Dawn Hughes — Direct

DR. HUGHES: Witness called on behalf of the Defendant and Counterclaim Plaintiff, having been fast duly sworn by the Clerk, testified as follows: Honor.

DR. HUGHES: Good afternoon, Your

DR. HUGHES: Good afternoon.

DR. HUGHES: Dawn Hughes.

DR. HUGHES: I'm a clinical and forensic psychologist.

DR. HUGHES: I practice in New York City.

DR. HUGHES: Sure. So a clinical psychologist is somebody who assesses, evaluates, and treats individuals who are suffering from a variety of ailments or problems that they have in their lives. It could be a major psychiatric disorder and it could be problems in living. Clinical psychologists also participate in training and education and research ventures.

DR. HUGHES: So a forensic psychologist is someone who applies the science and principles of clinical psychologists to a particular legal question at hand.

DR. HUGHES: So, I received my bachelor degree in psychology from Hamilton College, which is in upstate New York. I then received my master's degree and my Ph.D. from Nova Southeastern University, which is in Florida. I then had to complete my yearlong internship, and that was at Yale University in the School of Medicine, in the department of psychiatry, and there I did two full-year rotations. I did a year rotation in the substance abuse treatment unit and another year rotation in the West Haven Mental Health Clinic, where we saw individuals suffering from a wide array of difficulties in psychiatric illnesses.

DR. HUGHES: After that, I had to complete my postdoctoral fellowship, which is another year that's required in order to get licensed, and that was back in New York at Cornell medical college in the anxiety and traumatic stress program there.

DR. HUGHES: So, my experience in trauma has been predominantly throughout graduate school. I started at a domestic violence program that was housed within our community mental health center of the university. And that program, we saw both men and woman who were coming through the program. The majority of the men were court ordered for batterer's intervention programs, to participate in mostly group therapy because of their behavior in intimate partner violence, domestic violence. We also treated the female victims who were victims of intimate partner violence, and mostly in individual therapy, but we did run some groups there as well.

DR. HUGHES: After that practicum experience, I went to work at the Veterans Administration in their Is outpatient psychiatry clinic. And in that clinic, I treated mostly, this was Florida, so they're much older adults, so we saw a lot of Vietnam-era veterans and, actually, World War I veterans in that program, and a few veterans who served combat in the first Iraq war.

DR. HUGHES: So overlapping in that time, I also was the research coordinator for the child sex abuse survivor's program, and that was also a treatment program that was housed within that same community mental health center. And we saw individuals, both men and women, who were coming for treatment to deal with the consequences, the psychological aftereffects of having been sexually abused as a child. After that, I completed my internship, when I was at Yale, at the substance abuse program because we know there's a high occurrence, a high rate of trauma-based disorders with substance abuse. I put together a group, a women's group of female heroin addicts, recovering heroin addicts who also had either domestic violence or childhood abuse history. We did a dual substance abuse reduction model with the healing from the traumatic effects of the violence that they experienced.

DR. HUGHES: On my postdoctoral fellowship, I was in the anxiety and trauma stress program. As the name sounds, we saw individuals who were suffering from trauma-based disorders and anxiety, mostly late adolescents and adults, men and women, from rape, sexual assault, violence. Some were simple assaults, on the street, being mugged, and things of that nature.

DR. HUGHES: I also did teaching and training for victims services, which is New York City's largest victim-based organization, who runs a lot of g services for victims of domestic violence and shelter-based programs. I did some education and training for them and teaching for a number of years.

DR. HUGHES: So, I currently have a private practice in Manhattan, and I also have a faculty position at Weill Cornell Medical College. I'm the clinical assistant professor of psychology in the department of psychiatry there. This is what we call voluntary faculty, which means you don't get paid, but you participate in bringing in interns, selecting the interns for that year. In that program, I teach, I think for the past seven, eight years, the ethics seminar to the interns and also participate in other didactics that they have.

DR. HUGHES: I'm also called upon to sort of troubleshoot difficult scenarios that clinicians, either trainees or full, like, clinicians, might have if there's an issue of intimate partner violence or child sex abuse and they don't really know sort of what to do in that situation. I get consulted to do that. Most recently, I was part of our program's COVID response team, where in pretty much March, April, May, June, July of 2020, where New York City was the epicenter, we sort of mobilized and were really doing psychological first aid and helping our hospital-based workers deal with the stress and the trauma from seeing so much death and destruction because of COVID in those first months of New York City's COVID wave.

DR. HUGHES: So, my independent practice is predominantly, I say, three things. The bulk is I see individuals in therapy, two and a half days; I see people who come to my office who are mostly dealing from the traumatic effects of victimization, childhood abuse, rape, sexual assault, sexual harassment, domestic violence. I will see those people in therapy. I have a ,22 percentage of individuals who do not have a trauma I history, and that's usually the anxiety disorder I see. They might have panic disorder or generalized anxiety disorder or other difficulties and just relational difficulties and problems in IS living. _ The second big part of what I do is this, forensic psychology, like I'm doing here today. I evaluate individuals who were involved in legal matters. I consult with prosecutors and district attorneys and U.S. attorneys on their cases, and just something that has to do with the legal system. And then the other smaller percentage is the engagement in professional activities in the profession.

DR. HUGHES: Yes. I specialize in interpersonal violence and traumatic stress.

DR. HUGHES: Interpersonal violence is the umbrella term for when one person does something violent or abusive toward another, and that includes domestic violence, childhood sexual abuse, rape, sexual assault, sexual harassment, physical assault. All those types of behavior, we understand as interpersonal violence.

DR. HUGHES: Traumatic stress is the consequence of that, what happens to individuals when they experience these sort of life-altering events. These really adverse live events. Traumatic stress is one of the outgrowths and psychological consequences that people have when they've been exposed to these type of traumas.

DR. HUGHES: That's correct.

DR. HUGHES: So I treat adults, mostly, men and women, in my practice. I sometimes will treat late adolescents, 17 or 18. They'll come to me, usually, after a rape or sexual assault, and I'll treat them in short-term treatment, but mostly adults who are, you know, have sustained some kind of traumatic event in their lives.

DR. HUGHES: Well, I started practicing in graduate school, in 1992, and I was licensed in 1996, so 25, 30 years.

DR. HUGHES: Board certification is the highest degree of postdoctoral certification that a psychologist can obtain. And I am board certified in forensic psychology, and that means that I have just amassed a competency in the area of forensic psychology. I j 6

DR. HUGHES: Yes, I am.

DR. HUGHES: I'm licensed in three states; in New York, North Carolina, and Connecticut. And then I have some temporary licenses in other states as well.

DR. HUGHES: I have. I am not predominantly a researcher or somebody who writes, I'm a clinician. I'm doing direct clinical service. But over the course of my graduate school and postdoctoral time, I have published some things, yes.

DR. HUGHES: Yes, I have. Rape and sexual assault in adult women.

DR. HUGHES: Yes. I co-authored a book chapter entitled -- I guess it is "Structured Clinical Assessment of Risk of Violence."

DR. HUGHES: Yes. I've given many trainings at national conferences, at legal conferences, for attorneys, for mental health professionals, on understanding trauma and how trauma may show up in the courtroom and understanding what a victim of intimate partner violence might look like. Understanding the difficulties that a rape victim might have to come into court to testify, and training just regular sort of mental health professionals on how to understand trauma, how to look for trauma, what does it look like when it comes into your office, how do you treat it, how do you assess it. All of those factors, I've done a number of trainings on.

