家庭暴力中严重躯体施暴行为的代际传袭：从心理—社会—精神病理—遗传学角度探讨
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摘要
第一部分社区成年男性家庭暴力中严重躯体施暴行为代际传袭的社会心理学因素研究
目的
比较暴力家系施暴组(Abusers with Violent Pedigree,简称AP)、无暴力家系施暴组(Abusers without Violent Pedigree,简称ANP)、暴力家系非施暴组(Non-Abusers with Violent Pedigree,简称NAP)、无暴力家系非施暴组(Non-Abusers without Violent Pedigree,简称NANP)四组间个体儿童期虐待及目睹家庭暴力情况、家庭环境、创伤经历以及个体愤怒情绪、冲动特质之间的差异,探讨家庭暴力严重躯体施暴行为代际传袭的环境-素质因素。
方法
1结合当地派出所、妇联、社区街道办事处、社区卫生服务中心机构提供的存在严重家庭暴力的备案登记资料,经社区街道办事处、妇联、社区卫生服务中心等相关部门协助采样。
2采用横断面设计,对AP组136例、ANP组93例、NAP组105例及NANP组198例进行社会心理学特征的比较。评估工具采用自编社会人口学资料及自编精神活性物质使用问卷,自编家庭暴力高发家系调查定式访谈问卷,自编儿童期目睹家庭暴力及目前家庭暴力状况问卷,儿童期虐待简式问卷(Childhood Trauma Questionnaire-Short Form, CTQ-SF),状态-特质愤怒表达量表2(State-Trait Anger Expression Inventory-2, STAXI-2), Barratt冲动量表-11(Barratt Impulsive Scale11Version, BIS-11),家庭亲密度与适应性量表-Ⅱ(Family Adaptability and Cohedion Scale-II, FACES-II)及创伤性生活事件量表(Traumatic Life Event Questionnaire, TLEQ)。
结果
1AP组儿童期遭受躯体虐待、性虐待分及儿童期虐待总分、目睹家庭暴力分均高于其他三组。NAP组在儿童期情感虐待、躯体虐待、性虐待、情感忽视分和目睹家暴分均显著高于ANP和NANP组。严重躯体施暴行为与儿童期遭受各型虐待分及总分、目睹家暴分均呈显著正相关。
2四组家庭亲密度与适应性评分呈逐渐上升趋势：AP组 3创伤性事件分与儿童期遭受各型虐待分及总分、目睹家暴分均呈显著正相关,而家庭亲密度分与儿童期遭受虐待分、目睹家暴分、创伤性事件分均呈显著负相关,家庭适应性分与儿童期各型忽视、儿童期受虐总分及创伤事件分均呈显著负相关。儿童期遭受各型虐待分及儿童期受虐总分与分别愤怒感觉、躯体愤怒、冲动分呈显著正相关,而儿童期遭受躯体虐待分与愤怒表达外投分呈显著正相关,儿童期情感忽视、躯体忽视及儿童期受虐总分与愤怒对内及对外控制均呈显著负相关。家庭亲密度与躯体愤怒得分、愤怒对内控制呈显著负相关,而创伤经历得分与躯体愤怒分及愤怒表达外投分呈显著正相关。
4环境-素质多因素分层Logistic回归,影响依次是目睹家庭暴力,其次是冲动特质、创伤经历,言语愤怒、愤怒内投表达、儿童期躯体受虐再次,模型的决定系数为46.5%。其中,家庭亲密度仍是严重躯体施暴行为发生的保护因素。
结论
1国内社区家庭暴力严重躯体施暴行为存在代际传袭现象,但儿童期目睹家庭暴力成年后更容易成为严重躯体施暴者,而儿童期经历家庭暴力不一定成为严重躯体施暴者。
2家庭关系疏远,家庭成员之间缺乏情感投入与相互支持,家庭关系刻板僵化,家庭处境发生改变而难以适应改变,增加家庭暴力代际传袭的可能。反之,家庭关系适度亲密,适应力强,可以缓冲家庭暴力代际传袭的风险。
3暴力高发家系施暴者创伤性事件最多。不论在暴力家系还是无暴力家系,创伤性事件经历越多,出现严重躯体施暴行为的可能性呈上升趋势。个体经历某些创伤事件,却成为家庭暴力施暴行为出现的保护因素。暴力高发家系施暴者的愤怒情绪及冲动特质更明显,而愤怒控制能力较差。不论在暴力家系还是无暴力家系,言语愤怒、愤怒反应及表达越明显,出现严重躯体施暴行为的风险越大；而在无暴力家系中,对内控制愤怒能力越强,越不易出现严重躯体施暴行为。
4个体儿童期目睹家庭暴力或经历躯体虐待,冲动特质明显,容易愤怒并内投表达愤怒,对内控制愤怒,经历创伤性应激事件,家庭关系疏远,家庭成员之间彼此分离、缺乏良性沟通互动,均成为增加家庭暴力严重躯体施暴行为风险的高危因素。
第二部分严重躯体施暴者代际传袭精神创伤及人格特质的中介机制研究
目的
对四组不同家系来源的国内社区成年男性家庭暴力严重躯体施暴者及对照的创伤症状以及偏执型、边缘型、反社会型人格障碍特质进行比较分析；采用AMOS软件运用结构方程模型的方法建立创伤症状及人格障碍特质作为严重躯体施暴行为代际传袭的中介因素模型,并对AP组及严重躯体施暴组(Severe physical violence, SPV组,即AP组+ANP组)两组进行多群组分析。
方法
调查方法同第一部分,研究工具包括一般资料(同前)、事件影响量表(Impact of Event Scale-Revision, IES-R)及人格障碍诊断量表(Personality Diagnostic Questionaire-4+, PDQ-4+)中对偏执型、边缘型、反社会型人格障碍的分量表。
结果
1AP组的回避、闯入症状分及总分均明显高于其他三组,AP组的高警觉性症状分高于NAP组及NANP组。AP组的偏执型、边缘型、反社会型三型人格障碍特质分最高。
2目睹家庭暴力、儿童期遭受情感虐待、躯体虐待、性虐待得分及儿童期受虐总分均分别与三大创伤主症状及总分、边缘型及反社会人格障碍特质呈显著正相关。此外,经历创伤事件数量与创伤三大主症状呈极显著正相关。经历创伤事件与三型人格障碍特质分呈极显著正相关。
3精神病理学因素分层logistic回归分析显示,偏执型及反社会型人格障碍特质及闯入创伤症状进入模型,且模型的决定系数为31.4%。
