The Neurobiology of Sexual Assault and Trauma

1. THE NEUROBIOLOGY OF SEXUAL ASSAULT Rebecca Campbell, Ph.D. Professor of Psychology Michigan State University .

2. The National Center for Victims of Crime is pleased to provide the slides used in our April 23, 2013 Webinar, Sexual Assault Cold Case Survivors and the Neurobiology of Trauma. Please be advised that these materials are provided through the generosity of our presenter faculty. All copyright laws apply to the proper use and crediting of these materials.

3. Todays Presentation The neurobiology of sexual assault Introduction to neurobiology During the assault: What are victims experiencing? Take home lessons for first responders For current cases For cold cases (i.e., victim notification) Q&A (as best we can!)

4. This Is Your Brain A Brief Intro to Neurobiology

5. Brain Regions Impacted by Trauma

6. HPA Axis Balances body following stress by releasing of various hormones/chemicals Brain-Body Regions Impacted by Trauma (Southwick et al., 2005)

7. Brain-Body Regions Impacted by Trauma Catecholomines: Fight or flight response Cortisol: Energy available Opiods: Prevent pain Oxytocin : Promotes good feelings (Southwick et al., 2005)

8. Brain Regions Impacted by Trauma

9. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma (Southwick et al., 2005)

10. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma (Southwick et al., 2005)

11. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma (Southwick et al., 2005)

12. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma (Southwick et al., 2005)

13. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma (Southwick et al., 2005)

14. Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma (Southwick et al., 2005)

15. Like These . . . Catecholomines: Fight or flight response Cortisol: Energy available Opiods: Prevent pain Oxytocin : Promotes good feelings

16. Like These . . . THESE HORMONES IMPAIR MEMORY CONSOLIDATION Catecholomines: Fight or flight response Cortisol: Energy available Opiods: Prevent pain Oxytocin : Promotes good feelings (Southwick et al., 2005)

17. This Is Your Brain On Trauma During the Assault

18. What Happens During A Sexual Assault Amygdala Detects Threat Activates Hypothalamus HPA Axis Kicks In Hormonal Flood SOURCE: Banks, 2002; Southwick et al., 2005

19. What Happens During A Sexual Assault Damage to memory Impairs rational thought Cathecholamines Increase Reduces energy available Impair immune functioning Corticosteriods Decrease Causes flat affect Opiods Increase SOURCE: Banks, 2002; Southwick et al., 2005

20. What Happens During A Sexual Assault Amygdala Detects Threat Activates Hypothalamus HPA Axis Kicks In Hormonal Flood SOURCE: Banks, 2002; Southwick et al., 2005 Can Trigger a Complete Shut Down in the Body

21. Tonic Immobility (TI) AKA: Rape-induced paralysis Autonomic (uncontrollable) mammalian response in extremely fearful situations Increased breathing, eye closure, paralysis 12-50% rape victims experience TI during assault TI is ~more common in victims who have been assaulted before (childhood, adolescence, or adult) SOURCE: Fuse et al., 2007; Galiano et al., 1993; Heidt et al., 2005

22. Case Study: Tonic Immobility College house party 20 year-old woman Agreed to go back to one of the bedrooms Told man to stop He didnt and she froze Lay immobile afterwards Men lined up on the porch to take turns raping her

23. Case Study: Tonic Immobility Victim had rape kit and filed a police report Police didnt pick up rape kit (a sloppy mess) Police closed case She just laid there, so she must have wanted it . . . no one wants a have a train pulled on them, so if she laid there and took it, she must have wanted it.

24. Case Study: Tonic Immobility Victim had rape kit and filed a police report Police didnt pick up rape kit (a sloppy mess) Police closed case The real reason TONIC IMMOBILITY A DOCUMENTED NEUROBIOLOGICAL CONDITION

25. What Happens During A Sexual Assault

26. What Happens During A Sexual Assault Increased Stress Hormones Impaired Functioning in Hippocampus Memories Fragmented Memory Activation Can Be Unpredictable and Traumatic SOURCE: Koss et al., 1995, 1996; Roozendaal et al., 2009; Rubin et al., 2008

27. What Happens During A Sexual Assault Increased Stress Hormones Impaired Functioning in Hippocampus Memories Fragmented Memory Activation Can Be Unpredictable and Traumatic SOURCE: Koss et al., 1995, 1996; Roozendaal et al., 2009; Rubin et al., 2008 Events of the Assault CAN Be Recalled Accurately

28. What Happens During A Sexual Assault Increased Stress Hormones Impaired Functioning in Hippocampus Memories Fragmented Memory Activation Can Be Unpredictable and Traumatic SOURCE: Koss et al., 1995, 1996; Roozendaal et al., 2009; Rubin et al., 2008 Events of the Assault CAN Be Recalled Accurately BUT . . . Alcohol use during the assault may prevent encoding, which means theres nothing to retrieve

29. Case Study: Memory Fragmentation

30. Case Study: Memory Fragmentation My life was saved by a cup of coffee. I think about that a lot. Thats what saved me from going over the edge.