DR. HUGHES: Yes, I have. I was invited by the judicial conference to be part of the training curriculum to train New York State Supreme Court justices on issues of intimate partner violence and traumatic stress on some of the things that I've just been talking to you here, on how to understand what happens in those situations; how to understand the myths and misconceptions that may be -- that may abound in these situations and how you can sort of more accurately understand what a victim is talking to you about and telling you when they come into your courtroom.

DR. HUGHES: Yes, I've also been contacted by - sometimes judges will have symposiums in their courtroom. They will make a decision to hold a particular symposium on particular topics, and I was, you know, asked to come do presentations for judges on numerous occasions.

DR. HUGHES: That was a recent presentation. I think I was invited by one of the judges on the office of domestic violence in New York, and the title was when women use force in situations of intimate partner violence. And my topic was to talk about the complexities of that issue and what does that look like, and how can we differentiate if both people are fighting, how do we know that this is intimate partner violence, sort of what does the research tell us about that? How do we understand that and how can we really accurately assess that? That was sort of the bulk of what that training was about.

DR. HUGHES: I belong to a number. I belong to the American Psychological Association, which is the largest body of psychologists in the United States, over here, headquartered in D.C. Because it's so big, there are subdivisions of the American Psychological Association, so I belong to a division of trauma psychology; I belong to a division of psychology in the law, the division of psychologists in private practice.

DR. HUGHES: I belong to other organizations, the International Society for Traumatic Stress Studies, which, as the name says, it's an international society where we are interdisciplinary, mostly psychology and psychiatry, researchers and clinicians, to really understand and further our awareness about trauma and traumatic stress.

DR. HUGHES: I belong to the International Society for Trauma and Dissociation. I belong to the Anxiety Disorders Association of America. I'm a fellow in the American Board of Forensic Psychology.

DR. HUGHES: I don't know if I'm forgetting any.

DR. HUGHES: Well, clearly, the trauma division of the American Psychological Association, the International Society for Traumatic Stress Studies, and the International Society for Trauma and Dissociation. And then, also, the anxiety disorders of association continues to talk about trauma because, prior to this new DSM-5, it was - PTSD was originally categorized under the anxiety disorders. So there are colleagues and researchers in the anxiety disorders organizations who talk about PTSD and trauma.

DR. HUGHES: Yes. I am currently the president elect of the trauma division of the American Psychological Association. That is an elected position. You have to be elected by our membership. And now I serve with the presidential trio, so there's three of us who serve, with the immediate past president, the current president and the present elect, so it's a three-year term. And what we try to do is continue to disseminate best practices in trauma psychology, and, also, interface with the larger American Psychological Association organization to continue to disseminate best practices and have just a voice for trauma psychology with our larger body and policymaking.

DR. HUGHES: I've been involved in the trauma psychology executive board since its inception. I was a founding member of that division. I served as a membership chair, a program chair, awards chair. I was the AP A counsel of representatives, which means I was also elected to serve a three-year term and sit on the governor's board of AP A representing the division of trauma psychology. So I've been very actively involved in the trauma division.

DR. HUGHES: So the division of trauma psychology are psychologists who come together who want to disseminate best practices in trauma psychology. Want to make sure that we have our finger on the pulse of research and evidence-based interventions for people who are struggling with trauma events that have happened to them.

DR. HUGHES: Yes. I was -- there's a New-york-city-based organization called the Women's Mental Health Consortium, and that's also an interdisciplinary organization, psychology, psychiatrist, nursing, social work, and this was formed in order to give women a referral base and more information about mostly what's reproductive psychiatry. We know that certain difficulties and psychological difficulties that you have can erupt when you're pregnant or postpartum. So we wanted to have a number of resources available to women in the New York City area. I was a membership chair there for a number of years, and then I was the president of that organization, I think, 2009 to 2017. I don't have my CV, but I think that's about right.

DR. HUGHES: Well, it's important to me because I do believe very much in service. I do believe very much in giving back. I do believe that it's important, as a psychologist, to believe strongly in trauma psychology and helping people, that I can be part of a voice at the table, part of that push to get policy and understanding, especially with the insurance companies, to make sure that people are getting, you know, the appropriate care that they deserve.

DR. HUGHES: So it's something that just has always been part of my life in varying degrees, and as a psychologist, I feel like it's, you know, a very rewarding part of my job.

DR. HUGHES: Yes, I do. Typically, multiple times a year. Of course COVID threw a little bit of a wrench in that, since some things are virtual, but, yes, I do routinely attend conferences.

DR. HUGHES: It's important to stay abreast of developments in the field. It's important to meet with your colleagues across the country and see what they're doing and what they're hearing and what's working and what's not working. So when you're at a conference and somebody's presenting new or novel research, then you can take that information and bring that back to your clients and bring that back to my forensic work. So, it absolutely enhances the work that I do.

DR. HUGHES: Yes, I have.

DR. HUGHES: I was first qualified in 1998. So since then, about 50 times.

DR. HUGHES: Probably more than half.

DR. HUGHES: Yes, I have. Frequently.

DR. HUGHES: Yes, I do.

DR. HUGHES: Many.

DR. HUGHES: Frequently.

DR. HUGHES: No.

DR. HUGHES: Sure. So I'm probably going to be interchanging the language, domestic violence and intimate partner violence, and for purposes here, these are the same thing.

DR. HUGHES: So, intimate partner violence is a pattern of manipulation, fear, and coercive control that happens within an intimate relationship. It constitutes using a variety of abusive behaviors, and that could be physical violence, sexual violence, psychological aggression, emotional abuse, stalking or surveillance behaviors, and economic abuse.

DR. HUGHES: The abusive behaviors occur over time, not all at once. And they're also interspersed with very normal times, times without violence, times with love and happiness. And it's this inter-positioning of the violence with the love and the care that makes it very difficult for a victim to extricate herself from that situation and from that relationship.

DR. HUGHES: So the overarching dynamic is the abusive power and control of one person wanting to have dominance in that relationship, say, over most things that the couple or that the victim does or does not do.

DR. HUGHES: So coercive control is a tactic of victimization. The goal of it is to establish IS dominance. What coercive control does is that it imposes negative consequences for noncompliance with your partner's expectations or demands. What that does is it erodes away at the victim's autonomy and her independence.

DR. HUGHES: So, physical violence is when one person uses their body against the body of another with the intent to cause injury or harm. That can be push, shove, slap, kick, punch, beat up, meaning multiple types of physicality in one instance, throw, slam into a wall, push into something hard that you could hurt yourself. Clearly, use of a weapon would be a physically violent act as well.

DR. HUGHES: Yes, very much so. This is very well-documented in the literature about violence and abuse in relationships. And that's just physics. That's just proportional force, that if a 185-pound man is going to push a 120-pound woman, that's going to feel quite different than a 120-pound woman pushing an 185-pound man. And it's just about proportional force and the size and strength differential. And that is why, specifically, if you look at wrestling or boxing, they match weight classes, and they do that for a reason, because they know that it's not fair if somebody is bigger and stronger than the other.

DR. HUGHES: So it's certainly not the only factor, but it is a factor that one has to consider if a relationship is violent.

DR. HUGHES: So, psychological aggression is threats and the imposition of threats with the intent to control someone's behavior. So it's doing a threat so that you will modify your behavior and do what your partner wants.

DR. HUGHES: Some psychological aggression techniques are intimidation. Slamming your hand on a table, punching a wall, throwing something, and mumbling under your mouth, cursing, screaming. Sort of these high, emotional balance types of activities that can cause a victim to feel afraid and feel intimidated.

DR. HUGHES: And then if there has been an act of physical violence, where that contingency has already been established that this person, your partner has said, okay, I not only have the ability to use violence against you, I also have the willingness to do it. The intimidating tactics take on a greater flavor, they take on greater salience, they mean more because you know what could be coming down the pike.

