stimuli. This brain region is implicated in interoceptive awareness of bodily states (Craig, 2009), and is responsive to scenes and expressions of disgust (Stark et al., 2007).



Figure 1 (Simmons et al., 2008). Anticipation Task. The fMRI task combined a continuous performance task with the interspersed presentation of affective stimuli. Subjects were asked to press the left or right button on a touch pad on the basis of the shape on the screen. Subjects were instructed before the task that a switch from a blue to a green shape accompanied by a low tone would indicate that a positive image was going to appear on the screen. In contrast, a switch from a blue to a red shape accompanied by a high tone signaled an impending negative image.

A priori regions of interest (ROIs) were selected in bilateral anterior insula and right anterior/middle insula. These ROIs showed greater activation in anticipation of negative vs. positive images in both groups. Furthermore, the PTSD group showed greater signal change than controls in the right anterior/middle insula, as shown below.


Figure 3 (Simmons et al., 2008). Anticipation of negative images versus positive images leads to increased activation in bilateral anterior insula (A shows right-sided activation and B shows left-sided activation) and (C) right anterior/middle insula, which was significantly more active in IPV relative to NTC subjects.

Additional connectivity analyses suggested that correlations between activation in the insular regions and the amygdala were weaker in the IPV-PTSD group. The authors speculate that:

...the increased activation in anterior/middle insula observed in IPV subjects with PTSD, in particular on the left side, might represent a neural substrate linking emotional distress, anticipatory processing, and autonomic arousal, which can advance action planning to reduce exposure to the aversive stimuli. Therefore, the anterior/middle insula activation might be interpreted as a “warning signal” that is associated with the anticipation of aversive symptoms such as hyperarousal. This interpretation is supported by the strong functional connectivity between anterior/middle insula and amygdala observed in the current study...

Hyperarousal takes its toll on cognition, however, as demonstrated in another experiment that assessed neuropsychological functioning in a group of women with IPV-PTSD, who showed slower cognitive processing speed than controls (Twamley et al., 2009):

We speculate that the cognitive slowing seen in PTSD may be attributable to reduced attention due to a need to allocate resources to cope with psychological distress or unpleasant internal experiences.

A goal for the future is to see whether appropriate clinical treatment ameliorates this deficit. Overall, however, the best strategy is to stop the violence before it occurs. WHO, CDC, and womenshealth.gov have information on the prevention of intimate partner violence. You can also call the National Domestic Violence Hotline. Feel free to list addition resources in the comments.

References

Craig AD. How do you feel--now? The anterior insula and human awareness. (2009). Nat Rev Neurosci. 10:59-70.

SIMMONS, A., PAULUS, M., THORP, S., MATTHEWS, S., NORMAN, S., & STEIN, M. (2008). Functional Activation and Neural Networks in Women with Posttraumatic Stress Disorder Related to Intimate Partner Violence. Biological Psychiatry, 64 (8), 681-690. DOI: 10.1016/j.biopsych.2008.05.027

Stark R, Zimmermann M, Kagerer S, Schienle A, Walter B, Weygandt M, Vaitl D. (2007). Hemodynamic brain correlates of disgust and fear ratings. Neuroimage 37:663-73.

TWAMLEY, E., ALLARD, C., THORP, S., NORMAN, S., HAMI CISSELL, S., HUGHES BERARDI, K., GRIMES, E., & STEIN, M. (2009). Cognitive impairment and functioning in PTSD related to intimate partner violence. Journal of the International Neuropsychological Society, 15, 879-887. DOI: 10.1017/S135561770999049X

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