DOMESTIC VIOLENCE AND TBI

Millions of women worldwide are living with the impacts of traumatic brain injury (TBI) caused by domestic violence. These women often suffer injuries to their head, neck and face. The high potential for women who are abused to have mild to severe TBI is a growing concern since the effects can cause irreversible psychological and physical harm. Women who are abused are more likely to have repeated injuries to the head, and as injuries accumulate, the likelihood of full recovery dramatically decreases. To make matters worse, sustaining another head trauma before the complete healing of an initial injury may be fatal.

Severe, obvious trauma does not have to occur for a brain injury to exist. A woman can sustain a blow to the head without any loss of consciousness or apparent reason to seek medical assistance, yet display symptoms of TBI while loss of consciousness can be significant in helping to determine the extent of brain injury, people with minor to moderate TBI often do not lose consciousness yet still have difficulties as a result of their injury. Many women suffer from a TBI unknowingly and misdiagnosis is common since symptoms may not be immediately apparent and may mirror those of mental health diagnoses. In addition, subtle injuries that are not identifiable through MRIs or CT scans may still lead to cognitive symptoms.

Though domestic violence against women has existed for as long as domestic life has, there is little existing research on its connection to TBI. Dr. Eve Valera, Assistant Professor in Psychiatry at Harvard Medical School, and a Research Scientist at Massachusetts General Hospital is working to change that. She published one of the first studies examining the prevalence of intimate partner violence (IPV)-related TBI and its relationship to cognitive and psychological functioning. Her work is ongoing and expanding to address other potential neural consequences of TBIs from partner violence.

Dr. Valera’s preliminary study entitled Strangulation as an Acquired Brain Injury in IPV and its Relationship to Cognitive and Psychological Functioning aimed to examine the relationship between strangulation-related alterations in consciousness (AIC) and cognitive and psychological outcomes in women who have experienced intimate partner violence (IPV).

The first report to assess strangulation as part of IPV and demonstrate links to resulting cognitive and psychological functioning, the study recruited 99 women from a variety of settings, including women’s shelters and support programs. Of the 99, 52 were eliminated from the study for meeting criteria that could mask or confound the effects of strangulation on the brain.

The literature related to the study states that several cognitive measures were used to assess learning, long-term and working memory, visuomotor speed, cognitive flexibility and nonverbal cognitive fluency as well as several psychological measures to assess post-traumatic stress symptomatology, general distress, worry, anhedonic depression and anxiety. The Brain Injury Severity Assessment interview was used to examine the association between strangulation-related AICs and these measures of cognitive and psychological functioning. The results of the study found that women who had experienced strangulation-related AICs performed more poorly on a test of long-term memory and had higher levels of depression and post-traumatic stress than women who had not experienced strangulation-related AICs. The findings also showed that women who had experienced strangulation also performed more poorly on a measure of working memory.

“The number of women sustaining IPV-related TBIs dwarf the combined number of military and NFL TBIs or concussions reported. Using annual estimates of severe physical violence (totaling 3,200,000 women), about 1,600,000 women are estimated to sustain repetitive IPV-related TBIs in comparison to the total annual numbers of TBIs reported for the military and NFL (18,000 and 281, respectively),” says Dr. Valera.

Licensed clinical social worker Katherine Price Snedaker is also part of the crusade not only to bring awareness to IPV-related TBI but to highlight the marked differences between how women and men are affected by brain injury. She is the Executive Director and Founder of PINK Concussions, a non-profit organization focused on pre-injury education and post-injury medical care for women and girls with brain injuries including concussions incurred from sport, accidents, military service or domestic violence. The organization’s mission is to drive change and innovation to develop and implement sex-specific/gender-responsive, evidence-based strategies for the identification, management and support of women and girls with brain injuries. According to Snedaker, the organization has the vision to create a world in which women and girls with brain injuries are quickly identified and receive appropriate, compassionate care and support. You can learn more about the organization at pinkconcussions.com.

In addition to the physical violence leading to TBI as a result of IPV, there is also the psychological aspect to consider. Studies have shown that long-term psychological abuse, which can be constituted as IPV alone but also inevitably accompanies physical violence, can cause brain damage. According to Dr. Gail Gross, Ph.D., Ed.D., M.Ed., long-term emotional abuse shrinks the hippocampus, the complex brain structure embedded deep into the temporal lobe responsible for memory and learning, while enlarging the amygdala which is the integrative center for behavior and motivation and houses primitive emotions such as fear, grief, guilt, envy and shame.

The physiological changes to the brain caused by emotional abuse can be reversed thanks to neuroplasticity, the brain’s ability to modify, change, and adapt both structure and function throughout life and in response to experience. Research has shown that the hippocampus can regrow. One way to facilitate this regrowth is with Eye Movement Desensitization and Reprocessing (EMDR), a form of psychotherapy developed by Francine Shapiro in the 1980s that was originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder. A recent study showed that eight to twelve sessions of EMDR for patients with PTSD showed an average of a 6% increase in the volume of their hippocampi. Other methods that have been shown to repair both the hippocampus and amygdala include guided meditation and aroma and essential oil therapy.