DR. HUGHES: So, emotional abuse functions to denigrate a person's sense of self-worth and their self-perception. It's about name-calling, being very mean-spirited, putting yourself down, using gender-based language that's offensive, racial slurs. All types of behaviors to really make a person feel less than they actually should.

DR. HUGHES: So, sexual abuse in an intimate relationship functions to establish dominance and establish power.

DR. HUGHES: What it is, simply, in the psychological and psychiatric community, is forcing someone to do something sexual against your will when you did not want to. It can be forced sex, forced vaginal, oral, anal sex. It can be forced to engage in any other type of sexual act that you may not want to do. When I say "force," it doesn't mean it has to have physical force.

DR. HUGHES: There's a lot of psychologically coercive tactics that are used that many times, when violence has already been established in the relationship, the victim also feels that she can't say no for fear of reprisal, for fear of retaliation for saying no to those acts.

DR. HUGHES: So, sexual abuse, you know, does happen in intimate partner relationships. A lot of people don't want to talk about it and they don't want to ask about it because it makes people very uncomfortable.

DR. HUGHES: If it is nonconsensual, then it is abusive.

DR. HUGHES: Again, the operative word is consensual. If you are not consenting to those acts, then it is sexually abusive.

DR. HUGHES: Not really. Sexual violence is a term I of art. It is the overarching umbrella that we, ! in the psychological and psychiatric communities, talk about. So if we are looking at our diagnostic and statistical manual, and say what are the traumas that could cause PTSD, it's listed as sexual violence. So it's an umbrella term that allows us to understand. It could be childhood sexual abuse; it could be a rape, a sexual assault; it could be sexual abuse in an intimate relationship. So it's really just an overarching term that we use in the field.

DR. HUGHES: It doesn't mean -- I think people often mistake it to mean that when you are being sexually abused, that someone's punching you or someone's hitting you, or someone's doing something like that, because you hear the violence. It does not mean that. That can happen, but that term doesn't require that, nor does it mean that.

DR. HUGHES: So, stalking or surveillance behaviors are a common tactic of, typically, men who use violent behaviors in an intimate relationship. What they do is they allow the woman to know that wherever she is, wherever she goes, he's going to know. I'm going to maybe look at your phone, see who you're talking to, track you on my iPhone, look at your Instagram, look at your emails. You know, really having a way of knowing all of the personal information about you. And what that does, it, again, erodes the victim's autonomy and it erodes her sense of privacy. She doesn't feel that wherever she can go, that somewhere, he's not going to be part of her life in a very objectionable way. Sometimes there's the pop-ins.

DR. HUGHES: They will show up at places that they're not supposed to be and that we don't want them to be, just as a way of checking. Sometimes they'll have friends or family check up on their partners to make sure where they are. What time did you get home? But you didn't turn off your phone at this time, but you came in the door this time. Like, all of the sort of constant questioning and interrogation about an individual's whereabouts.

DR. HUGHES: So, economic abuse is a way to, again, continue to maintain control over your intimate partner. Sometimes it's withholding information I!

DR. HUGHES: About the finances, of not letting you have access to the finances. If you can't have access to a credit card or a checking account or, you know, Apple Pay on your phone, then you're rendered, usually, much more economically dependent on your partner, and that limits tangible options for you.

DR. HUGHES: For individuals where that sort of tangible options isn't there, we see the economic abuse or the economic restriction when one partner refuses to share any information about the funds. So it's not like I can't go shopping because I won't have money, but I don't have any decision-making in our family money. I don't have any idea of what we're doing in our family vis-a-vis our finances. So it's a way of definitely keeping that very separate, and not in a consensual way. Some couples make that choice. One person does all the money. That's fine.

DR. HUGHES: But when it doesn't come from a place of consensual p choice-making, it can be abusive.

DR. HUGHES: No. They're not all present in every one. And that's why it's very important to do a thorough assessment of a relationship that may be mired in violence to see which ones are present and which ones have a great impact in the relationship. Which ones are sort of making the structure of this relationship.

DR. HUGHES: So this is one of the myths, that people say, well, if she was sexually assaulted by her partner, she would have just left. And nothing could be further from the truth. That's not what happens, especially when it's your husband or your boyfriend or your partner. So what women do is they bury it. They compartmentalize it. They put it away. They avoid it. Because then they can continue to reach out for the kind and the loving man that they got into this relationship with. You know, the problem is that it does fester belief and causes more sort of psychological distress in the victim.

DR. HUGHES: So, that's one of the emotions that the victim is usually trying to suppress and compartmentalize and avoid and put away. One of the most, you know, frequently felt feelings after something so incredibly humiliating and violating is shame. And shame is a very sort of difficult emotion for people to have to live with and to have to experience. And then a lot of times, what they see in these relationships, especially ones where sexual assault is perpetrated, that's typically the emotional abuse as well.

DR. HUGHES: So if you're being called names, like a whore and a slut and easy and fat, and you're feeling ashamed from the sexual assault that just happened, it sort of acts as a compounding effect, and it kind of p g slowly deteriorates the psychological functioning of the victim and where they're just really trying to get back to the good guy, get the good guy to come back, that they're suffering these symptoms underneath.

DR. HUGHES: Intimidation is one of the - the huge factors that we see in coercive control. Again, the goal is to get your partner to do what you want them to do. And if you've established that you can use violence and other sexual violence and physical violence, slamming your hand on the table, throwing a glass, breaking a door, you know, throwing anything, causing a fit, yelling and screaming. You know, that can rise the fear level in a victim that she may modify her behavior quicker, and he may not need to use physical violence because he's already established that that fear is there.

DR. HUGHES: I mean, certainly, writing obscene messages to your partner could absolutely be an intimidating behavior. f 110

DR. HUGHES: So, emotional abuse and degradation, as I stated before, functions to decrease your sense of self-worth. It decreases your sense of agency. It makes you feel bad about yourself. And when you feel bad about yourself, you're less likely to actualize and see options for leaving. You're so sort of mired in this dynamic of abuse that you come, sometimes, to believe the bad things that the person is telling you about. So, you know, maybe I am not talented and fat and lazy and stupid. And it interferes with that ability to problem solve and figure out, you know, can I get out of this relationship. And sometimes you feel you don't even deserve to get out of the relationship when the abuse is so chronic and so repetitive.

DR. HUGHES: So, surveillance -- 9

DR. HUGHES: So, surveillance functions to let the victim know, wherever you are, there I am. So it makes her feel not secure in her movement, feeling that she has to restrict her movement. Her movement is not hers alone. It usually increases hypervigilance; it increases fear; it increases the need to -- for yourself, to mark where you've been what you've done so that you can go back and prove it to your partner because you know that there is going to be an interrogation later. When this pattern has been established, show receipts, show me your iPhone, where were you, what's your Google location. Those are types of surveillance behaviors that puts the victim very much on edge and increases that level of anxiety and trepidation.

DR. HUGHES: So, possessive jealousy is a very difficult dynamic in intimate partner violence. It's very common in situations of coercive control. It's rooted in possession, that the gentleman feels that he can possess her and that he can have her whenever he wants. It's a very possessive dynamic. But the accusations, the problem is, when you make the accusations, the woman's forced to refute the accusations. So, they are continuing in this dynamic where she's trying to prove that I didn't do what you said, this didn't happen.

DR. HUGHES: And then, unfortunately, sometimes it escalates because the man is not taking the no for an answer because this is a (indiscernible), perceptive pattern that's very difficult to penetrate, that often these type of conversations lend themselves to physical and sexual violence.

