Announcing latest Quantitative Research Findings
The field of trauma and family systems theory has reached a critical inflection point, which has in part been driven by the quantitative evidence emerging on the insidious systemic phenomenon I named Family Scapegoating Abuse (FSA). This post serves to consolidate and present the key findings from my FSA research studies to date (included in summary form at the end of this post), as well as highlighting two recent, high-impact (published) quantitative studies that I co-authored with Dr. Kartheek R. Balapala (Doctoral Research Scholar) and his dedicated team of research scholars.
The results of this work compel a fundamental shift in how practitioners—both clinicians and medical professionals—diagnose and treat survivors of complex systemic relational abuse, including FSA. Our quantitative, peer-reviewed data provides the essential scientific validation required to move FSA from a debated emotional dynamic to a medically relevant diagnosis.
In the following post, I detail the major conclusions of our recently published peer-reviewed research: from the initial confirmation that conventional mental health interventions are fundamentally inadequate for FSA survivors, to the groundbreaking, statistically significant association we revealed between FSA and the physiological markers of Autonomic Nervous System (ANS) dysfunction, specifically Orthostatic Hypotension (OH).
These findings, published in leading European public health and Asian medical journals, provide the objective biological proof that systemic relational trauma in the form of Family Scapegoating Abuse has severe, measurable somatic consequences, mandating a move toward specialized, systemic-informed care.
Below is an overview of our research to date, including links to the published peer-reviewed studies that substantiate these noteworthy claims.
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Summary of Quantitative FSA Research Findings
Our first quantitative study provided critical validation for the clinical community regarding the ineffectiveness of conventional therapeutic approaches for FSA. It revealed that many typical mental health interventions do not adequately address the unique dynamics of Family Scapegoating Abuse.
This confirmed the central hypothesis of my original qualitative research: FSA survivors present with complex trauma symptoms that are fundamentally reinforced by ongoing systemic abuse, rendering interventions focused solely on individual pathology (like standard cognitive-behavioral therapy or general anxiety management) insufficient.
This key finding underscores the necessity of specialized, systemic-informed therapeutic models that treat the family environment as the primary source of the trauma – This is especially critical in regard to helping child victims of FSA.
Our second, most recent quantitative study has dramatically elevated the clinical urgency of FSA by establishing a statistically significant link between this form of relational trauma and physical health markers. Published in both a European public health journal and an Asian medical journal—marking the first time FSA research has appeared in a medical journal—this study confirmed a statistically significant association between Orthostatic Hypotension (OH) and higher levels of Family Scapegoating Abuse.
Orthostatic Hypotension is a form of dysautonomia (dysfunction of the autonomic nervous system) that affects blood pressure regulation upon standing. This finding is critically important because it provides objective, biological evidence that the continuous stress, hypervigilance, and emotional isolation inherent in FSA are not merely psychological distress, but are severe enough to dysregulate the autonomic nervous system (ANS).
This dysregulation confirms that FSA can result in legitimate somatic illness driven by chronic trauma.
Clinical and Public Health Importance
These two studies collectively matter profoundly for several reasons. First, the publication in a European public health journal signals that FSA must be recognized as a social determinant of health, moving it out of the exclusive realm of individual psychology and into public discourse on health equity and child protection.
Second, the publication in a (Malaysian) medical journal validates FSA as a phenomenon with clear physiological consequences. The link between high FSA scores and Orthostatic Hypotension means that FSA symptoms should no longer be dismissed as purely “psychosomatic” or evidence of (self-manufactured) “emotional drama.” Instead, clinicians—both mental health practitioners and general medical doctors—must begin to screen for complex and/or systemic relational trauma (including FSA) when patients present with unexplained physical symptoms related to ANS dysfunction (like lightheadedness, chronic fatigue, or blood pressure irregularities).
This research finally provides the quantitative proof necessary to force the medical field to acknowledge relational trauma in general—and FSA specifically— as a severe, medically relevant diagnosis requiring specialized, multi-systemic treatment.
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Conclusion: The New Mandate for Clinical Care
The convergence of these recent quantitative findings—proving both the therapeutic failure of standard care and the objective, biological impact of FSA on the Autonomic Nervous System—shatters the notion that relational trauma (including scapegoating abuse in families) can be dismissed or treated solely with superficial psychological interventions.