4创伤症状、边缘型及反社会型人格障碍特质作为严重躯体施暴行为代际传袭的中介因素模型均有良好的适配性,多群组分析也显示了其模型不变性。创伤症状对儿童期虐待到严重躯体施暴有部分中介效应,是创伤经历到严重躯体施暴的完全中介。边缘型人格障碍特质是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介。反社会型人格障碍特质是目睹家庭暴力到严重躯体施暴行为的部分中介,也是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介。
结论
1在暴力高发家系中成长的施暴者创伤症状最严重,而不管暴力高发家系还是无暴力家系中,闯入、高警觉症状越严重,严重躯体施暴行为的风险性越大。对创伤症状的预测能力依次是目睹家庭暴力,其次是创伤经历,儿童期遭受虐待最次,且儿童期遭受虐待或目睹家庭暴力都对严重躯体施暴行为的形成有显著直接效应。创伤症状对儿童期虐待到严重躯体施暴有部分中介效应,是创伤经历到严重躯体施暴的完全中介。
2严重躯体施暴者的偏执型、边缘型及反社会型人格障碍特质明显。边缘型人格障碍特质是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介。反社会型人格障碍特质是目睹家庭暴力到严重躯体施暴行为的部分中介,反社会型人格障碍特质是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介
第三部分严重躯体施暴行为代际传袭的基因初探及基因-环境交互作用分析
目的
对国内社区不同家系来源的成年男性严重躯体施暴者进行5-羟色胺转运体(5-HTT)、儿茶酚氧位甲基转移酶(COMT)相关基因多态性包括SNP位点rs2066713,rs4680,rs4818,rs6354,及单胺氧化酶A(MAOA)-uVNTR短串联重复多态性研究；探讨基因-基因交互作用以及基因-环境交互作用对严重躯体施暴行为代际传袭的影响。
方法
1样本采集方法同第一部分,SPV组112例(包括AP组53例及ANP组59例),非施暴组183例(包括NAP组61例及NANP组122例)完成血样采集及全血DNA提取。
2采用连接酶检测反应和测序法对5-HTT rs2066713,rs6354SNP, COMT rs4680, rs4818SNP及MAOA-uVNTR基因型进行判读,并四组各多态性比较基因型、等位基因型及单体型之间的差异。运用MDR软件探讨基因-基因交互作用以及基因-环境交互作用对严重躯体施暴行为代际传袭的影响。
结果
1基因型频率比较发现,MAOA-uVTNR的片段多态性四组间比较有显著统计学差异,并且AP组的3-repeat片段频率高于NAP组,有显著统计学意义。AP及ANP组的5-HTT基因rs6354SNP的A等位基因频率分别显著高于NAP组和NANP组。
2SPV组的5-HTT基因的rs6354SNP基因型频数AA基因型高于NANP组。SPV组rs6354的A等位基因频率高于NANP组,COMT基因rs4680的G等位基因频率高于NANP组。
3SPV组及NANP组比较,5-HTT基因rs2066713-rs6354单体型T/A及T/C型的OR值分别为1.694,1.505。COMT基因rs4680-rs4818的A/G及G/C单体型的OR值分别为0.629,1.281。AP组与NANP组比较,发现COMT基因的A/G单体型的OR值为0.452。ANP组与NANP组比较,发现5-HTT基因rs2066713-rs6354单体型T/A的OR值为2.128；COMT基因rs4680-rs4818单体型G/C单体型的OR值为1.535,以上结果均有显著统计学意义。
4SPV组相比NANP组,rs6354-儿童期虐待-家庭亲密度-家庭适应性的交叉验证一致性较高。AP组相比NANP组,MAOA-uVNTR-儿童期情感忽视-儿童期受虐三因素模型的交叉验证一致性最高,rs6354-MAOA-uVNTR-儿童期情感忽视-儿童受虐其次。
结论
1个体5-HTT基因rs6354SNP的A等位基因、COMT基因rs4680的G等位基因与MAOA-uVNTR多态性呈低活性的3-repeat会增加成为严重躯体施暴者的风险。5-HTT基因rs2066713-rs6354单体型T/A及T/C、COMT基因rs4680-rs4818单体型G/C为严重躯体施暴行为的危险因子,而COMT基因rs4680-rs4818单体型A/G为严重躯体施暴行为的保护因子,在暴力家系严重躯体施暴行为产生中尤甚。5-HTT基因rs2066713-rs6354T/A单体型及COMT基因的rs4680-rs4818单体型G/C可能增加无暴力家系严重躯体施暴行为的风险。
2不论暴力高发家系还是无暴力家系,rs6354SNPA等位基因频率较高个体儿童期遭受虐待,且家庭关系彼此疏远分离,互动及情感支持较少,应对生活变故和应激事件能力差,不灵活,会增加家庭暴力中严重躯体施暴行为的风险。
3暴力高发家系中,个体MAOA-uVNTR的3-repeat序列及rs6354的A等位基因频率高,在儿童期遭受虐待可能会增加暴力高发家系严重躯体施暴行为的风险。
Part I Psychosocial factors in the intergenerational transmission of male-perpetrated severe physical violence in Chinese Community
Objectives
To compare childhood abuse, witness DV, family environment, traumatic experiences and state-trait anger, impulsivity in the four groups: the group of the Abusers with Violent Pedigree(AP), the group of Abusers without Violent Pedigree(ANP), Non-Abusers with Violent Pedigree(NAP), Non-Abusers without Violent Pedigree(NANP), and to explore the environmental and predisposing factors of the intergenerational transmission of severe physical violence(SPV).