DR. HUGHES: No, it doesn't happen overnight. It happens over time. And we don't - one doesn't get into a relationship with a man who's beating her up and sexually assaulting her and calling her names and doing all that. You know, she gets into the relationship for all the right reasons. Just like we all get into relationship, for love, for companionship, for kindness, for a future. But then slowly, you know, all these behaviors start to take form Like I say, it's sort of like sucking the oxygen out of the room, and then before you know it, you're suffocating.

DR. HUGHES: So, love and normalcy are almost always in these relationships that, you know, when you are in a lull and the violence is not happening, you're back to sort of the loving man that you wanted, the person who you wanted to be with. And when you pair sort of this violent dynamic, physical violence, sexual violence, with love and attachment, it creates a trauma bond.

DR. HUGHES: It creates a psychological bond, and emotional dependency is created, so it makes it very difficult for the victim of the abuse to extricate herself from that relationship and for her to even believe, frankly -- I mean, that takes a lot of time, to even believe that she can and that she should.

DR. HUGHES: So, what do we know from the research? The research with working with battered men who come into treatment is that the only person who can change the abuse is the abuser. So, no matter what the tactics that the woman uses, she's trying to do all these different things to fix him, to have him not be violent, to have him not be sexually violent, to have him not be excessively jealous. And all those things don't change his behavior because it's up to him to change his behavior. And this was played out a million times in the batterer's intervention groups that I led.

DR. HUGHES: The man would tell us, it doesn't matter what she does. I don't care. So the problem is, is that the woman continues to think that she can fix it and, yet, she can't. But she's the one who's, then, rendered sort of helpless and hopeless because everything that she's trying to do is failing.

DR. HUGHES: So, the cycle of violence is one way to describe this domestic violence pattern. Typically, what we see, the cycle can be different in a variety of relationships, but, typically, what we see is in the first phase, the sort of multiple, three to four phases.

DR. HUGHES: In the first phase, there's a tension building phase. You're sort of starting to feel that apprehension. He may be throwing his papers on the table a little more. He may be slamming the fridge door a little more. He may be mumbling under his mouth a little more. He may grab a glass a little more forcefully than he normally is.

DR. HUGHES: And then there is the incident phase. Then there's the blowup, where the violence, the abuse, the screaming, the sexual violence or the physical violence, all that occurs.

DR. HUGHES: Then we come to the attrition phase. I'm sorry. I didn't mean it. It wasn't me. I'm not going to do it again. The promises for g g g p change. And then we sort of slide into the calm phase where, you know, this isn't going to happen again. I'm back to stable ground. I'm going to live in this place, this sort of honeymoon place. The problem in the calm phase is we often see rationalizations and the justifications for the behavior. It's not like, typically, the man is taking full responsibility for what he did. But it's calm because there's no, you know, violence and no sort of tension at that moment. And then it reoccurs, and then it reoccurs.

DR. HUGHES: So you're stuck in this vicious cycle of trying to figure out how can I be with this man who hurts me and, yet, I love him so much.

DR. HUGHES: So the love bombing is, it's more of the colloquial term for the younger folks here, where you shower someone with affection and love, you know, in this attrition and calm phase. Where, you know, everything about you is special. You're the best thing in the world. I'm never I going to do anything to hurt you again. I would never let anyone hurt you. It could be sending flowers and buying gifts or going on trips or your favorite restaurants. And that is, you know, an array of where the man is trying to make those amends and then it gets the woman hooked. So they get hooked on the kindness. They get hooked on the love. They don't get hooked on the abuse. I've never met one woman, in the hundreds and s hundreds and hundred that I've evaluated, who was 1;11 not concerned about the violence.

DR. HUGHES: They're all concerned about the violence, but they go for the love.

DR. HUGHES: Absolutely.

DR. HUGHES: We know, from the research, that women use verbal and physical acts of aggression in these relationships. That's not uncommon. This has been researched for five decades. And a woman may yell at her partner because she's angry, and anger is a very normal emotion to having been abused. She can also be afraid, but they don't have to be mutually exclusive. We can absolutely, as human beings, feel two or three or four different emotions at once. People do often say to me, oh, she would never yell at him if she knew he was going to hit her. And that's not true. That's just patently not true. That's not supported in the research, and that's not supported in my clinical practice. You know, the problem is, there's a classic double bind. The violence has been so normalized in the relationship now. She gets hit if she does yell; she gets hit if she doesn't yell.

DR. HUGHES: So for women that feel, at certain moments, that they need some preserve, some sense of autonomy and their independence and stand up for themselves, they will yell and they will fight back, even though the risk of violence is there.

DR. HUGHES: So it doesn't mean that she's not afraid and that she's not concerned about the violence, and it doesn't mean she doesn't also use placating and compliance strategies most of the time as well.

DR. HUGHES: No. I mean, this is classically what we talk about "behind closed doors." Most of the intimate partner violence or domestic violence happens, you know, in the privacy of your own home. So sometimes we see the remnants of it, the aftereffects, or victims talk to their friends or family about it. But very rarely are you seeing it happen, the actual blowup phase happen in the middle of witnesses and other people.

DR. HUGHES: So, bystander effect means what happens when people are aware that domestic violence is happening? What happens when they're aware, even if they're not seeing it, that it could be happening? What happens is we know that it's very difficult for people to stand up and say something. It's very difficult, especially in situations where there's a larger community of folks and the person who, perhaps, is perpetrating the abuse is the leader of that community. It becomes very difficult to go up against that, to go up against the sort of head honcho of the community. People are very fearful of losing their jobs. I've seen this, time and time again, in the cases that I've worked on. You know, the Boy Scout cases or the clergy leader abuse cases.

DR. HUGHES: You know, all of those type of cases where -- the USA Gymnastics, where when we go back and we look, we see people knew, but the secretary doesn't want to lose her job; she has kids to feed. The guy who, you know, checks your room, he doesn't want to lose his job because he has a mortgage to pay. So people are quiet and they don't say anything. And then other people are very -- it's a very worrisome dynamic. They don't want to put their foot out there if they're wrong. And maybe I didn't see it right or I don't really know what happened. I certainly am not going to jeopardize my job if I don't really know what happened behind closed doors, even if I see a trashed room or a bruise. And then people still believe it's a family matter. You know, it's between Amber and Johnny, let them figure it out. You know, I'm not going to get in the middle.

DR. HUGHES: Yes. I believe so.

DR. HUGHES: So, mutual abuse isn't really a term of, y l h art that we use. What we look at is situational I couple violence and intimate partner violence.

DR. HUGHES: And when we look at situational couple violence, that really does characterize the majority of types of violence and abuse that happens in relationships. That's when a couple gets out of hand, they may push, shove, slap, yell, say some things that they don't want. It's not that those behaviors are okay, but those are sort of what our larger-scale, community-based studies says happens in these relationships. That's distinguished from intimate partner violence, What I've talked to you about, that has this constellation of symptoms and is rooted in the abuse of power and control.

DR. HUGHES: Yeah, there's research that addresses what does gender symmetry look like? Male and female, are they the same? And there is certainly, as I said, research on the lower end types of violent behaviors, push, shove, slap. You know, we may see similar rates between men and women. In psychological aggression, yelling, name-calling, putting down, in some of our big, community-scale studies, we may see similar rates of perpetration on those behaviors.

DR. HUGHES: But then there are, you know, other situations where we don't have gender symmetry. And what the research talks about, very clearly, is you have to examine context. You have to examine the differential of power and control and coercive control in the relationship to make a full determination.

