9/20/2016
1
Sexual Assault:Brain, Experience, Behavior & Memory
Jim Hopper, Ph.D.Independent Consultant &
Harvard Medical School
www.jimhopper.com
Summit County Prosecutor’s OfficeSeptember 29, 2016
Overview•Key Brain Circuitries
•The Brain During Assault
•Trauma and Memory
•Trauma Informed
Victim’s Experience
Fear
Attention
Habits & Reflexes
Memory
9/20/2016
2
Prefrontal Cortex
Fear Circuitry
Amygdala
The BrainSexual Assault
9/20/2016
3
• Loss of prefrontal regulation
• Bottom‐up attention
• Survival reflexes
• Self‐protection habits
• Altered memory encoding and
consolidation
Fear Circuitry in Control
High Stress and Fear =
Impaired Prefrontal Cortex
Arnsten 1998, Science, 280, 1711‐1712; Arnsten 2009, Nature Reviews Neuroscience, 10, 410‐422
911
9/20/2016
4
WeaponFocus
Bottom‐upAttention
Survival Reflexes
9/20/2016
5
Fight or flight?
We evolved to freeze first,
then flee if possible.
Freeze
Ready to suddenly burst into action
When the
fearkicks in
9/20/2016
6
Self‐Protection Habits• Polite responses to aggressive and dominant people
• Polite responses to unwanted sexual advances
• Hoping and pretending its no big deal – trying to save face
9/20/2016
7
Fear‐Habit ParadoxFrom normal, expected scenario
to unexpected attack…
Fear‐based responses can be
habitual behaviors appropriate to
scenario that’s just been left behind
e.g., Schwabe 2013, Hippocampus, 1035‐1043; Packard 2009, Brain Research, 121‐128.
My boyfriend will be angry.
My roommate is home.
I have to leave soon.
You’ve got a girlfriend.
9/20/2016
8
Real CasePerpetrator describing methods on social media:
“Feign intimacy,” “then stab them in the back”
and “THROW EM IN THE DUMPSTER.”
His victim at trial:
• “I didn’t kick or scream or push.”
• “I felt like I was frozen.”
• “I tried to be as polite as possible.”
• “I wanted to not cause a conflict”
• “I didn’t want to offend him.”
991
9/20/2016
9
27
9/20/2016
10
Survival Reflex
Amygdala Amygdala
Ramirez, Moscarello, LeDoux & Sears, 2015, J Neurosci, 3470
Self‐Protection Habit
Drastic survival reflexes…
Escape When There’s No (Perceived) Escape
Dissociation
Blanked/Spaced Out
Disconnected from Body
Autopilot
30
9/20/2016
11
Embodiment Circuitry
Netter 1985, CIBA Collection: The Nervous System
Tonic Immobility• Freezing = Alert and immobile, but able to move
• Tonic immobility = Paralysis, can’t move or speak
• Caused by extreme fear, physical contact with
perpetrator, restraint, perception of inescapability
• Not uncommon in sexual and non‐sexual assaults
Marx et al. 2008, Clin Psychol Sci Practice, 74; Bovin et al. 2008, J Trauma Stress, 402;Brickman & Briere 1984, Int J Women’s Studies, 195; Fuse et al. 2007, J Anx Disord, 265
9/20/2016
12
9/20/2016
13
Tonic Immobility• Response over 300 million years old
• Sudden onset, usually after failed struggle
• Sudden termination
• Can last from seconds to hours
• Does not impair alertness or memory encoding
Humphreys et al. 2010, J Interpersonal Viol, 358
Tonic ImmobilityOther common elements / Evidence to look for:
• Fixed or unfocused staring
• Intermittent periods of eye closure
• Rigid or trembling muscles
• Sensations of coldness
• Numbness or insensitivity to pain
Marx et al. 2008, Clin Psychol Sci Practice, 74; Bovin et al. 2008, J Trauma Stress, 402
While being raped,
half of victims fear
death or serious injury
9/20/2016
14
Collapsed ImmobilitySimilar to tonic immobility
• Can’t move or speak
• Causes = extreme fear, physical contact with
perpetrator, restraint, perceived inescapability
• Evolutionarily old response (and more recent‐
human version associated with blood‐injury)
• Sudden onset (but more gradual offset)
Kozlowski et al., in press, Harvard Rev Psychiatry ; Baldwin 2013, Neurosci Biobehav Rev, 1549; Bracha 2004, CNS Spectrums, 679
Collapsed Immobility
Key differences from TI
• Physiological cause = Heart gets massive
parasympathetic input, resulting in…
• Extreme ↓ in heart rate and blood pressure
• Faintness, “sleepiness” or loss of consciousness
• Loss of muscle tone – Collapsed, limp, etc.
Kozlowski et al., in press, Harvard Rev Psychiatry ; Baldwin 2013, Neurosci Biobehav Rev, 1549
9/20/2016
15
9/20/2016
16
I felt like a rag doll.
He was just moving me around.