Methods
1we identified cases of domestic violence based on appeals for help to police stations, local Women's Federations, Residents'Community Committee, Center of Community Health Services, the judicial branch of city governments.
2Using Cross sectional design to compare the psychosocial characteristics of AP group(n=136), ANP group(n=93), NAP group(n=105) and NANP group(n=198). Assessing instruments were adopted including self-edited questionnaires of psychosocial data and using psychoactive drug, self-edited structured interview questionnaire of domestic violence pedigrees, Childhood Trauma Questionnaire-Short Form(CTQ-SF), State-Trait Anger Expression Inventory-2(STAXI-2), Barratt Impulsive Scale11Version(BIS-11), Family Adaptability and Cohesion Scale-II (FACES-II), Traumatic Life Event Questionnaire (TLEQ).
Results
1Scores of childhood physical abuse, sexual abuse, CTQ-SF added scores and witness domestic violence(DV) in AP group were higher than the other three groups. Scores of childhood emotional, physical and sexual abuse, emotional neglect, witnessing DV in NAP group were higher than ANP and NANP group significantly. Scores of SPV were positively related with scores of the sub-scales and added scores of childhood abuse, scores of witness DV.
2Scores of FACES-II in the four groups were increasingly escalated: AP group 3The numbers of traumatic events were positively correlated with the scores of sub-scales and added scores, witness DV, and the scores of family cohesion were negatively related with scores of sub-scales and added scores of CTQ-SF, witness DV, traumatic events, the scores of family adaption were negatively related with scores of childhood neglect and added scores of CTQ-SF, traumatic events. The scores of sub-scales and added scores of CTQ-SF were positively related with anger feeling, physical anger and impulsivity, the scores of childhood physical abuse were positively correlated with the scores of anger expression, and the scores of childhood emotional and physical neglect, added scores of CTQ-SF were negatively related with anger control. The scores of family cohesion were negatively related with physical anger and anger control to self, and the numbers of traumatic events were positively related with physical anger and anger expression outside.
4Using Multivariate Hierarchical Logistic Regression methods, the environmental and predisposing factors of the intergenerational transmission of SPV were witness DV, impulsivity, traumatic experiences, verbal anger, anger expression to self, childhood physical abuse by turns according the Relative Risk of the model, and the coefficient of determination of the model was46.5percent. Furthermore, the family cohesion was the protective factor in the model.
Conclusions
1The intergenerational transmission of SPV exists in the Chinese community, but childhood witness DV influences more on the intergenerational cycle than experiencing childhood abuse.
2Estrangement of family relations, lacking for emotional investment and support among family members, stereotyping or fixed family structure, difficulty to adapt for changes of family situation, may increase the risk of the intergenerational cycle of SPV. On the contrary, moderately intimate family relations and strong adaptive capacity of family members may buffer the risk of the intergenerational cycle of SPV.
3Perpetrators with violent pedigree experience the most traumatic events. Despite violent pedigree, individuals experience more traumatic experiences are more possible to perpetrate SPV. Some traumatic experiences may be the protective factors of the intergenerational cycle. The anger and impulsivity of AP group are more significant than the other groups, and the ability of anger control is worse than the other groups. Despite violent pedigree, individuals with more verbal anger and anger reaction, anger expression are more possible to perpetrate SPV, while in the family without violent pedigree, more able to control anger to self, more impossible to perpetrate SPV.
4Individuals with more experiences of childhood witness DV and physical abuse are more impulsive, irritable, and more likely to control anger inside or express angry to self. They experience more traumatic events, and their family relations may be more estrange, separating from each other, lacking for benign communication and interactivity. The risk factors mentioned upper may increase the risk of the intergenerational cycle of SPV.