DR. HUGHES: Absolutely. We've known this for five decades in our research. We've been studying this since the '70s. And when we look at what happens, you know, women do report their use of violence. The majority of violence that we do see is what we call reactor violence or self-defense violence, or sometimes violence that's perpetrated independently of an assault, of something that's going on.

DR. HUGHES: But mostly that when a partner begins to become violent, then she may become violent and fight back. That's not an uncommon dynamic. That if somebody is being pushed or shoved or hit, that a person will fight back. That's been established in the research.

DR. HUGHES: Well, you have to find out. Does it? Does her use of violence change the overarching power structure of coercive control and violence and abuse in this relationship? You have to examine those variable to see, does it or does it not?

DR. HUGHES: Absolutely. Certainly we know that we have to be careful of gendered stereotypes. We can't go in and think, oh, only the woman is the victim, and only the man is the perpetrator. That just does not comport with the research. We know that the research also shows that we can have domestic violence in same-sex relationships. My very first case was a same-sex domestic violence homicide in Brooklyn. So that was in 1998. So I've been examining and treating individuals in a variety of types of violence contexts. So, we have to be careful that that bias doesn't get in our way when we're evaluating a particular situation in a particular case. That said, we do know that there still are differences. You know, in a heterosexual couple, in a male/female dyad, the research still is clear that there are differences. Men still perpetrate more severe acts of violence.

DR. HUGHES: Women are still more likely to be injured. They're much more likely to suffer sexual violence at the hands of their partner. They're more likely to be intimidated, afraid, and they're much more likely to be killed. So we know that those differences exist, but we do examine, you know, in those individual circumstances, knowing that either one could be a perpetrator or a victim.

DR. HUGHES: So, I thoroughly examine all of those other variables. I look for the coercive control. Who holds the power in the situation? Who's able to say no? Who makes the decisions? What are the consequences if you don't follow the decisions of your partner? Is there sexual violence? Is there intimidation and fear? All the statistical factors that are associated with severe and (indiscernible) of domestic violence. So there's a lot of data that we have in the field that we can use to assess a particular relationship and really find out what's going on.

DR. HUGHES: It certainly doesn't cause people to be violent. We have plenty of people who can be, you know, struggling with substance abuse and addiction and they're not violent. But when you have a substance abuse, an addiction, and you perpetrate domestic violence, it does create a much more disastrous effect. It's a co-occurring variable, and we know that, also from the research, that the majority of the women will report that when their partner is drinking, the physical violence goes up.

DR. HUGHES: So a lot of the times, when he's physically violent is when he's been consuming drugs or alcohol. When he's not consuming drugs and alcohol and he's not violent, those other behaviors continue to persist, the coercive control, the surveillance, that obsessive jealousy, the possessiveness, the psychological abuse. Those usually persist. But the alcohol can just throw lighter fluid on a flame in a situation of domestic violence.

DR. HUGHES: Yes, there is.

DR. HUGHES: So there's been a lot of research to talk about what do women do? That's the question that everyone wants to know. Why doesn't she just leave? And in asking that question, why doesn't she just leave, we actually are able to say, well, let me tell you what she does do. And what the research shows is women do a lot of things in that relationship.

DR. HUGHES: So, sort of three main categories. One are the formal responses, the formal things that she does. Call the police. Participate in the prosecution of your partner. Go see a therapist. Go to a shelter. Go to a hospital. These are sort of the very formal strategies that women can use.

DR. HUGHES: And then there are the informal strategies. That's talking with your best friend, talking with your mom, talking with your friends, trying to get that emotional support from your social network.

DR. HUGHES: But the most common one are these personal strategies. And the personal strategies are really talking with your partner. They're trying to fix the relationship from within the confines of the relationship. You know, trying to get him to go to counseling. Try to get him to go to church. Try to get him to understand his ways. Try to get him to get into AA or sober counseling or harm reduction model to help with his addiction. Compliance with his demands. Anticipating his demands. All these coping strategies that are sort of, you know, embedded within that intimate relationship.

DR. HUGHES: It's not a common response. Many women do not want to call the police on their partners. You know, using criminal justice interventions in crimes of women and children are the least likely to be called into law enforcement. And most of the time, when the police are called, it's because a particular incident has got out of hand, and she feels I'm safe. And the only way that she feels I can get this incident to end and stop is by calling law enforcement.

DR. HUGHES: I mean, this has been a problem and a difficulty for prosecutors across the country since I've been doing this work. I'm actually frequently called by the prosecutor to testify about a fact pattern because the victim won't come in and testify. So dropping restraining orders, not participating in the prosecution is a very common dynamic in situations of intimate partner violence, domestic violence. And what we know, and what we know from our law enforcement data and colleagues is that when you get that 911 call, they're very specifically trained to say, that's likely not the first episode.

DR. HUGHES: The chances are there have been more severe episodes before you get this call. So you can't go on the scene and : :::h::: :!; t:h:r::;: e!i::s::::i: used to be done when police officers arrive on the scene. So usually that episode that calls the police is just meant to stop that incident in that moment, to get a sense of safety, but most women don't want to participate and go forward with a restraining order.

DR. HUGHES: I mean, they stay for all the reasons we talked about in the cycle of violence. They stay for the loving man. They stay for the man who's kind. Stay for the man they decided to marry and had hope and promises for their future. So there's a lot of sort of love and attachment as why they're connected to their partner. Some people stay because they have economic reasons, and they don't have tangible resources to leave. Some people have children in common, and they don't want to deprive their children of a father. So some people feel retaliation.

DR. HUGHES: Fl leave, I'm going to get seriously hurt, and, frankly, the statistics spell it out. The most dangerous time for a woman is when she's leaving that relationship. Her likelihood of getting killed p g g grows substantially at that moment. So leaving sometimes isn't the best strategy. Staying keeps her safe.

DR. HUGHES: So there's usually a multiple of factors of why a woman decides to stay in a relationship. Again, as I said previously, it doesn't mean she's unconcerned about the violence, just she hasn't figured out a way out yet.

DR. HUGHES: That's, you know, probably the biggest one, is that you have this -- we talked about that trauma bond that has developed, that psychological attachment to your partner. You don't want to leave him. You've connected with him on so many other levels that giving that up just feels like a threat to your integrity. You're just sort of in the threats of his because you're just so intertwined and attached.

DR. HUGHES: Hope and optimism are really what keeps I victims alive in these situations. That's what gets them going from one episode to the next. To get up the next day and maybe he's not going to drink today. Maybe it's going to be on his good side. Maybe he's going to come home and not disappear for three days. Continuing to hope that some type of change is coming down the pike.

DR. HUGHES: So, lethality means death, fatality. We have very well-validated instruments and data somebody is in a very dangerous situation.

DR. HUGHES: So some of the factors are an increased frequency and severity of the violence, threats to kill, choking behavior, sexual assault, obsessive and possessive jealousy, controlling behavior, the perpetrator's use of substances, alcohol and substance, the perpetrator's threatening of suicide himself. Those are some of the top factors, and there are more, that are very, very dangerous. When we hear that and we hear a woman is in a situation where those are present, then we are moving out of our situational couple violence.

DR. HUGHES: And destroying property, destruction of property, personal property is also one of the risk factors for danger and fatality.

DR. HUGHES: That's also a risk factor for I lethality.

DR. HUGHES: So, these have also been well-researched, and are wide and varied. We see depression and depressive disorders, sometimes with suicidality. We see anxiety and anxiety disorders, a lot of stress. We see post-traumatic stress disorder. We see substance abuse and substance abuse disorders. We see trust difficulties and difficulties in interpersonal relationships as a result. We see a lot of shame and humiliation. We see anger and rage. A whole - sleep disruption. A whole host of difficult psychological consequences having sustained a relationship of intimate partner violence.

