It Is Our Responsibility to Recognize Brain Injuries and Intimate Partner Violence in the Women We Serve

By Eve M. Valera, Ph.D.

Intimate partner violence (IPV) is extremely common, with estimates of nearly 1 in 3 women reporting violence from a partner. If you think you don’t know anyone who has experienced IPV, I can almost assure you that you are wrong. IPV is stigmatizing and can feel embarrassing, and it traverses all socioeconomic, ethnic, and political boundaries. Unfortunately, it is also true that the majority of injuries reported by women are to the neck and higher (Wu et al, 2010). Women are hit in the heads with baseball bats, stomped on the head with work boots, punched in the head with fists, and have their heads slammed against hard objects such as car windows, door jams, walls, and floors. All of these violent acts have the potential to cause traumatic brain injuries in women experiencing IPV. Additionally, women are frequently strangled which can cause other types of damage to the brain including ischemic and hypoxic brain injury, meaning that there may be a lack of blood flow and necessary oxygen that can result in damaged brain cells.

This next fact is critical: brain injuries from IPV are commonly invisible! What this means is that neither the women themselves nor the providers who are meant to help and/or treat them, typically recognize that a brain injury has occurred or recognize the importance of asking about the potential occurrence of a brain injury – especially from a partner. So my message to you is to ask. First, we should be asking if women feel safe at home, and if we identify a woman who we think has experienced IPV, we should consider the possibility that she has sustained an IPV-related brain injury either from a strong force to the brain (e.g., punch, kick), or a strangulation incident. My work has shown that approximately 75% of women I interviewed had sustained one such brain injury from a partner and that about half had sustained repetitive brain injuries from a partner. My work also showed that the more brain injuries a woman had sustained from her partner, the more trouble she had learning and remembering a list of words and performing a cognitive flexibility task. Additionally, the more brain injuries she sustained, the more likely she was to have higher ratings of depression, anxiety, worry and post-traumatic stress symptoms.

In short, it seems that a range of cognitive and psychological issues that have been reported by women in a host of different situations, have likely been misinterpreted as something other than the symptoms of a brain injury, and this needs to change. We should be asking about times when women have lost consciousness, been dizzy, dazed, disoriented or confused, seen stars or spots, or suffered memory loss after anything their partner ever did to them. If the answer is ‘yes,’ she has likely sustained an IPV-related brain injury, and her care and intervention need to take this information into account. It is only in asking that we will identify this information and consequently be able to provide appropriate care to so many women who have sustained, and will sustain, IPV-related brain injuries.

References

1. Devries, K.M., et al., Global health. The global prevalence of intimate partner violence against women. Science, 2013. 340(6140): p. 1527-8.
   Valera, E.M. and H. Berenbaum, Brain injury in battered women. J Consult Clin Psychol, 2003. 71(4): p. 797-804.
2. Wu, V., H. Huff, and M. Bhandari, Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: a systematic review and meta-analysis. Trauma Violence Abuse, 2010. 11(2): p. 71-82.

This article was contributed by Eve Valera, Ph.D., Director, Valera Lab; Associate Professor, Harvard Medical School; Research Scientist, Massachusetts General Hospital.