The Importance of Screening Domestic Violence Victims for Brain Injury

By Sandra K. Ziebold, CEO of Beacon of Hope Crisis Center

Domestic violence, also known as domestic abuse or intimate partner violence, is defined by the United States Department of Justice as “a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain control over another intimate partner.”

Domestic violence is not just physical. It can be emotional, verbal, financial, psychological, spiritual, economic, and social. Often, as abusive situations escalate, things eventually become physical. The prevalence of head trauma and events of strangulation are unfortunately high in this population, which makes screening for brain injury in the intake process when working with individuals who have experienced domestic violence crucial. Too frequently, this is not identified or not identified timely and prolongs the suffering of those who have sustained this trauma.

Domestic violence is about power and control and often includes complete isolation of the victim or tracking of the victim’s whereabouts, intimidation, threats, and escalation to physical violence. It comes to light repeatedly that these victims have never been permitted medical care. Domestic violence is often a medical emergency because head and neck injuries require immediate medical care to prevent further damage to the brain.

If an incident such as blunt force trauma impacts the head and causes swelling in the brain, medical intervention may be vital to relieve pressure in the head and prevent further injury. Quick treatment can provide the care needed to minimize brain cell damage and help with healing. Not getting care after a head injury increases the risk of experiencing long-term physical, cognitive, behavioral, emotional, and psychological problems, or permanent damage. The connection between domestic violence and brain injury is bafflingly under-discussed despite data showing that victims are sustaining head, neck, and strangulation injuries at alarming rates.

Strangulation is among the most lethal forms of domestic violence. Often, reporting is delayed as these individuals are at an increased risk of death trying to flee these situations. Abusers repeatedly go to extremes to prevent the victim from leaving. In fact, leaving an abuser is the most dangerous time for a victim of domestic violence.

Domestic violence service providers must focus on early intervention and prevention. When a victim gets the opportunity and makes contact seeking help, advocacy service providers must ask the right questions at intake to identify those most at risk of a medical emergency. We need to know if they have experienced trauma to the head or neck. It is essential to ask questions like, “Have you ever suffered a head or neck injury?” and “Has anyone applied pressure to your neck?” If a victim answers “Yes,” then additional questions must follow; with these answers, we can determine if they meet the criteria for a brain injury assessment referral. When these questions are not asked early, it is devastating to learn of this trauma many months into counseling. The trauma sustained finally comes to light, and so much time is lost. Worse yet is to think that so many are perhaps never identified, and behaviors that might be presenting because of brain injury are incorrectly labeled due to never asking the right questions.

Often, strangulation victimization is repeated trauma; with each event, the damage grows, and the risk of death is extremely high. Unconsciousness may occur within seconds and death within minutes. When domestic violence perpetrators choke (strangle) their victims, not only is this felonious assault, but it may be an attempted homicide. Strangulation is an ultimate form of power and control where the batterer can demonstrate control over the victim’s next breath: it may have devastating psychological effects or a fatal outcome.

Having a trauma-informed approach is imperative when working with this population. The importance of stressing medical care, whether the incident just happened or whether it is belatedly shared, cannot be overstated. When we educate victims about their medical concerns, we can help mitigate barriers, like transportation or medical costs, so they can receive that care. It’s also important to let them know that they matter, as their abuser may make them feel worthless, and it often takes much patience and persistence. This approach leads survivors to decide to put themselves first and agree to referral for medical care, improving quality of life and, in many cases, saving lives.