DR. HUGHES: Well, low self-esteem is a very common aftereffect. When you're embedded in the relationship, it also makes it very difficult for you to climb your way out.

DR. HUGHES: Emotional dysregulation, so it's a D-Y-S, dysregulation, is when you sort of don't feel that you have control of your emotions. You feel like you're fluctuating, you know, from one to the ex - one to the next. It's not the same as a bipolar disorder. You know, it can happen in short moments that, you know, it's really because your central nervous system is so out of haywire from being exposed to so many traumatic events. That you may feel things deeply and with a short trigger and a very quick time.

DR. HUGHES: Well, memory for traumatic events is something that has been well researched. Sometimes people have what we call "dissociative amnesia." Where because of the physical or psychic pain of what they're going through, a portion of the memory gets blocked or it can't get retrieved. We've either stored it, retrieved it, we're not really sure. But most of the time, the memory is really about when you have multiple repeated events of the same type of thing. So if you're abused multiple times and the abuse is very similar, it's very common for the victim to lose discrete details of a particular incident.

DR. HUGHES: They may not retain the memory for the complete incident, and that might be dissociative amnesia, that just might mean forgetting because you have so many chronic events that have happened to you.

DR. HUGHES: There are. I hope I've dispelled some of them here already, but, I mean, that's certainly are that women are meek, passive, just sitting there Jetting the abuse happen. That women don't fight back. That women don't yell back. That they-- some old ones, that they like the violence, they're not concerned about the violence. That if it was really bad, she really would have left. If it was really bad, she really would have told the police. All of those myths and misconceptions that just don't comport with the research.

DR. HUGHES: Yes, they are. What we say is, you know, how laypeople think someone who has suffered a traumatic event is supposed to act. So in the immediate aftermath of a trauma, people think, oh, they should be hysterical, overreacting, emotional, all over the place. That's typically not the first reaction of a trauma survivor. The first reaction is, you know, suppression, emotional numbing, emotional constriction. How do I get through this? You know, women who are beaten, they get up the next morning, they get their kids dressed, they get them to school. They go to work. They do a presentation in their office. They go on with life. The most normal thing that a person does who has experienced trauma is to get up and try to be normal. They're striving for that all the time. So sometimes if you see somebody who is more emotionally constricted, looks maybe stoic, looks like they're not feeling, it doesn't mean that they're not having internal reactions. We say this in the field of clinical psychology all the time. The inside doesn't match the outside.

DR. HUGHES: What you're seeing on the outside may not match what's going on for the person inside because they have to be so controlled because the fear is that if I let out a little of this emotion, I'm not going to be able to put the floodgates back on. It's just going to be too overwhelming. And that's true for people who are involved in litigation and also true for my private patients who are - even though they're coming to me for help, they try very, very cleverly to not want to feel the y y difficult emotions of the trauma that they experienced.

DR. HUGHES: Yeah.

DR. HUGHES: We call that the appearance of normalcy. The appearance of competency. That doesn't mean that they're not. It doesn't mean that they're not normal or that they're not competent, but it doesn't give you a bird's eye into their inner experience. And that's what we do in the -- we say in the rooms, in the rooms of therapy, where we really help people deal "1th that, that they keep to themselves. But, yes, someone can be smiling and happy. It doesn't mean that they're not suffering inside.

DR. HUGHES: No.

DR. HUGHES: No.

DR. HUGHES: Yes.

DR. HUGHES: Yes.

DR. HUGHES: Forensic psychological evaluation is an evaluation that is conducted for the courts to answer a particular legal question. It contains multiple parts. Ms. Heard is not a client of mine. She's never been in therapy with me. She's not under my clinical care. It is an objective evaluation to determine a particular legal question.

DR. HUGHES: Forensic evaluation follows a methodology that, what we say, is a multi-method, multi-hypothesis-driven methodology, which means I look at a variety of different documents and data using multiple hypotheses. It's not just one hypothesis, one theory of the case. You're going and looking to see, you know, what possibly could be going on here. And then you use the data to arrive at that opinion. You look for consistency across the data to arrive at that opinion.

DR. HUGHES: And the forensic psychological evaluation has many parts. It has a clinical interview part, a structured, or semi-structured clinical interview, where I'm asking Ms. Heard lots of things about her life, both before Mr. Depp and after. It involves a psychological testing component of the evaluation, which allows me to do a good, broad, scan of different symptomatologies that people might have in their lives, as well as to have indicators of how she approached the tests. Is she defensive? Is she malingering? Is she feigning? Is she exaggerating?

DR. HUGHES: It gives me indications about how she approached the evaluation.

DR. HUGHES: I review a number of documents, medical records, psychological records, the texts, the audio, all the different things that we've had in I this case. And then I conduct collateral interviews.

DR. HUGHES: No, of course not. I always approach a forensic evaluation with a healthy dose of skepticism. With any forensic evaluation, there exists a motivation that the individual may be telling you something that is not accurate. It doesn't mean that that's there, but you have to control for that and know that you're looking for, again, what does the data tell you, the external data, about what the person is also telling you.

DR. HUGHES: No. This is my standard methodology ?9 that I would use with any individual who's in a forensic matter and I would be called to evaluate them.

DR. HUGHES: Okay. So I met with Ms. Heard for a total of about 29 hours. I met with her, for the first time, in September 2019. I saw her for four visits, live, in my New York City office. That's about 21, 22 hours. And then I saw her twice over Zoom, one was in January 2021.

DR. HUGHES: Dr. Hughes.

DR. HUGHES: Dr. Curry's here, I guess, as well.

DR. HUGHES: I'm consulting my cheat sheet of the dates that I saw Ms. Heard so that I could accurately report to the Court. I also have my final designation in front of me so that I could give the most accurate information to what I put in that report.

DR. HUGHES: Sure. So, there are four dates in person, in New York City, for a total of about 21 1/2 hours, and then I saw her on January 18th, 2021, over Zoom, for three hours, and then December 27th, 2021, for four hours over Zoom

DR. HUGHES: So, as I stated, the evaluation consisted of psychological testing, a I! semi-structured clinical interview with Ms. Heard, a review of a whole host of documents, relative to this case, and medical records and psychological records, and then three collateral interviews, two with her treating therapists, Dr. Bonnie Jacobs, Dr. Connell Cowan, and also with her mom.

DR. HUGHES: Well, when someone comes in for the evaluation, you sometimes don't know what you're going to see or what you're going to get. So you absolutely have to do a full clinical interview, and have a sense of their life, their life patterns, things that have affected them in their lives, you know, where they have worked, where they have lived. Just get a full sense of their sort of being before the incident for which they're talking about.

DR. HUGHES: Then I do a full intimate partner violence assessment, looking at all those characteristics that I talked to you about earlier, to get a sense of the full structure of and the dynamic of this relationship. I also did -- looking at what were the effects, what were the psychological consequences of being in that relationship. And I also looked at the psychological consequences of some of the statements that were made by Mr. Depp through his attorney that are part of this -- the counterclaim in this lawsuit.

DR. HUGHES: Yes, I did.

DR. HUGHES: So, like I said, there are opinions embedded within them. But the main opinion is that Ms. Heard's report of intimate partner violence, and the records that I reviewed, is consistent with what we know in the field about intimate partner violence, characterized by physical violence, psychological aggression, sexual violence, coercive control, and surveillance behaviors.

DR. HUGHES: The second main opinion was that, that Ms. Heard demonstrated very clear psychological and traumatic effects or the exacerbation of trauma from those statements that Mr. Depp made through his attorney. There were three statements that we evaluated to see how they affected her emotionally and psychologically, and it was my determination that they did

DR. HUGHES: Yes, I did.

