Clinical, Psychological, Epigenetic, and Medico-Legal Aspects related to the Development of Posttraumatic Stress Disorder in Violence Against Women

Violence against women represents both a critical public health issue and a profound social problem, with severe consequences for victims. These repercussions extend beyond immediate physical harm, exerting long-term psychological effects, including the development of post-traumatic stress disorder (PTSD). While the correlation between epigenetic modifications and exposure to traumatic environmental factors has been extensively studied in other contexts —such as among war veterans— its exploration within the framework of gender-based violence remains largely uncharted. This PhD thesis, developed within the Epigenetics for Women (EpiWE) project of the “Italian Higher Institute of Health” (ISS), aimed to conduct an initial pilot study to assess: whether exposure to violence induces PTSD; whether epigenetic modifications occur in victims of violence and how these alterations evolve over time; and the feasibility of such an investigation given the inherent vulnerabilities of the study population. A multidisciplinary approach integrating medico-legal, psychiatric, and genetic expertise was adopted. The research focused on a panel of ten genes, analyzing methylation pattern variations. Three genes —IGF2, DRD2, and BDNF— exhibited significant epigenetic modifications in response to trauma. In addition, the study identified critical challenges in research involving victims of violence, particularly difficulties in recruiting participants and the lack of sustained support mechanisms, which hindered the creation of a standardized follow-up protocol. From a forensic medicine perspective, this thesis also explores the potential utility of these epigenetic markers in both therapeutic interventions and legal contexts, raising the possibility of their application in judicial proceedings. In conclusion, the findings underscore the potential of an epigenetic approach to the study of violence against women, marking a crucial preliminary first step that will premise the implementation of subsequent studies.