Domestic Violence and Brain Injury
Categories: Living with Brain Injury, Professionals
What you’ll find on this page:
- Overview of common causes of brain injuries among survivors of domestic violence.
- Examples of possible brain injury signs and symptoms that survivors of domestic violence may experience.
- Actions you can take to improve the identification of brain injuries among survivors of domestic violence.
- How to get involved in preventing violence-related brain injuries.
*Content on this webpage was created in partnership with the Ohio Domestic Violence Network and The Center on Partner-Inflicted Brain Injury.
If you or someone you know is unsafe in a relationship, help is available. Reach out to thehotline.org or call 800-799-SAFE (7233) for free, confidential 24/7 support.
Partner-inflicted brain injuries are injuries caused by an intimate partner through often repeated blows to the head, neck, and face, strangulation, or other assaults that affect how the brain works. These injuries often occur alongside ongoing psychological trauma, coercive control, and a history of past abuse that can worsen or add to the harm linked to the brain injury.1-4
Exposure to domestic violence (also referred to as intimate partner violence or IPV) can profoundly impact a person’s lifelong health and well-being.1-4
Exposure to domestic violence may also place individuals at increased risk for death and serious injuries, such as brain injuries.5 In one state, 1 in 4 domestic violence-related deaths resulted from strangulation or other brain injury.6 Among survivors of domestic violence, a brain injury may result from:
- A direct force to the head, neck, or face
- Hit, punch, or slap to the head, neck, or face, or hit to the head, neck, or face with an object
- Impact to the head after being pushed, knocked, or thrown into an object, a wall, or the ground.
- A force on the body
- Being shaken violently
- A hit or punch to the body that causes the head and brain to move quickly back and forth in a whiplash motion
- A penetrating injury
- A gunshot wound to the head
- Being stabbed in the head
- Loss of oxygen to the brain
- Being choked, smothered, strangled, or suffocated
- Pressure applied to the neck or any other violence that leads to a loss of oxygen to the brain or makes it hard to breathe.
It is common for them to be exposed to numerous hits to the head and have a history of multiple partner-inflicted brain injuries.8
Many survivors of domestic violence are exposed to physical violence over a long period of time.7 In one study, 90% of survivors of domestic violence who experienced hits to the head and face reported having at least one partner-inflicted brain injury.8 Partner-inflicted brain injuries happen among people of all races and sexes.2,8,9 However, the exact number of survivors living with a partner-inflicted brain injury is unknown.
Partner-inflicted brain injuries occur in a dangerous environment.
Partner-inflicted brain injuries usually happen in private and are extremely traumatic and scary. The violence—especially severe hits to the head, neck, and face—shows that the abuse is getting worse. This kind of violence is often part of a pattern of control that keeps the survivor from getting help, leaving the relationship, or seeing a healthcare professional. After the attack, the survivor is dealing with the trauma and a potential brain injury while still being in a dangerous situation. Strangulation (choking) is a major warning sign that the violence could become deadly. It means the survivor is at a very high risk of being severely or fatally harmed again. If someone is experiencing a partner-inflicted brain injury, the most important step is to connect them with local domestic violence services immediately. They can discuss the danger, especially if the abuser owns a gun or has threatened to kill the survivor before.
A partner-inflicted brain injury may lead to short-or long-term changes in the brain and how it works.10,11
Changes in the brain may result in symptoms that can last for weeks or months, and for some, these symptoms will be lifelong.8,12 Symptoms of a partner-inflicted brain injury are different for each person. Examples of common symptoms among survivors of a partner-inflicted brain injury are provided below.
| Symptoms | What a person may feel or experience |
|---|---|
| Physical problems | Physical symptoms of a partner-inflicted brain injury may include headaches, problems with vision and sleep, sensitivity to light or noise, and chronic pain. |
| Trouble learning, communicating, or processing information | A person living with a partner-inflicted brain injury may respond slowly to questions or become confused or distressed when presented with information or instructions. They may also have problems with organizing tasks or planning, and may become confused when their schedule is changed. |
| Changes in behavior | Having trouble making decisions and impulsive behavior may appear or get worse after a partner-inflicted brain injury. These symptoms may affect a person’s ability to do daily activities and lead to frustration and anxiety. |
| Trouble with motor skills and speech | Trouble with motor skills may include problems with balance or walking in a straight line. Trouble with speech may include difficulty communicating or speaking. For example, a person may slur their words. These symptoms can resemble the effects of drug and alcohol use and may be misinterpreted as such. |
| Difficulty regulating or controlling emotions | Difficulty regulating or controlling emotions may make being employed and building and keeping relationships more challenging. For example, a person may show emotions that do not match the situation (such as laughing or smiling when given serious information). |
| New or worsening mental health problems | Mental health problems may appear because of a partner-inflicted brain injury or may become worse following this injury. Common mental health problems include anxiety, depression, and PTSD.8,17 |
Survivors of domestic violence who experience multiple brain injuries are more likely to have physical and emotional changes.12,18-21 They may also have problems with sleep and thinking clearly.12,18-21 Symptoms and recovery may get more difficult after each brain injury.10,19,22
Brain injuries are currently under-identified, under-diagnosed, and under-treated among survivors of domestic violence.
