One in three women in the United States experience intimate partner violence, which is defined as physical, sexual, or psychological harm committed by a current or former partner or spouse. Also called domestic violence, these encounters can often cause traumatic brain injuries (TBI) that occur when the brain is twisted, stretched, penetrated, bruised, or swollen as the result of rapid movement within the skull. To see how well understood the TBI risk is, researchers conducted focus groups with 49 domestic violence survivors, 45 staff workers, and 17 administrators at service agencies participating in a brain injury awareness project run by the Ohio Domestic Violence Network. Almost one-half of the survivors in these focus groups reported being hit in the head or having their head slammed into an object “too many times to remember,” and 1 in 5 of them said the same thing about how often they had been strangled. But service providers in the focus groups often said they couldn’t recall working with any survivors with brain injuries, or that this was a rare occurrence. “Knowledge about brain injury in both advocacy and medical settings, along with the stigma associated with both domestic violence and brain injury, are the fundamental reasons why there has been limited recognition of the impact of brain injury on the long-term health and functioning of many domestic violence survivors,” says Julianna Nemeth, PhD, lead author of the study and an assistant professor at The Ohio State University College of Public Health in Columbus. “Survivors themselves don’t know that the violence they have sustained can lead to unseen brain injuries — and may think their symptoms are a result of trauma or other mental health issues resulting from the abuse,” Dr. Nemeth adds. The research was published in 2019 in the Journal of Aggression, Maltreatment & Trauma. When patients and providers don’t recognize TBIs, they may fail to understand that these injuries can affect survivors’ ability to think clearly or navigate paperwork or court appearances needed to get services or protection from an abuser, the study team noted. “Because mild TBIs — the type of TBIs most common in intimate partner violence — may leave no marks or visual signs of injury, they are often overlooked,” says Eve Valera, PhD, an assistant professor in psychiatry at Harvard Medical School and researcher at Massachusetts General Hospital in Boston. Even when shelter workers do suspect TBIs, they may be unsure how to talk to survivors about it or be hesitant to bring it up because they don’t know where to send women for treatment for these injuries, the researchers also found. Survivors who have been choked or strangled may not realize that they experienced a brain injury because they didn’t lose consciousness for a long time, and they may give incorrect information about their injuries to doctors or shelter workers as a result, says Jacquelyn Campbell, PhD, RN, a professor at the Johns Hopkins University School of Nursing in Baltimore, who wasn’t involved in the study. “Most people think of loss of consciousness as being totally ‘out,’ so we need to ask women if they felt dizzy or blacked out, even if only for a minute,” Dr. Campbell says. “This is also true of any alteration in consciousness from being hit on the head, hit in the face, shaken violently, pushed to the ground, or being slammed up against something.”