Part II Traumatic symptoms and personality features:Mediating analysis on the intergenerational transmission of male-perpetrated severe physical violence
Objectives
1To compare the traumatic symptoms and paranoid, borderline and antisocial personality disorder features in the four groups of participants;
2To analyze the mediating mechanism of the traumatic symptoms and personality disorder features on the intergenerational transmission of SPV through establishing the structural equation modeling(SEM) model using AMOS software package, and carry out the multi-group analysis of AP group and SPV group(AP+ANP).
Methods
The procedure methods and partial assessing instruments were the same as part I. Additionally included Impact of Event Scale-Revision (IES-R) and Personality Diagnostic Questionaire-4+(PDQ-4+).
Results
1The scores of avoidance and intrusion and added scores of IES-R in AP group were significantly higher than the other groups, the scores of hyper-vigilance were higher than NAP and NANP group. The scores of paranoid, borderline and antisocial personality disorder features were the highest in the four groups.
2The scores of witness DV, childhood emotional, physical and sexual abuse and added scores of CTQ-SF were positively related with the scores of three main traumatic symptoms. Furthermore, the numbers of traumatic events were positively related with the traumatic symptoms and personality disorder features.
3Using Multivariate Hierarchical Logistic Regression methods to analyze the psychopathological factors, results showed that paranoid and antisocial personality disorder features and intrusion entered into the model, and the coefficients of decision was31.4percent.
4The three SEM models of traumatic symptoms, borderline and antisocial personality disorder features as mediating factors on the intergenerational transmission of SPV had satisfactory adaptation. Multi-groups analysis showed their invariance. Traumatic symptoms were the partial mediators of relationships between childhood abuse and SPV, and the full mediators between traumatic experiences and SPV. Borderline and antisocial personality disorder features were the full mediators between the traumatic experiences, childhood abuse and SPV, and antisocial personality disorder features were partial mediators between witness DV, childhood abuse and SPV.
Conclusions
1In the violent pedigrees, abusers have the most severe traumatic symptoms. The traumatic symptoms, especially intrusion and hyperarousal symptoms are more severe, more possible to perpetrate SPV. The predictors of traumatic symptoms are witness DV, traumatic experiences, childhood abuse by turns, and childhood abuse or witness DV may be the indirect predictor of SPV. Traumatic symptoms are the partial mediators of relationships between childhood abuse and SPV, and the full mediators between traumatic experiences and SPV.
2Despite violent or non-violent pedigrees, paranoid, borderline or antisocial personality disorder features of abusers are more significant. Borderline personality disorder features are the full mediators between the traumatic experiences, childhood abuse and SPV, and antisocial personality disorder features are partial mediators between witness DV, and SPV, and full mediators between childhood abuse, traumatic experiences and SPV.
Part III Preliminary study on the genetic factors and interaction between genetic and environmental factors of the intergenerational transmission of male-perpetrated severe physical violence
Objectives
1To investigate the related single nucleotide polymorphism(SNP) of5-HT transporter(5-HTT) and Catechol-O-methyltransferase(COMT) gene, Monoamine oxidase A-uVNTR(MAOA-uVNTR) polymorphism of male perpetrated sever physical violence from different violent pedigrees in the Chinese community.
2To explore the interaction between gene and gene, interaction between gene and environment of the the intergenerational transmission of male-perpetrated severe physical violence.
Methods
1The methods of sampling were consistent to the part one. The blood sampling and DNA extraction from the whole blood of the112SPV abusers (including53AP and59ANP) and183non-abusers (including61NAP and122NANP) were finished in our study.
2Using the ligase detection reaction and sequencing methods, the genotype interpretation of rs2066713, rs6354SNP, rs4680, rs4818SNP and MAOA-uVNTR were finished. Then we compared the frequences of the alleles and haplotypes of four different polymorphic genotypes. Using MDR software package, the analysis of G×G interaction and G×E interaction on the intergenerational transmission of severe physical violence were conducted.
Results
1The genotype frequency of MAOA-uVNTR3-repeat was different in the four groups, and the frequency of3-repeat in AP group was higher than NAP group significantly, and the frequency of rs6354A allele in AP and ANP group was higher than NAP and NANP group respectively.
2The genotype frequencies of rs6354AA in SPV group(AP+ANP group) were higher than NANP group. The frequencies of rs6354A allele, rs4680G allele were higher than NANP group.
3To compare SPV group and NANP group, the Risk Ratios of the rs2066713-rs6354haplotypes T/A and T/C were1.694,1.505respectively. The Risk Ratios of the rs4680-rs4818haplotype A/G and G/C were0.629,1.281respectively. To compare AP group and NANP group, the Risk Ratio of the rs4680-rs4818haplotype A/G was0.452. To compare ANP and NANP group, the Risk Ratios of the rs2066713-rs6354haplotype T/A was2.128, the Risk Ratios of rs4680-rs4818haplotype G/C was1.535.
4In the G×E analysis of SPV and NANP group, the consistency of cross validation of the rs6354-childhood abuse-family cohesion-family adaption model was the best. In the GXE analysis of AP and NANP groups, the consistency of cross validation of MAOA-uVNTR-childhood emotional neglect-childhood abuse model was the best, next was rs6354-MAOA-uVNTR-childhood emotional neglect-childhood abuse.