Individuals with a partner-inflicted brain injury who do not receive treatment are more likely to experience a prolonged recovery. They may also be more likely to have problems with thinking and memory that would benefit from support.2,8,10,13,23 The first steps to help survivors get needed care include:4,24
1. Educating survivors about brain injury using a trauma-informed approach
Building connections with survivors is essential to begin to address partner-inflicted brain injury. Discussing brain injury symptoms and potential health problems resulting from domestic violence may feel like a reminder of the violence a survivor has experienced. Approaching this topic using the principles of trauma-informed care, which include safety, trustworthiness, transparency, empowerment, voice, and choice. This approach can help make conversations about brain injuries with survivors easier.26
- Tips for talking with survivors about treatment
-
1. Let them know that what they’re feeling isn’t their fault and that there are treatments for many of the symptoms of a partner-inflicted brain injury.
2. Meet them where they are. It may take time to build trust. Survivors might avoid addressing emotional trauma because it’s a painful experience to revisit or because they have lost trust in others. They may also feel uncomfortable or scared sharing their experiences due to concerns about stigma or judgment from others.
3. Use the right language. Brain injury is a medical condition that can only be diagnosed by medical professionals. Use the word “possible brain injury” and let the survivor know that they need to get checked by a medical professional.
4. It may be helpful to talk about brain injury in the context of the survivor’s experience—like saying “injury to the head, neck, or face.” Use the survivor’s own words when appropriate and clarify what you mean when you say, “possible brain injury.”26
2. Identifying survivors with a possible brain injury
Using screening tools is an important way to identify a survivor with a possible brain injury. Screening may occur wherever you regularly meet with survivors, including in the shelter, during home visits, or during medical visits. To screen for a history of brain injury, you can start by asking the following questions. These questions are based on the CHATS: Head Injury Identification and Accommodation Tool.25
- Screening Questions
-
1. Did your partner ever put their hands around your neck or put something over your mouth that stopped or slowed your breathing?
2. Have they done anything else that made you feel choked, strangled, suffocated, or like you couldn’t breathe?
3. Have they ever hit or hurt your head, neck, or face?
- If a survivor answered yes to any of the above questions, you can ask these as a follow-up:
-
1. Did these things happen more than once?
2. After you were hurt, did you ever feel dazed, confused, dizzy, or in a fog?
3. Did you see stars, spots, or have trouble seeing clearly?
4. Did you feel like you couldn’t remember what happened or blacked out?
It is important for a survivor to see a medical professional if a brain injury is suspected. These screening questions are not designed to diagnose a brain injury. Only a medical professional can diagnose a brain injury. Sometimes screening may not be possible or may be challenging. In line with trauma-informed principles, always inform survivors why you would like to ask them some questions about their history and ask for their permission to do so. If screening is not desired or possible, you can still share information on brain injury with them.
3. Using universal accommodations and referrals to care and support
The types of accommodations you can provide will depend on the types of symptoms a person is experiencing.27 Examples of accommodations may include:
- Breaking down information and instructions into simple steps
- Giving the person time to respond and process information
- Sharing written instructions and information
- Providing sunglasses if the person is bothered by light
- Allowing time to rest when needed
Be sure to offer to refer a survivor with a possible brain injury to a medical professional with training in brain injuries and caring for survivors of domestic violence. Getting the right medical care can speed their recovery. Keep in mind that some survivors may be reluctant to see a medical professional. Work with them to identify barriers to treatment and come up with solutions together.
Providing resources and services can help survivors feel like they have control of their recovery. Start by linking them to their local domestic violence program to support their domestic violence-related needs. You can also connect them with the National Brain Injury Information Center to speak with someone about brain injury and get help with care needs, legal and financial advice, and learn about brain injury services in their area.
A survivor may have limited or no medical insurance. Consider sharing a list of low-cost or free options for care or linking them to community-based services. This may include help finding a job, mental health and substance abuse treatment, financial assistance, and housing and childcare.27
There are many ways to support brain health and healing.
Assisting a survivor in developing supportive relationships with family, friends, and others can make a big difference. Encourage and share with the survivor that doing healthy things—such as building meaningful relationships, managing stress, avoiding alcohol and drugs, staying physically active, getting good sleep, and eating a balanced diet—support brain healing.28
Additional resources for domestic violence survivors
- The National Domestic Violence Hotline
- Head Injuries and Strangulation Hurt Your Brain
- Abused and Brain-Injured Toolkit