A cause of brain injury that has been under-reported is domestic violence. Often the victims of domestic violence do not seek health care after the assault or they live in areas where the healthcare services lack the expertise and resources to identify brain injury. The nature of the victim’s relationship with the perpetrator may further prevent them from calling for help from the police, advocacy organizations or healthcare professionals. They may be one among several victims in a family or they be the one who absorbs the abuse to protect the others. Domestic violence is not confined to the poor, it occurs in all economic groups and involves men as well as women and children. For many it’s “a private issue” or “secret” that is kept hidden.
In the aftermath of abuse, the consequences of brain injury may be confused with mental health or substance abuse problems and not understood as the outcome of repeated blows to the head or strangulation attempts depriving the victim of oxygen during a violent attack by a domestic partner. The person who is agitated, depressed, forgetful, confused, having slurred speech, experiencing headaches, pain, vertigo and other physical symptoms that we associate with brain injury may be not appropriately diagnosed and treated. In situations were the abuse is ongoing, the effects of repeated brain injury are cumulative and not unlike those experienced by a boxer or football player who has had multiple concussions. Health care professionals need training in recognizing that the pattern of symptoms following domestic abuse may, in fact, be brain injury and learn to look for the real cause of problems.
In studies of the prison populations in many states, more female inmates were found to have experienced brain injuries than males. The higher rate of injuries was correlated with exposure to domestic violence. Do the behavioral and cognitive effects of brain injury account for some of the problems which land women in prison?
And, then we have the toll of psychological trauma, of living in fear of each attack and of the next event which could happen tomorrow or at any minute in a relationship characterized by explosive violence. Coupled with the effects of brain injury, PTSD symptoms are real and complicating factors.
As healthcare professionals we need to increase our awareness of domestic violence as a cause of traumatic brain injury and understand the cumulative and total effects of violence on the person. The victims of domestic violence are exposed to enormous and ongoing risk for severe brain injury and psychological problems stemming from trauma.