31. Case Study: Memory Fragmentation 25 year-old woman Raped by a friends brother at 4 th July party Filed police report Detective interview was when it all went to hell He wouldnt let up, pounding me with question after question after question. Trying to trick me, trying to get me to mess up. I wanted to say, hold on, give me a minute to think. No, he kept coming at me.

32. Case Study: Memory Fragmentation Then I guess it was classic good-cop / bad-cop. He stormed off and another detective sat down next to me. He offered me a cup of coffee. Its 90 fing degrees outside and Im a wreck. Coffee? OK fine. How do I take it? WHAT? Why does he care how I take my coffee? Well, he did. He made me coffee. He gave me a long time to just sit, collect my thoughts.

33. Case Study: Memory Fragmentation We talked it through. And I didnt feel rattled and freaked out. Im sure I was incoherent and he just let it roll. He was patient. I felt like I was piecing it together, like a puzzle, we were putting together a puzzle together. And drinking coffee.

34. Case Study: Memory Fragmentation I: So, why did you do that? (give her the coffee) R: It helps. Not the coffee so much, just the moment to let it all come together in their heads. I: What do you mean? R: I dont know why its like that, Ive just noticed that over the years. If you give them a few minutes to breathe . . . . it starts to make more sense. I dont know why, it just does.

35. Case Study: Memory Fragmentation I: So, why did you do that? (give her the coffee) R: It helps. Not the coffee so much, just the moment to let it all come together in their heads. I: What do you mean? R: I dont know why its like that, Ive just noticed that over the years. If you give them a few minutes to breathe . . . . it starts to make more sense. I dont know why, it just does. MEMORY CONSOLIDATION A DOCUMENTED NEUROBIOLOGICAL CONDITION

36. Case Study: Memory Fragmentation I: Were you worried that if you gave her some time, shed just make something up? R: Nah, not really. I mean, some victims lie, but most dont. Besides, if theyre lying, well catch em at it eventually. I think its just hard for victims to talk about and we just need to have a little patience.

37. Case Study: Memory Fragmentation I: Were you worried that if you gave her some time, shed just make something up? R: Nah, not really. I mean, some victims lie, but most dont. Besides, if theyre lying, well catch em at it eventually. I think its just hard for victims to talk about and we just need to have a little patience. MEMORY FRAGMENTATION A DOCUMENTED NEUROBIOLOGICAL CONDITION

38. Implications for Current & Cold Cases Take Home Lessons

39. CURRENT CASES COLD CASES Assaults that occurred recently & are reported ~ 24-96 hours Assaults that occurred a long time ago, but may be re-opened due to new evidence, SAK testing, CODIS hit, etc.

40. . . . BUT from the perspective of the victim . . .

41. COLD CASES Assaults that occurred a long time ago, but may be re-opened due to new evidence, SAK testing, CODIS hit, etc.

42. CURRENT CASES COLD CASES Assaults that occurred recently & are reported ~ 24-96 hours Assaults that occurred a long time ago, but may be re-opened due to new evidence, SAK testing, CODIS hit, etc. FEEL LIKE

43. What Is Victim Notification ? Reactivation of the assault memories HPA Axis re-activation will cause neurobiological distress Could trigger flashbacks and other symptoms Could exacerbate PTSD and/or other MH issues Could increase substance use/abuse Could trigger substance abuse relapse A cold case feels like a current case

44. Take Home Lessons Neurobiological changes can lead to flat affect or strange emotions or emotional swings Hormonal soup Misinterpreted as being cavalier about it or lying Wide range of emotions are in fact normal and it can be helpful to normalize those reactions SOURCE: Campbell & Patterson, 2011

45. Take Home Lessons Neurobiological changes can make memory consolidation difficult Story may come out fragmented or sketchy Misinterpreted as evasiveness or lying The content of the memory is accurate, just may take some time and patience for it to come together SOURCE: Campbell & Patterson, 2011; Koss et al., 1995, 1996

46. Take Home Lessons Tonic immobility is often frightening to victims Associated with increased self-blame Associated with decreased likelihood of seeking help Friends, family, service providers reactions to a disclosure of TI are often hurtful Helpful to explain what TI is and normalize it SOURCE: Fuse et al., 2007; Galiano et al., 1993; Heidt et al., 2005; Marx et al., 2008

47. Take Home Lessons Services for victims Advocacy to buffer effects of continued contact with the legal system Mental health services to address long-term mental and physical health impact Substance abuse services (as needed) Services that are culturally appropriate Services that are developmentally appropriate (Campbell, 2008)

48. Linking Research to Practice Conclusions

49. Concluding Thoughts There are neurobiological reasons for victims behavior The criminal justice system is a180 from what victims need psychologically and neurologically Every contact is an opportunity to help . . . or hurt

50. This project was supported by Grant No.2011-TA- AX-K048 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.