Conclusions
1A allele of5-HTT rs6354, G allele of COMT rs4680, MAOA-uVNTR3-repeat may increase the risk of perpetration of SPV. The rs2066713-rs6354hypoltypes T/A and T/C, the rs4680-rs4818hypoltype G/C may be the risk factors of SPV, while the rs4680-rs4818hypoltype A/G may be the protective factor of SPV, especially in the violent pedigrees. In the non-violent pedigrees, the rs2066713-rs6354hyplotype T/A and rs4680-rs4818hyplotype G/C may increase the risk of perpetration of SPV.
2Despite violent pedigree, individuals with rs6354AA homozygote experienced childhood abuse in the estrange family, and the family lack for emotional support, communication and interactivity, difficult to adapt family change and life stress, may perpetrate SPV.
4In the violent pedigrees, MAOA-uVNTR3-repeat and rs6354A allele may increase the risk of SPV in the individuals with the history of childhood abuse, and interaction between rs6354A allele and MAOA-uVNTR3-repeat may increase the risk of SPV in the individuals with the history of childhood abuse.
目的
比较暴力家系施暴组(Abusers with Violent Pedigree,简称AP)、无暴力家系施暴组(Abusers without Violent Pedigree,简称ANP)、暴力家系非施暴组(Non-Abusers with Violent Pedigree,简称NAP)、无暴力家系非施暴组(Non-Abusers without Violent Pedigree,简称NANP)四组间个体儿童期虐待及目睹家庭暴力情况、家庭环境、创伤经历以及个体愤怒情绪、冲动特质之间的差异,探讨家庭暴力严重躯体施暴行为代际传袭的环境-素质因素。
方法
1结合当地派出所、妇联、社区街道办事处、社区卫生服务中心机构提供的存在严重家庭暴力的备案登记资料,经社区街道办事处、妇联、社区卫生服务中心等相关部门协助采样。
2采用横断面设计,对AP组136例、ANP组93例、NAP组105例及NANP组198例进行社会心理学特征的比较。评估工具采用自编社会人口学资料及自编精神活性物质使用问卷,自编家庭暴力高发家系调查定式访谈问卷,自编儿童期目睹家庭暴力及目前家庭暴力状况问卷,儿童期虐待简式问卷(Childhood Trauma Questionnaire-Short Form, CTQ-SF),状态-特质愤怒表达量表2(State-Trait Anger Expression Inventory-2, STAXI-2), Barratt冲动量表-11(Barratt Impulsive Scale11Version, BIS-11),家庭亲密度与适应性量表-Ⅱ(Family Adaptability and Cohedion Scale-II, FACES-II)及创伤性生活事件量表(Traumatic Life Event Questionnaire, TLEQ)。
结果
1AP组儿童期遭受躯体虐待、性虐待分及儿童期虐待总分、目睹家庭暴力分均高于其他三组。NAP组在儿童期情感虐待、躯体虐待、性虐待、情感忽视分和目睹家暴分均显著高于ANP和NANP组。严重躯体施暴行为与儿童期遭受各型虐待分及总分、目睹家暴分均呈显著正相关。
2四组家庭亲密度与适应性评分呈逐渐上升趋势：AP组
4环境-素质多因素分层Logistic回归,影响依次是目睹家庭暴力,其次是冲动特质、创伤经历,言语愤怒、愤怒内投表达、儿童期躯体受虐再次,模型的决定系数为46.5%。其中,家庭亲密度仍是严重躯体施暴行为发生的保护因素。
结论
1国内社区家庭暴力严重躯体施暴行为存在代际传袭现象,但儿童期目睹家庭暴力成年后更容易成为严重躯体施暴者,而儿童期经历家庭暴力不一定成为严重躯体施暴者。
2家庭关系疏远,家庭成员之间缺乏情感投入与相互支持,家庭关系刻板僵化,家庭处境发生改变而难以适应改变,增加家庭暴力代际传袭的可能。反之,家庭关系适度亲密,适应力强,可以缓冲家庭暴力代际传袭的风险。
3暴力高发家系施暴者创伤性事件最多。不论在暴力家系还是无暴力家系,创伤性事件经历越多,出现严重躯体施暴行为的可能性呈上升趋势。个体经历某些创伤事件,却成为家庭暴力施暴行为出现的保护因素。暴力高发家系施暴者的愤怒情绪及冲动特质更明显,而愤怒控制能力较差。不论在暴力家系还是无暴力家系,言语愤怒、愤怒反应及表达越明显,出现严重躯体施暴行为的风险越大；而在无暴力家系中,对内控制愤怒能力越强,越不易出现严重躯体施暴行为。
4个体儿童期目睹家庭暴力或经历躯体虐待,冲动特质明显,容易愤怒并内投表达愤怒,对内控制愤怒,经历创伤性应激事件,家庭关系疏远,家庭成员之间彼此分离、缺乏良性沟通互动,均成为增加家庭暴力严重躯体施暴行为风险的高危因素。
第二部分严重躯体施暴者代际传袭精神创伤及人格特质的中介机制研究
目的
对四组不同家系来源的国内社区成年男性家庭暴力严重躯体施暴者及对照的创伤症状以及偏执型、边缘型、反社会型人格障碍特质进行比较分析；采用AMOS软件运用结构方程模型的方法建立创伤症状及人格障碍特质作为严重躯体施暴行为代际传袭的中介因素模型,并对AP组及严重躯体施暴组(Severe physical violence, SPV组,即AP组+ANP组)两组进行多群组分析。
方法
调查方法同第一部分,研究工具包括一般资料(同前)、事件影响量表(Impact of Event Scale-Revision, IES-R)及人格障碍诊断量表(Personality Diagnostic Questionaire-4+, PDQ-4+)中对偏执型、边缘型、反社会型人格障碍的分量表。
结果
