Intimate partner violence and traumatic brain injury: An “invisible” public health epidemic

Eve Valera, PhD

Contributor

While studying brain injuries in the mid-1990s, I began volunteering in a domestic violence shelter. I noticed that the abuse and problems many women reported were consistent with possibly experiencing concussions. Women reported many acts of violence that could cause trauma to the brain, as well as many post-concussive symptoms. Shockingly, my search for literature on this topic yielded zero results.

When I decided to focus my graduate work on this topic, I was even more shocked by what I learned from women who had experienced intimate partner violence (IPV). Of the 99 women I interviewed, 75% reported at least one traumatic brain injury (TBI) sustained from their partners and about half reported more than one — oftentimes many more than one. Also, as I predicted, the more brain injuries a woman reported, the more poorly she tended to perform on cognitive tasks such as learning and remembering a list of words. Additionally, having more brain injuries was associated with higher levels of psychological distress such as worry, depression, and anxiety.

When I published these results, I was excited about the possibility of bringing much needed awareness and research attention to this topic. Unfortunately, over 20 years later — despite the plethora of concussion-related research in athletics and the military — concussion-related research in the context of intimate partner violence remains scant, representing a barely recognized and highly understudied public health epidemic.

What do we know about intimate partner violence-related traumatic brain injuries?

First, we need to understand that an estimated one in three women experience some type of physical or sexual partner violence in their lifetimes. IPV is not a rare event, and it traverses all socioeconomic boundaries. It is the number one cause of homicide for women and the number one cause of violence to women. For many reasons, including the stigma of being abused, many women hide their IPV — so the chances that we all know personally at least a few people who have sustained IPV are quite high.

Though we lack good epidemiological data on the number of women sustaining brain injuries from their partners, the limited data that we do have suggest that the numbers are in the millions in the US alone. Most of these TBIs are mild and are unacknowledged, untreated, and repetitive. Consequently, many women are at risk for persistent post-concussive syndrome with completely unknown longer-term health risks.

What are the signs and symptoms of IPV-related TBI?

A concussion, by definition, is a traumatic brain injury (TBI). All that is required for someone to sustain a TBI or concussion is an alteration in consciousness after some type of external trauma or force to the brain. For example, either being hit in the head with a hard object (such as a fist), or having a head hit against a hard object (such as a wall or floor), can cause a TBI. If this force results in confusion, memory loss around the event, or loss of consciousness, this is a TBI. Dizziness or seeing stars or spots following such a force can also indicate a TBI. A loss of consciousness is not required, and in fact does not occur in the majority of mild TBIs.

There are often no physical signs that a TBI has occurred. Recognizing that an IPV-related TBI has occurred will typically involve asking the woman about her experience following a blow to the head or violent force to the brain, and then listening for signs of an alteration of consciousness (such as confusion, memory loss, loss of consciousness). Within the next days or week, a range of physical, emotional, behavioral, or cognitive issues may indicate post-concussive symptoms that could include

  • headaches
  • dizziness
  • feeling depressed or tearful
  • being irritable or easily angered
  • frustration
  • restlessness
  • having poor concentration
  • sleep disturbances
  • forgetfulness
  • taking longer to think.

If a TBI is suspected, a woman should see a doctor if possible. Sustaining additional TBIs while still symptomatic will likely increase the time to recovery, and possibly increase the likelihood of more long-term difficulties.

What can we do?

An important component of addressing IPV-related TBI is to raise awareness and destigmatize intimate partner violence. IPV is unfortunately quite common, and some estimates suggest that millions of women may be sustaining unacknowledged, unaddressed, and often repetitive mild TBIs or concussions from their partners. Talking openly and honestly about this problem, especially in cases were abuse may be suspected, is critical. As we open up this conversation about the commonality of IPV with nonjudgmental acceptance of a woman’s experience, we will be in a better place to hear, understand, and support women who may be unknowing members of this invisible public health epidemic.

Resources

If you or someone you know is experiencing intimate partner violence, The Hotline is a 24/7 support service that has a wealth of resources, including access to service providers and shelters across the US.

