Traumatic Brain Injury From Intimate Partner Violence

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Recent research focusing on the experience of survivors of intimate partner violence (IPV) reveals astounding numbers of traumatic brain injuries (TBI) that go unseen and untreated. Like the harm caused by psychological and emotional abuse that’s often undetected, the symptoms of a TBI are also hard to recognize unless you know what to look for.

Often, treatment for post-traumatic stress disorder (PTSD) is the primary course for domestic violence (DV) survivors; unfortunately, this may do little to help in the long run when a concurrent TBI has not been diagnosed. Recognizing symptoms of TBI in survivors of IPV and advocating for treatment in addition to trauma recovery are critical to the well-being of the survivor.

Frequency of Traumatic Brain Injuries of IPV Survivors

Eve Valera, Ph.D., an associate professor of psychiatry at Harvard University and a leading researcher on TBIs among IPV survivors, hypothesizes that this population experiences TBIs at a significantly higher rate than other high-risk groups like athletes or soldiers. Valera estimates that each year hundreds of concussions occur in the NFL and thousands occur in the military; by comparison, she estimates that 1.6 million occur among DV survivors.

A TBI is a concussion that can result from being hit in the head with a hard object, such as a fist, or having one's head hit against a hard object, such as the floor or wall. When confusion, memory loss around the event, and dizziness occur, there may be a TBI. Loss of consciousness can sometimes occur, but it does not happen in the majority of mild TBIs. During their time in an abusive home, survivors of IPV can experience concussions frequently.

Identifying Intimate Partner Violence

IPV is not rare and occurs across all socioeconomic groups. According to the Centers for Disease Control and Prevention (CDC), IPV can include physical violence, sexual violence, stalking, and psychological aggression. Physical violence can include hitting, punching with a fist, kicking, shoving, choking or strangling, or another type of physical force.

For women, IPV is the number-one cause of homicide and violence. According to statistics from the National Coalition Against Domestic Violence:

• On average, nearly 20 people per minute are physically abused by an intimate partner in the United States.
• One in four women and one in seven men have been victims of severe physical violence (e.g., beating, burning, strangling) by an intimate partner in their lifetime.
• One in seven women and one in 25 men have been injured by an intimate partner.

IPV often causes shame and humiliation that prevent the victim from revealing their abuse. This suggests that the rates cited above may be underestimated.

Similar Symptoms in IPV-Related TBI and PTSD

There aren't always immediately noticeable signs that a TBI has occurred, and it may take significant work in therapy before an IPV victim reveals their physical abuse at all. Valera makes the following point:

"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. Symptoms could include headaches, dizziness, feeling depressed or tearful, being irritable or easily angered, frustration, restlessness, having poor concentration, sleep disturbances, forgetfulness, and taking longer to think." (Valera, March 2022).

The symptoms an IPV survivor experiences will often be seen through the lens of PTSD, which then becomes the focus of treatment. However, there is a significant overlap between PTSD symptoms and symptoms of TBIs—an overlap that can complicate treatment. This makes these types of TBIs significantly different from those that occur in a sports injury or civilian-type accident. Some of the obvious overlapping symptoms are depression, irritability, poor concentration, memory loss surrounding the traumatic event, sleep disturbances, and forgetfulness.

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Danielle Eagan, a clinical neurologist at the Barrow Concussion & Brain Injury Center who works with DV survivors points out: “You could treat PTSD for a long time and not have a person who comes out functioning better because they have a brain injury that hasn’t been recognized, diagnosed and treated.”

Addressing TBIs Among IPV Survivors

On the national level, two important actions are underway to address this problem. First, the National Institutes of Health has provided funds to study the health impact of TBIs on IPV survivors. Second, in 2022, the CDC started collecting data on TBI and survivors through its ongoing National Intimate Partner and Sexual Violence Survey.

On an individual level, we can pay attention to IPV and be aware that physical acts of violence, especially those that involve an impact to the head, face, and neck, greatly heighten the risk and likelihood of a TBI. Trauma recovery is helpful but not enough when a secondary TBI needs identification and treatment as well.

©Lambert

The National Domestic Violence Hotline: 800-799-SAFE