1AP组的回避、闯入症状分及总分均明显高于其他三组,AP组的高警觉性症状分高于NAP组及NANP组。AP组的偏执型、边缘型、反社会型三型人格障碍特质分最高。
2目睹家庭暴力、儿童期遭受情感虐待、躯体虐待、性虐待得分及儿童期受虐总分均分别与三大创伤主症状及总分、边缘型及反社会人格障碍特质呈显著正相关。此外,经历创伤事件数量与创伤三大主症状呈极显著正相关。经历创伤事件与三型人格障碍特质分呈极显著正相关。
3精神病理学因素分层logistic回归分析显示,偏执型及反社会型人格障碍特质及闯入创伤症状进入模型,且模型的决定系数为31.4%。
4创伤症状、边缘型及反社会型人格障碍特质作为严重躯体施暴行为代际传袭的中介因素模型均有良好的适配性,多群组分析也显示了其模型不变性。创伤症状对儿童期虐待到严重躯体施暴有部分中介效应,是创伤经历到严重躯体施暴的完全中介。边缘型人格障碍特质是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介。反社会型人格障碍特质是目睹家庭暴力到严重躯体施暴行为的部分中介,也是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介。
结论
1在暴力高发家系中成长的施暴者创伤症状最严重,而不管暴力高发家系还是无暴力家系中,闯入、高警觉症状越严重,严重躯体施暴行为的风险性越大。对创伤症状的预测能力依次是目睹家庭暴力,其次是创伤经历,儿童期遭受虐待最次,且儿童期遭受虐待或目睹家庭暴力都对严重躯体施暴行为的形成有显著直接效应。创伤症状对儿童期虐待到严重躯体施暴有部分中介效应,是创伤经历到严重躯体施暴的完全中介。
2严重躯体施暴者的偏执型、边缘型及反社会型人格障碍特质明显。边缘型人格障碍特质是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介。反社会型人格障碍特质是目睹家庭暴力到严重躯体施暴行为的部分中介,反社会型人格障碍特质是创伤经历及儿童期虐待到严重躯体施暴行为的完全中介
第三部分严重躯体施暴行为代际传袭的基因初探及基因-环境交互作用分析
目的
对国内社区不同家系来源的成年男性严重躯体施暴者进行5-羟色胺转运体(5-HTT)、儿茶酚氧位甲基转移酶(COMT)相关基因多态性包括SNP位点rs2066713,rs4680,rs4818,rs6354,及单胺氧化酶A(MAOA)-uVNTR短串联重复多态性研究；探讨基因-基因交互作用以及基因-环境交互作用对严重躯体施暴行为代际传袭的影响。
方法
1样本采集方法同第一部分,SPV组112例(包括AP组53例及ANP组59例),非施暴组183例(包括NAP组61例及NANP组122例)完成血样采集及全血DNA提取。
2采用连接酶检测反应和测序法对5-HTT rs2066713,rs6354SNP, COMT rs4680, rs4818SNP及MAOA-uVNTR基因型进行判读,并四组各多态性比较基因型、等位基因型及单体型之间的差异。运用MDR软件探讨基因-基因交互作用以及基因-环境交互作用对严重躯体施暴行为代际传袭的影响。
结果
1基因型频率比较发现,MAOA-uVTNR的片段多态性四组间比较有显著统计学差异,并且AP组的3-repeat片段频率高于NAP组,有显著统计学意义。AP及ANP组的5-HTT基因rs6354SNP的A等位基因频率分别显著高于NAP组和NANP组。
2SPV组的5-HTT基因的rs6354SNP基因型频数AA基因型高于NANP组。SPV组rs6354的A等位基因频率高于NANP组,COMT基因rs4680的G等位基因频率高于NANP组。
3SPV组及NANP组比较,5-HTT基因rs2066713-rs6354单体型T/A及T/C型的OR值分别为1.694,1.505。COMT基因rs4680-rs4818的A/G及G/C单体型的OR值分别为0.629,1.281。AP组与NANP组比较,发现COMT基因的A/G单体型的OR值为0.452。ANP组与NANP组比较,发现5-HTT基因rs2066713-rs6354单体型T/A的OR值为2.128；COMT基因rs4680-rs4818单体型G/C单体型的OR值为1.535,以上结果均有显著统计学意义。
4SPV组相比NANP组,rs6354-儿童期虐待-家庭亲密度-家庭适应性的交叉验证一致性较高。AP组相比NANP组,MAOA-uVNTR-儿童期情感忽视-儿童期受虐三因素模型的交叉验证一致性最高,rs6354-MAOA-uVNTR-儿童期情感忽视-儿童受虐其次。
结论
1个体5-HTT基因rs6354SNP的A等位基因、COMT基因rs4680的G等位基因与MAOA-uVNTR多态性呈低活性的3-repeat会增加成为严重躯体施暴者的风险。5-HTT基因rs2066713-rs6354单体型T/A及T/C、COMT基因rs4680-rs4818单体型G/C为严重躯体施暴行为的危险因子,而COMT基因rs4680-rs4818单体型A/G为严重躯体施暴行为的保护因子,在暴力家系严重躯体施暴行为产生中尤甚。5-HTT基因rs2066713-rs6354T/A单体型及COMT基因的rs4680-rs4818单体型G/C可能增加无暴力家系严重躯体施暴行为的风险。
2不论暴力高发家系还是无暴力家系,rs6354SNPA等位基因频率较高个体儿童期遭受虐待,且家庭关系彼此疏远分离,互动及情感支持较少,应对生活变故和应激事件能力差,不灵活,会增加家庭暴力中严重躯体施暴行为的风险。
3暴力高发家系中,个体MAOA-uVNTR的3-repeat序列及rs6354的A等位基因频率高,在儿童期遭受虐待可能会增加暴力高发家系严重躯体施暴行为的风险。
Part I Psychosocial factors in the intergenerational transmission of male-perpetrated severe physical violence in Chinese Community
Objectives
To compare childhood abuse, witness DV, family environment, traumatic experiences and state-trait anger, impulsivity in the four groups: the group of the Abusers with Violent Pedigree(AP), the group of Abusers without Violent Pedigree(ANP), Non-Abusers with Violent Pedigree(NAP), Non-Abusers without Violent Pedigree(NANP), and to explore the environmental and predisposing factors of the intergenerational transmission of severe physical violence(SPV).