DR. HUGHES: I diagnosed Ms. Heard with post-traumatic

DR. HUGHES: So, the etiology is the cause. In stress disorder. order to have a - to meet criteria for post-traumatic stress disorder, you have to have an actual cause. It's one of the few diagnoses, diagnostic entities that we have to have a cause for, and the cause was the intimate partner . violence by Mr. Depp. That was what was pushing the symptoms. That was what was related to intrusive phenomenon; that was related to her avoidance; that was related to her differences in her mood; that was related 11:o her avoidance efforts. So it was - the cause was the intimate partner violence by Mr. Depp.

DR. HUGHES: So, I'm going to refer to my list of documents so that I can be clear for you all.

DR. HUGHES: It is a four-page --

DR. HUGHES: Dr. Hughes.

DR. HUGHES: Correct. I just don't want this to be a memory test of having conducted many documents, 80 pages of notes, full psychological testings.

DR. HUGHES: Yeah, no problem.

DR. HUGHES: So I reviewed a number of documents, a plethora of documents, most -- and I obviously won't read them all, but I reviewed, certainly, all of Ms. Heard's testimony that she gave in her deposition testimony, her deposition testimony in this case, her deposition -- or her trial testimony in the U.K. case. I did the same thing for Mr. Depp. I reviewed his deposition testimony, as well as his trial testimony in the U.K., as well. I reviewed a number of the depositions that were put forth in this case. I reviewed the psychological treatment notes for Dr.

DR. HUGHES: Bonnie Jacobs, Dr. Connell Cowan, Dr. Laurel Anderson, and Dr. Amy Banks, although she did not have treatment records. So I reviewed not only their records, did collateral interviews with some of them, and also read their deposition testimony. And also read all the medical records in this case, nursing notes in this case. The highlights. I also listened to the audios that were put forth in this case and the text messages and emails.

DR. HUGHES: And I also saw the video in the kitchen, yes.

DR. HUGHES: Well, collateral interviews is a standard part of a forensic evaluation. It's an opportunity to hear from another treating clinician, the person who is actually treating the individual you're evaluating, and get a better sense, from that person, of what they saw, what they knew, how they experienced this person. Sometimes our clinical notes don't give the full breadth of what really was going on in that therapy because the notes are meant to be sort of short and to the point of what was - what happened, who was there, and what was the plan.

DR. HUGHES: So it was really helpful to talk to these two clinicians who really were with Ms. Heard throughout the duration of her relationship with Mr. Depp. So they give us sort of a contemporaneous look at what was going on for her emotionally. I mean, what was she reporting? What was she saying about the relationship to her therapist?

DR. HUGHES: So, Dr. Bonnie Jacobs was Ms. Heard's therapist.

DR. HUGHES: May I refresh my recollection with my notes, Your Honor?

DR. HUGHES: If you'd like me to tell the dates. Honor.

DR. HUGHES: May I?

DR. HUGHES: May I?

DR. HUGHES: Thank you. So she treated with Dr. Bonnie Jacobs, who is a psychologist, from October 2011 through August 2014. She actually was seeing Dr. Jacobs somewhat earlier before she got in the relationship with Mr. Depp. And then she transferred care to Dr. Connell Cowan, who was referred by Dr. Kipper, who was the treating physician for Mr. Depp, and then later for Ms. Heard. And she treated with Dr. Cowan from -- after she left Dr. Bonnie Jacobs in September 2014 to June 7th, 2015.

DR. HUGHES: That's correct

DR. HUGHES: That's correct

DR. HUGHES: Paige Heard"is Amber Heard's mother.

DR. HUGHES: I spoke with all of these individuals at the end of 2019. Again, I can check my notes and let you know the exact date, if you'd like.

DR. HUGHES: Yeah, the end of '19. Yes.

DR. HUGHES: Yes, I am aware, sadly.

DR. HUGHES: That is correct.

DR. HUGHES: I administered 12.

DR. HUGHES: So I am going to refer to my designation that has the list so that I don't forget anything.

DR. HUGHES: So I administered -

DR. HUGHES: So I can look and just look up and that's refreshing my recollection?

DR. HUGHES: Yes, I can. I administered the Personality Assessment Inventory, which is a broadband instrument to scan for psychopathology and psychological symptoms that people have.

DR. HUGHES: I administered the Trauma Symptom Inventory-2, which is an instrument to scan for common traumatic effects that people have. I administered the Miller Forensic Assessment of Symptoms Test, which is a measure of malingering. I administered the Post-traumatic Stress Disorder Checklist for the fifth edition, for the DSM-5. I administered the fifth clinician-administered PTSD scale for DSM-5.

DR. HUGHES: I administered the Beck Depression Inventory, the Beck Anxiety Inventory, the Mood Disorders Questionnaire, the Danger - I did 3, intimate partner violence measures, the Conflict Tactic Scales, the Abusive Behavior Observation Checklist, and the Danger Assessment Scale. O And then I also did the Life Events Checklist, which scans and, I guess, asks about a lot of traumatic events that an individual may have experienced And we administer that, typically, before either doing the PCL or doing the CAPS.

DR. HUGHES: Yes, there were.

DR. HUGHES: So, malingering is the false production of psychological symptomatology for the purpose of some external material gain. Feigning is the false production of psychological symptomatology with no identification of what that gain may be. So, basically, feigning is saying your mental health is worse than it actually is.

DR. HUGHES: So I administered -- three of the tests had validity indices built in that could allow us to address that question.

DR. HUGHES: The M-FAST, the Miller Assessment -- Forensic Assessment of Symptoms Test is a specific malingering instrument. It looks at malingering psychopathology. Is this someone, you know, malingering psychopathology? She scored zero on that scale -- on that test, not that scale, but test. So, on that test, there was no evidence of malingering.

DR. HUGHES: On the TSI, there are two validity indices, and she scored within the normal range on those scores as well. One was slightly elevated, but when testing the limits, because it has rare symptoms and over-endured symptoms, I determined that that also was a valid measure. Finally, the PLI, the large-scale, 344-question instrument, has very robust validity scales on it to test for exaggeration or feigning or malingering. And she did not score on any of those scores in those scales, at all. Those were not elevated. So the combined results between those three tests suggest to me that Ms. Heard is not malingering her psychological symptomatology.

DR. HUGHES: No.

DR. HUGHES: Because that test, the scale that she's referring to, is called ATR, it's the atypical response scale. As I said, that combines rare symptoms and over-endured symptoms. It's very frequently elevated in people who have high levels of distress. And then, importantly, on this test specifically, it says do not use the percentile rank. It is in the manual, it's in italicies [sic]. Because the way that this test was normed, it was normed on people who have trauma, so it's what we called negatively skewed. That means it falls on the tail end of the continuum. It is not a normal curve where we would normally think of how a percentile would work. So you would not use the percentile range on this test.

DR. HUGHES: So, that is a very inaccurate way to describe that scale and that test.

DR. HUGHES: And the ATR scale on this test is probably the least robust of all validity scales, so you would never make a comment like that based on one scale if you don't have consistency across data. And when you look at the consistency across the testing, with the PAI, the TSI, and the M-FAST, and there's research to support that, that when they go together, you have a higher degree of likelihood that this is not feigned PTSD, that this is not feigned symptomatology.

DR. HUGHES: And then, actually, if I look at the validity scores on the MMPI-2 that Dr. Curry administered, those scales are not elevated for, exaggeration or malingering either. So if I add that, now I have really robust data that Ms. Heard is not malingering or feigning her psychological symptomatology.