Evolved and Adaptive*Responses of Brain and Body
Perpetrator Victim• Not stressed
• Prefrontal cortex in control
• Thinking and behavior:
• Planned
• Practiced
• Habitual
• Afraid, overwhelmed
• Fear circuitry in control
• Attention and thoughts driven by perpetrator actions
• Behavior controlled by survival reflexes and habits from childhood (incl. abuse)
9/20/2016
17
Did not resist
No attempt to escape
Did not scream
‘Active participant’
Sexual Assaultand Memory
Fear circuitry focus: what seems most
important to survival and coping
Attended = Central Details = Encoded
Bottom‐Up Attentionand Memory
9/20/2016
18
Encoding Consolidation Stored Memory
Episodic Memory Formation
What are the
central details?
9/20/2016
19
e.g., Schwabe et al., 2012; Neurosci Biobehav Rev, 1740; Joels et al., 2012, Pharmacol Rev, 901.
Some Aspects CAN Be Recalled Accurately:Fear Onset, Central Details, Survival Reflexes
and Other “Islands of Memory”
Fear Circuitryin Control
Bottom‐Up Attention
Retrieved Memories Can Be Unpredictable,
Incomplete, Disorganized
Impaired Prefrontal Cortex
Increased Stress
Hormones
Altered Hippocampal Functioning
Fragmentary Memories
Encoding,Consolidation
When the
fearkicks in
(Fear) Memory: Sensations
Simple links between sensations and reflexive fear behaviors:
LeDoux 2000, Ann Rev Neurosci, 155
Amygdala
9/20/2016
20
(Fear) Memory: Context
LeDoux 2000, Ann Rev Neurosci, 155
Predict = Survive
Zoladz et al., 2014, Costa & Villalba (Eds.), Horizons in Neuroscience Research (Vol. 14), 1‐40
FearKicks In
NormalEncoding
Super‐Encoding
MinimalEncoding
Secs ‐Mins Mins ‐ Hours
Still being consolidated
Time‐Dependent Hippocampus Effects
What Gets Encodedand Consolidated
• Fragments ‘burned into’ memory
• Islands of memory
• Few peripheral details
• Little or no time‐sequence information
• Little or no words or narrative
9/20/2016
21
Islands of Memory• Micro‐islands – Fragmentary sensations
• Larger islands – Key periods within assault
• Early phase, especially habit‐based responses
• When fear kicked in, right before and after
• Survival reflexes
• Freezing
• Dissociation
• Tonic Immobility
• Collapsed Immobility
• Defeat / giving up
e.g., Schwabe et al., 2012; Neurosci Biobehav Rev, 1740; Joels et al., 2012, Pharmacol Rev, 901.
Some Aspects CAN Be Recalled Accurately:Fear Onset, Central Details, Survival Reflexes
and Other “Islands of Memory”
Fear Circuitryin Control
Bottom‐Up Attention
Retrieved Memories Can Be Unpredictable,
Incomplete, Disorganized
Impaired Prefrontal Cortex
Increased Stress
Hormones
Altered Hippocampal Functioning
Fragmentary Memories
Encoding,Consolidation
Vulnerability to Distortion?
• Central Details = Very Low Vulnerability
• Peripheral details = High Vulnerability
9/20/2016
22
• Low‐moderate dose/intoxication
• Impairs context encoding (hippocampus)
• Does not impair encoding of sensations
• Resembles effect of fear/trauma
• High dose/intoxication:
• Impairs hippocampus‐mediated encoding and consolidation of both context and sensations
• Does not necessarily impair implicit memories
Melia… LeDoux, 1996, Neuroscience, 74, 313Bisby et al. 2009, Psychopharmacology, 204, 655; Bisby et al. 2010, Biol Psychiatry, 68, 280
Alcohol and Memory
Beginnings and Endings
Transitions
Most Intense Elements
Other Key Principlesof Memory
9/20/2016
23
Piece of Memory
Trauma‐Informed
1. Victim’s Experience
2. Perpetrator‐Victim Dynamics
9/20/2016
24
Two Essentials of Healing – And Seeking Justice
“The core experiences of psychological trauma
are disempowerment and disconnection.
Recovery, therefore, is based upon the
empowerment of the survivor and the creation
of new connections….”
‐ Judith Herman, Trauma and Recovery
ChoicesWhat to Expect
Respect Empathy
Partner with Skills, Preferences
9/20/2016
25
“I Don’t Have Time for Empathy” = More Time, Less Understanding, Worse Case
“I don’t have time for empathy,”“I’ve got to get the bad guy,” etc.
Lack of empathy for victim,Failure to empower victim
Victim feels unsafe, is less cooperative,
less able to remember, less willing to report
Less and lower qualityinformation is collected,
Poorer case is built
Investigation and prosecution fail
“I’m going to help this person feel understood, safe, in control, competent, and cared for.”
Empathy for person,Empowerment of person
Person feels more safe
Is more cooperativeMore able to rememberMore willing to report
More and better qualityinformation is collected
Stronger case is builtStronger case heard
Investigation succeedsBetter prosecutionBetter adjudication
Empowerment, Empathy, Compassion =
More Objective Information, Better Case
Expect Little, Don’t Push
• Peripheral details
• Contextual information
• Time‐sequence information
• Organized or coherent narrative
9/20/2016
26
Are you getting central details?
Islands of memory?
Are you empowering and connecting
with the victim?
Are you getting information
about brain‐based trauma responses?
