More attention and, accordingly, research have gone into the prevention and treatment of traumatic brain injury, or TBI, specifically in athletes—from elementary schoolers enrolled in soccer to linebackers in the NFL—over the last several years. But there’s an important affected group that has been nearly absent in that research until recently: domestic violence survivors.
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While a small but powerful group of researchers has been sounding the alarm about the intersection of domestic violence and brain injury for almost 20 years, the knowledge is just beginning to be considered in direct service agencies, including domestic violence shelters.
“We’ve done a lot of work around around the short- and long-term psychological impact of domestic violence, but not the physical impact on the brain,” says Rachel Ramirez, LISW-S, RA, founder and director of the Ohio Domestic Violence Network’s Center on Partner-Inflicted Brain Injury. “It just wasn’t something we were looking at ... that anyone was looking at.” But her organization and others are now working to help change that and ensure brain injuries are identified early so survivors can get the care they need.
Ramirez recently co-led the first community-based study featuring perspectives of domestic violence program staff on this topic, along with researchers from The Ohio State University and her organization. Their study found that 81 percent of women who’d been abused by a partner and sought help suffered a head injury, and 83 percent had been strangled. Previous literature established that many survivors had experienced multiple head injuries as well as oxygen deprivation from strangulation, but the Ohio study was the first to directly ask domestic violence survivors about blows to the head and strangulation occurring concurrently in the same violent assault. The damage from these combined forces can be lifelong—from causing forgetfulness and difficulty concentrating to vision and hearing problems and other chronic health problems that can become permanent disabilities. (You can watch this video for a quick summary of their findings.)
Other recent studies have found similar results. In a two-year study by the Brain Injury Alliance of Nebraska, 58 percent of women screened tested positive for brain injuries and 91 percent reported being hit on the head or strangled.
Why Injuries Get Missed
Brain injuries in survivors are a widespread problem that’s been largely missed for a variety of reasons. First, there are typically no bystanders like there are with sports injuries, for example.
“That’s a setting where you can easily train coaches and develop protocols, and that’s one of the pieces missing for identification with domestic violence survivors,” Ramirez says. “And we can’t treat something that doesn’t get identified.”
Many injuries also go undocumented because survivors don’t seek treatment. And if they do receive care, they may be understandably fearful about revealing the true cause of their injuries. Combine this with the previously mentioned cognition and memory issues from the injury itself and the fact that side-effects may not appear until years down the road when it’s hard to connect them to the original incident, and it’s easy to see why survivors are often frustrated and misunderstood.
“This lack of identification can leave survivors feeling that they’re ‘stupid’ or ‘crazy’—the same thing their abusers may have told them they were, when really what they have is a head injury,” she says.
Shining a Light on the Problem
Ramirez and her colleagues—along with other domestic violence researchers—are working together and sharing data to help improve identification and services for survivors. The center Ramirez leads was created to help educate and support researchers and practitioners working with victims of domestic violence as well as make their own services more accessible to survivors who may have experienced a brain injury.
They’ve also joined forces with groups like the PINK Concussions National Task Force on Partner-Inflicted Brain Injury. (PINK is one of the first organizations to focus on head injuries in women.) And they’ve created a tool called CHATS to help advocates identify brain injury, as well as a Head Injury Education Card for survivors that details what a brain injury can look like—including symptoms they may not expect like vomiting, a headache that won’t go away, or one pupil being larger than the other—and how and when to seek treatment.
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“A brain injury is more than just a brain injury in the context of domestic violence. There’s so much more going on,” Ramirez says. “Identification is so important in helping survivors feel like they’re not ‘stupid’ or ‘crazy’ and it can also help prevent them from suffering from additional health problems.”
It’s important to know that the effects of brain injuries and strangulation are cumulative—symptoms can get worse each time. Read more in “Undiagnosed Brain Injuries Common In Survivors.”
Live Webinar With Rachel Ramirez
DomesticShelters.org and Rachel Ramirez, LISW-S, RA, founder and director of the Ohio Domestic Violence Network’s Center on Partner-Inflicted Brain Injury hosted a live webinar on Dec. 10, 2020. You can view a recording of the event in our video library.
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