Methods
1we identified cases of domestic violence based on appeals for help to police stations, local Women's Federations, Residents'Community Committee, Center of Community Health Services, the judicial branch of city governments.
2Using Cross sectional design to compare the psychosocial characteristics of AP group(n=136), ANP group(n=93), NAP group(n=105) and NANP group(n=198). Assessing instruments were adopted including self-edited questionnaires of psychosocial data and using psychoactive drug, self-edited structured interview questionnaire of domestic violence pedigrees, Childhood Trauma Questionnaire-Short Form(CTQ-SF), State-Trait Anger Expression Inventory-2(STAXI-2), Barratt Impulsive Scale11Version(BIS-11), Family Adaptability and Cohesion Scale-II (FACES-II), Traumatic Life Event Questionnaire (TLEQ).
Results
1Scores of childhood physical abuse, sexual abuse, CTQ-SF added scores and witness domestic violence(DV) in AP group were higher than the other three groups. Scores of childhood emotional, physical and sexual abuse, emotional neglect, witnessing DV in NAP group were higher than ANP and NANP group significantly. Scores of SPV were positively related with scores of the sub-scales and added scores of childhood abuse, scores of witness DV.
2Scores of FACES-II in the four groups were increasingly escalated: AP group
4Using Multivariate Hierarchical Logistic Regression methods, the environmental and predisposing factors of the intergenerational transmission of SPV were witness DV, impulsivity, traumatic experiences, verbal anger, anger expression to self, childhood physical abuse by turns according the Relative Risk of the model, and the coefficient of determination of the model was46.5percent. Furthermore, the family cohesion was the protective factor in the model.
Conclusions
1The intergenerational transmission of SPV exists in the Chinese community, but childhood witness DV influences more on the intergenerational cycle than experiencing childhood abuse.
2Estrangement of family relations, lacking for emotional investment and support among family members, stereotyping or fixed family structure, difficulty to adapt for changes of family situation, may increase the risk of the intergenerational cycle of SPV. On the contrary, moderately intimate family relations and strong adaptive capacity of family members may buffer the risk of the intergenerational cycle of SPV.
3Perpetrators with violent pedigree experience the most traumatic events. Despite violent pedigree, individuals experience more traumatic experiences are more possible to perpetrate SPV. Some traumatic experiences may be the protective factors of the intergenerational cycle. The anger and impulsivity of AP group are more significant than the other groups, and the ability of anger control is worse than the other groups. Despite violent pedigree, individuals with more verbal anger and anger reaction, anger expression are more possible to perpetrate SPV, while in the family without violent pedigree, more able to control anger to self, more impossible to perpetrate SPV.
4Individuals with more experiences of childhood witness DV and physical abuse are more impulsive, irritable, and more likely to control anger inside or express angry to self. They experience more traumatic events, and their family relations may be more estrange, separating from each other, lacking for benign communication and interactivity. The risk factors mentioned upper may increase the risk of the intergenerational cycle of SPV.
Part II Traumatic symptoms and personality features:Mediating analysis on the intergenerational transmission of male-perpetrated severe physical violence
Objectives
1To compare the traumatic symptoms and paranoid, borderline and antisocial personality disorder features in the four groups of participants;
2To analyze the mediating mechanism of the traumatic symptoms and personality disorder features on the intergenerational transmission of SPV through establishing the structural equation modeling(SEM) model using AMOS software package, and carry out the multi-group analysis of AP group and SPV group(AP+ANP).
Methods
The procedure methods and partial assessing instruments were the same as part I. Additionally included Impact of Event Scale-Revision (IES-R) and Personality Diagnostic Questionaire-4+(PDQ-4+).
Results
1The scores of avoidance and intrusion and added scores of IES-R in AP group were significantly higher than the other groups, the scores of hyper-vigilance were higher than NAP and NANP group. The scores of paranoid, borderline and antisocial personality disorder features were the highest in the four groups.