After nearly two decades of clinical observation and dedicated research, the scientific evidence is now irrefutable: Family Scapegoating Abuse is a systemic illness with severe, measurable somatic consequences. This mandates a fundamental shift in clinical practice toward models that prioritize systemic awareness and physiological restoration over individual blame.
The time for ambiguity is over; the time for informed, targeted intervention is now. The comprehensive summary of my 18 years of research on FSA that follows serves as the authoritative resource supporting this essential evolution in both mental and physical health fields.
FSA Research Summary—2007 to 2025
The term Family Scapegoating Abuse (FSA) was coined by psychotherapist and clinical researcher Rebecca C. Mandeville. Mandeville’s work is foundational to the field, and she has collaborated with other researchers to study this insidious systemic phenomenon. Her recent peer-reviewed quantitative studies serve to further legitimatize the devastating reality of FSA and recovery challenges survivors face.
Key researchers and their contributions
Rebecca C. Mandeville
As the central figure in FSA research, Mandeville’s work includes:
- Creating and defining the term ‘Family Scapegoating Abuse’ (FSA): This has provided a crucial framework for understanding the systemic psycho-emotional abuse that occurs when a dysfunctional family unfairly targets one member with blame and criticism.
- Qualitative research: Through her clinical practice and studies, she identified that FSA often leads to Complex Trauma (C-PTSD), Betrayal Trauma, Complicated Grief; Anxiety Disorders; Depressive Disorders; Impostor Syndrome; and Toxic Shame.
- Quantitative research: In 2024, she co-authored (with Doctoral Research Scholar Dr. Kartheek R. Balapala and his team) the first peer-reviewed quantitative study on Family Scapegoating Abuse (FSA), followed by a second study in 2025 (scroll down for links to these studies, which were published in peer-reviewed health and medical journals in Europe and Asia).
- Authoring content: Mandeville wrote Rejected, Shamed, and Blamed: Help and Hope for Adults in the Family Scapegoat Role, which details her findings and provides resources for survivors. She also publishes new articles about FSA regularly on her Healing the Scapegoat Wound Substack and is a licensed Healthcare Partner on YouTube via her Beyond Family Scapegoating Abuse channel.
- A Unique Nomenclature: Other terms coined by Mandeville as a result of her original FSA research that enhance survivor and clinician discussions include ‘family scapegoat trauma’; ‘scapegoat narrative’; ‘righteous rage’; and ‘scapegoat grief’.
Key findings from the research of Rebecca C. Mandeville
- Complex trauma and other effects of FSA: Mandeville’s research revealed that many FSA survivors suffer from complex trauma as a result of chronic systemic relational trauma; betrayal trauma; attachment trauma; anxiety; depression; and toxic shame. As such, FSA results in a variety of psycho-emotional symptoms and social impediments, including feeling that the world is an unsafe place, emotional dysregulation, a sense of not belonging anywhere, and difficulty forming healthy, secure relationships.
- Systemic dynamics: The research reveals that scapegoating is a systemic issue often fueled by intergenerational trauma, projection, and the splitting of family roles, where one child is designated as the “scapegoat”.
- Clinical consequences: Survivors often report a long history of seeking treatment for various diagnoses like depression, anxiety, or personality disorders without the root cause of the scapegoating being identified.
- Impact on relationships: FSA can lead to a distorted relationship with oneself and others, self-doubt, difficulty expressing emotions, and a tendency to engage in “fawning” or people-pleasing behaviors due to the betrayal trauma and toxic shame experienced within their family-of-origin.
Dr. Kartheek R. Balapala
Co-authored quantitative studies: As a research fellow and MD, Dr. Balapala co-authored the first peer-reviewed quantitative study on FSA with clinician and Family Systems researcher Rebecca C. Mandeville in 2024. This study was published in the European Journal of Public Health Studies. Mandy Sizalobuhle Mpofu, Research Scholar, also co-authored this study.
*Read our first FSA quantitative study at https://oapub.org/hlt/index.php/EJPHS/article/view/202/202
Dr. Kartheek R. Balapala also collaborated on a second quantitative study with Family Systems and Scapegoat Abuse expert Rebecca C. Mandeville; Research Scholar Dr Suriyakala Perumal Chandran; and researcher Chanda Chisanga, which focused on how Family Scapegoating Abuse (FSA) affects women with Postpartum depression (PPD).
*Read our second FSA quantitative study at https://oapub.org/hlt/index.php/EJPHS/article/view/232/232