Follow me on Twitter @EveValera2

Related Information: Anxiety and Stress Disorders

Comments:

  1. TMSHELP

    Does TMS work for TBI. I heard that it helps with depression and that some TBI’s can cause this also. My girlfriend’s father fell off a ladder and we later discovered he started to become depressed and angry. I am not sure if this works for TBI issues.

    • Eve Valera

      Yes – depression and irritability as well as more difficulty with impulse control could all be possible symptoms of the TBI. Regrading TMS, there can be a role for TMS in some treatment of depression but you would want to have your friend’s father evaluated. A good person to talk to about TMS would be Dr. Joan Camprodon at MGH as that is his specialty. Best of luck to you!

  2. Suzanne Griffin TBI Survivor

    I have heard that someone who is in Domestic Violance, should be evauluated at least every 6 months, if not more. Once you receive a TBI you are 3 times likely to get a 2nd and 8 times likely to get a 3rd.

    Even Several Mild TBI’s are Not Mid, and can become severe

    • Eve Valera

      Yes – once you sustain one TBI your chances of sustaining another go up and there are definitely cumulative effects in many cases. As you mention, repetitive “mild” TBIs can have long lasting negative effects – some of which we may not even be aware of. All that said, how often someone should be evaluated really depends on the situation.

  3. Michael Kaplen

    I was honored to present the keynote address to the American Academy of Matrimonial Attorneys Foundation on the silent epidemic of domestic violence. You can view and share my power point presentation here: https://brainlaw.com/brain-injuries/domestic-violence/

  4. Jami

    After experiencing severe long term psychological/ emotional abuse from an ex-spouse I wish there could be more awareness/research of how this type of abuse affects the brain as well. I came out of that situation with learning problems among many other symptoms similar to TBIs. Tests I had done even validated this. I think Domestic Violence organizations understand this but the law enforcement and courts don’t always see it as abuse.

  5. Arlene Valera

    Since TBI’s affect so many people and there, incredibly, was so little research done on this, it’s wonderful that finally work is being done on this problem. Your work on this subject has been a real eye-opener since usually the problem is unseen & thus unacknowledged. Great job, Eve!

  6. Amy Lamb-Eng

    Thank you for this article and for trying to encourage an increased recognition of intimate partner violence related TBI. As the Program Director for the Alabama Head Injury Foundation, I can attest that this is a growing population among the clients that we serve, and further research and awareness is needed.

    • Shirley Fitzgerald, RN, BS

      I agree that further research is needed however as long as groups actively encourage women to use false reports of IPV to gain child custody in divorces and advocates tamper with witnesses embellishing and exaggerating subjective police and medical reports, they do the true victims a serious disservice. Prosecutors who exaggerate and embellish IPV injuries eg. Taking bruise photos on day 3 when nurses know bruises are most likely to look their worst also do IPV victims a huge disservice as there is no way to prove via chain of custody that the IPV BRUISES in the photos are actually the result of the claimed IPV and not another event that happened in the interim.

    • Eve Valera

      Thank you Amy for your comment. I would love to hear more about what you are finding and/or offer materials that could be useful to your and your staff. Feel free to email eve_valera@hms.harvartd.edu if interested.

      Happy holidays!

  7. Robert Demichelis II

    Eve, be interested if you think this bill addresses your findings and concerns.
    H.R.7212 – Violence Against Women Health Act of 2018115th Congress (2017-2018)
    https://www.congress.gov/bill/115th-congress/house-bill/7212/text?r=7

    • Eve Valera

      Hi Robert – The bill (if renewed) is certainly a step in the right direction for domestic violence in general. However, it still does not specifically address the “hidden” danger of TBI or help ensure accountability for perpetrators. Just as we have become aware of concussions in athletics on the fields, we need to become aware of the concussions from partner violence in our homes. We need to acknowledge it so that we can start to understand its short and long term effects through research in order to help the possibly millions of women who have sustained repetitive concussions/TBIs.

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