2The scores of witness DV, childhood emotional, physical and sexual abuse and added scores of CTQ-SF were positively related with the scores of three main traumatic symptoms. Furthermore, the numbers of traumatic events were positively related with the traumatic symptoms and personality disorder features.
3Using Multivariate Hierarchical Logistic Regression methods to analyze the psychopathological factors, results showed that paranoid and antisocial personality disorder features and intrusion entered into the model, and the coefficients of decision was31.4percent.
4The three SEM models of traumatic symptoms, borderline and antisocial personality disorder features as mediating factors on the intergenerational transmission of SPV had satisfactory adaptation. Multi-groups analysis showed their invariance. Traumatic symptoms were the partial mediators of relationships between childhood abuse and SPV, and the full mediators between traumatic experiences and SPV. Borderline and antisocial personality disorder features were the full mediators between the traumatic experiences, childhood abuse and SPV, and antisocial personality disorder features were partial mediators between witness DV, childhood abuse and SPV.
Conclusions
1In the violent pedigrees, abusers have the most severe traumatic symptoms. The traumatic symptoms, especially intrusion and hyperarousal symptoms are more severe, more possible to perpetrate SPV. The predictors of traumatic symptoms are witness DV, traumatic experiences, childhood abuse by turns, and childhood abuse or witness DV may be the indirect predictor of SPV. Traumatic symptoms are the partial mediators of relationships between childhood abuse and SPV, and the full mediators between traumatic experiences and SPV.
2Despite violent or non-violent pedigrees, paranoid, borderline or antisocial personality disorder features of abusers are more significant. Borderline personality disorder features are the full mediators between the traumatic experiences, childhood abuse and SPV, and antisocial personality disorder features are partial mediators between witness DV, and SPV, and full mediators between childhood abuse, traumatic experiences and SPV.
Part III Preliminary study on the genetic factors and interaction between genetic and environmental factors of the intergenerational transmission of male-perpetrated severe physical violence
Objectives
1To investigate the related single nucleotide polymorphism(SNP) of5-HT transporter(5-HTT) and Catechol-O-methyltransferase(COMT) gene, Monoamine oxidase A-uVNTR(MAOA-uVNTR) polymorphism of male perpetrated sever physical violence from different violent pedigrees in the Chinese community.
2To explore the interaction between gene and gene, interaction between gene and environment of the the intergenerational transmission of male-perpetrated severe physical violence.
Methods
1The methods of sampling were consistent to the part one. The blood sampling and DNA extraction from the whole blood of the112SPV abusers (including53AP and59ANP) and183non-abusers (including61NAP and122NANP) were finished in our study.
2Using the ligase detection reaction and sequencing methods, the genotype interpretation of rs2066713, rs6354SNP, rs4680, rs4818SNP and MAOA-uVNTR were finished. Then we compared the frequences of the alleles and haplotypes of four different polymorphic genotypes. Using MDR software package, the analysis of G×G interaction and G×E interaction on the intergenerational transmission of severe physical violence were conducted.
Results
1The genotype frequency of MAOA-uVNTR3-repeat was different in the four groups, and the frequency of3-repeat in AP group was higher than NAP group significantly, and the frequency of rs6354A allele in AP and ANP group was higher than NAP and NANP group respectively.
2The genotype frequencies of rs6354AA in SPV group(AP+ANP group) were higher than NANP group. The frequencies of rs6354A allele, rs4680G allele were higher than NANP group.
3To compare SPV group and NANP group, the Risk Ratios of the rs2066713-rs6354haplotypes T/A and T/C were1.694,1.505respectively. The Risk Ratios of the rs4680-rs4818haplotype A/G and G/C were0.629,1.281respectively. To compare AP group and NANP group, the Risk Ratio of the rs4680-rs4818haplotype A/G was0.452. To compare ANP and NANP group, the Risk Ratios of the rs2066713-rs6354haplotype T/A was2.128, the Risk Ratios of rs4680-rs4818haplotype G/C was1.535.
4In the G×E analysis of SPV and NANP group, the consistency of cross validation of the rs6354-childhood abuse-family cohesion-family adaption model was the best. In the GXE analysis of AP and NANP groups, the consistency of cross validation of MAOA-uVNTR-childhood emotional neglect-childhood abuse model was the best, next was rs6354-MAOA-uVNTR-childhood emotional neglect-childhood abuse.
Conclusions
1A allele of5-HTT rs6354, G allele of COMT rs4680, MAOA-uVNTR3-repeat may increase the risk of perpetration of SPV. The rs2066713-rs6354hypoltypes T/A and T/C, the rs4680-rs4818hypoltype G/C may be the risk factors of SPV, while the rs4680-rs4818hypoltype A/G may be the protective factor of SPV, especially in the violent pedigrees. In the non-violent pedigrees, the rs2066713-rs6354hyplotype T/A and rs4680-rs4818hyplotype G/C may increase the risk of perpetration of SPV.
2Despite violent pedigree, individuals with rs6354AA homozygote experienced childhood abuse in the estrange family, and the family lack for emotional support, communication and interactivity, difficult to adapt family change and life stress, may perpetrate SPV.
4In the violent pedigrees, MAOA-uVNTR3-repeat and rs6354A allele may increase the risk of SPV in the individuals with the history of childhood abuse, and interaction between rs6354A allele and MAOA-uVNTR3-repeat may increase the risk of SPV in the individuals with the history of childhood abuse.
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