Domestic violence involving both children and adults is a problem of growing national concern. Both our clinical experience and a published report indicate that a significant number of subjects who perpetrate these abusive acts may have an underlying diagnosis of panic disorder. We postulate that the mental state of """"""""being out of control"""""""", frequently described by these individuals during the abusive act, is linked to the pathophysiology of panic disorder. To test this hypothesis and to elucidate unique psychological and biological characteristics of patients who perpetrate abusive acts, we will compare subjects who have panic symptoms (e.g., """"""""loss of control"""""""") and become aggressive with: (1) subjects who are aggressive but don't have panic symptoms; and (2) normal volunteers. These comparisons will consist of psychosocial and family histories, pharmacological challenge studies, and a determination of cerebral spinal fluid metabolites, as well as a careful analysis of the precipitating events associated with the violence. Preliminary results show that individuals who initiate acts of domestic violence have a higher than expected prevalence of alcoholism/abuse, panic disorder, borderline personality and obsessive compulsive personality disorders. Results from the lactate challenge paradigm, lying/standing norepinephrine orthostatic challenge, CSF 5-HIAA concentration, determination and PET scans all suggest that perpetrators of domestic violence are different from non-violent controls.