DR. HUGHES: Yes, I did.

DR. HUGHES: So that was the Conflict Tactics Scale, the Abusive Behavior Observation Checklist, and the Danger Assessment Scale.

DR. HUGHES: I would like to refer to the testing.

DR. HUGHES: To refresh my recollection. Just a glance, just to be clear with the jury.

DR. HUGHES: So, what the overall gist of the testing was, was that - and the benefit of these tests is that they allow me to ask for what Mr. Depp did to Ms. Heard and then, also, what Ms. Heard did to Mr. Depp.

DR. HUGHES: So it was asking about both sets of behavior.

DR. HUGHES: So what these tests show is that there was a high degree of serious violence perpetrated

DR. HUGHES: Psychological aggression scale, where Mr. Depp engaged in more severe acts of psychological aggression; whereas, Ms. Heard did engage in, also, some mild and severe acts of psychological aggression. The amount of injury that was reported was significantly higher and more severe by Ms. Heard, what she was subjected to. And then she was subjected to sexual violence, where Mr. Depp, based on her report, was subjected to none. And then, the other - on the Danger Assessment Scale, that there were a number of factors that were related to severity in violent relationships, and a risk factor when we looked - as I said earlier, when behaviors come up on this scale, they're very worrisome, very scary, and we have to take them seriously. So there were a number of behaviors that came up on this scale, such as Mr. Depp threatened to kill her, the increase in severity of the abuse, the forced sexual activity, the choking behavior, his obsessive jealousy.

DR. HUGHES: The obsessive jealousy, the control aspect, and his threatening of suicide, to kill himself.

DR. HUGHES: So those were risk factors that placed her in the increased danger range, and this is a range that says, you know, that we certainly have to advise women of their risks and consult with law enforcement, if they're involved, or judges, if they're involved, because this means that a woman is at risk for more serious or lethal domestic violence.

DR. HUGHES: Sure. So there were four tests that supported that diagnosis. One was the PAI, which was that 344-question, large-scale personality inventory. On that test, her largest subscale, her highest subscale was the one that measures traumatic stress, so that was clinically significant. On the TSI, two of her scales were the intrusive experiences dimension and the defensive avoidance dimension, two of the classic scales of trauma and PTSD.

DR. HUGHES: The PCL, which is the Post-traumatic Stress Disorder Checklist-5, that, she scored in all four domains of PTSD, and that's an instrument that says how much are you bothered by these symptoms. And in all four clusters, which would be the intrusive experiencing, when things about the abuse or the trauma enter your mind when you did not want them to, sometimes they're cued, sometimes they're uncued, she answered in avoidance category, which is the second category of PTSD, that I do things to try not to think about this, to try not to feel this, to try not to get upset. Sometimes I avoid certain people because they become a trigger for me. She scored in what we call the negative alterations in cognition and mood. Changes in her thoughts and feelings as a result of the abuse and trauma. And also in the physiological hyperactivity, the hyperarousal, the hypervigilance, the startled response.

DR. HUGHES: So on the PCL, she endorsed symptoms in all four of those categories, saying, you know, some of these sometimes are bothering me a lot. Then finally, the Clinician-Administered PTSD scale for the DSM-5. And what that allows me to do, unlike the PCL, is really look at symptom severity and symptom frequency. How is this really playing out for this individual. And, similarly, she scored in all four categories of trauma and of having intrusive experiences and nightmares and avoidance efforts and physiological hyperactivity and changes in her mood and her thoughts. And her total score was a 28, which falls in the moderate range. So that means that she has experienced a moderate degree of post-traumatic stress disorder symptomatology, and those tests allow me to make that definitive diagnosis that she suffers from PTSD.

DR. HUGHES: I mean, that was a significant consideration, given that we know that childhood -- well, first of all, we know that people can experience multiple traumas across the life-span. And we wanted to make sure that the symptoms that she was experiencing were related to what she experienced with Mr. Depp and not her childhood. And certainly, you know, earlier on in the evaluation, and when I evaluated and spoke with her, that was true, and that was also true on the latest measure of the Clinician-Administered PTSD scale for DSM-5, the CAPS-5. And that's because the content, you have to look at what is the content of the symptoms? So it's not that someone says, oh, yeah, something traumatic comes into my mind. No, what is it? What comes into your mind? What bothers you? What are the triggers?

DR. HUGHES: And those were all specific to Ms. Beard's relationship with Mr. Depp.

DR. HUGHES: The reason the childhood is also significant is that we know that if somebody suffers childhood abuse as a child, they are much more likely to have an adult re-victimization, and they're much more likely, then, to be more vulnerable to obtaining a PTSD -- to getting PTSD if they've had that prior vulnerability. So it's a very strong vulnerability characteristic to obtain PTSD when you have a subsequent trauma.

DR. HUGHES: The other aspect about her childhood abuse is that she was raised in a family of violence. She was physically abused by her father. She saw her father abuse her mother. Her father was very explosive and had violent outbursts. And both her parents also struggled with substance abuse, very significantly. So she had learned, from a very early age, how to caretake. How to live in a situation that is mired in chaos. How do I take care of a parent who is passed out, nodded out from heroin? And how do I get up and get my sister to school? She learned, at very early age, that she had to figure out how to do this in this scenario.

DR. HUGHES: And I would say, lastly, what that environment taught her was that she learned that she could love someone who hurts her. She knew that people who hurt her also could love her, and she learned how to have this tolerance for cognizant inconsistency. This tolerance for two, should be, diametrically opposed emotions. But she grew up knowing, or believing, perhaps, that this could happen. And she also believed that she could fix him, just like she tried to fix her father, and just like they tried to fix her mother. She truly, truly believed that she could fix Mr.

DR. HUGHES: Depp and rid him of his substance abuse problems. But that did not work.

DR. HUGHES: Yes, I did.

DR. HUGHES: I didn't agree with her interpretation, having been a trauma psychologist for over 25 years and administered hundreds of these. I found that there were flaws in how she chose to administer it, and then some of the coding. Ms. Heard, on that CAPS-5, to Dr. Curry, certainly reported trauma-based symptomatology related to the abuse by Mr. Depp, but somehow that was not coded as such.

DR. HUGHES: Yes, I did.

DR. HUGHES: No, I do not.

DR. HUGHES: Because this profile is a normal profile. It is the known clinical scores elevated above 65, which is one-and-a-half standard deviation of the mean, which is what we use to determine clinical significance. And if none of those scales are elevated, it becomes very difficult for us to make assumptions about a person's psychology and their functioning. Now, remember, the psychological testing generates hypotheses about a person that we, then, using our clinical judgment, have to make a decision about. We have to make an assessment about it.

DR. HUGHES: And if none of those scales are elevated, it just doesn't give us rich information to make those determinations. The one scale, which is accurate, that was elevated was one that measures defensive responding. Sort of a protective responding, an unwillingness to admit minor faults. That was elevated, and that was true. But the result of that is you have a defensive profile. You have somebody who's not giving you a lot of information. So the scales are all low. So there's no way you can take that MMPI and then say it meets - it's consistent with borderline personality disorder. You just don't have the symptom expression on it in order to do that.

DR. HUGHES: I did not make a personality disorder of Ms. Heard.

DR. HUGHES: For a number of reasons. Number one, a personality disorder requires a pervasive pattern in a variety of contexts. Two keys words: Pervasive pattern, variety of contexts. That means if her emotional instability, her affect dysregulation or her fear of abandonment is only occurring in the relationship with Mr. Depp, and we don't have evidence of it before, and we don't have evidence of it after, it is not --