Traumatic Brain Injuries Common in Victims of Intimate-Partner Violence, But Often Undiagnosed

by Women's Brain Health Initiative:Intimate-partner violence (IPV) is a pattern of physical and/or sexual violence inflicted by an intimate or ex-intimate partner. Global estimates published by the World Health Organization indicate that about 1 in 3 women have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime (although this figure is likely higher because cases of abuse are often underreported).The vast majority of victims of reported intimate violence are women (95%).The prevalence of IPV is striking, affecting nearly one third (30%) of all women who have been in a relationship worldwide, according to a 2013 estimate by the World Health Organization. It is estimated that between 40% and 92% of those women incur head injuries, and almost half experience strangulation, both of which can result in traumatic brain injury (TBI).TBI is an alteration in brain function caused by an external force or lack of oxygen. TBIs can range from mild (commonly referred to as a concussion) to severe (which can lead to death). TBIs of any severity can have serious negative consequences including:

• Physical disabilities, such as difficulty with balance and vision, headaches or migraines, sensitivity to sound and light, sleep disturbances and fatigue;
• Cognitive challenges, such as short-term memory loss, decreased ability to concentrate, and troubles problem solving;
• Executive functioning problems, such as difficulty with long-term planning and goal setting, and difficulty completing tasks;
• Behavioural and emotional symptoms, such as increased impulsivity, tension and anxiety, and hyper-vigilance; and/or
• Psychosocial impacts, such as difficulties with work and attending appointments, challenges in interpersonal relationships, and substance abuse.

While sometimes the symptoms of TBI are temporary, in other instances TBI causes permanent disability. A victim of intimate-partner violence may suffer a TBI without knowing it if she had no severe trauma or obvious symptoms at first, or if she did not lose consciousness. The consequences of TBI can change a woman’s life forever, impairing her daily functioning, and causing her to be labelled as “difficult,” “mentally ill,” “overdramatic,” or “drunk.”She may struggle to hold a job and may require more effort to care for her children. The symptoms of TBI may even make it more difficult for her to leave the abusive relationship by impairing her ability to assess danger, make safety plans, live independently, access services, navigate the criminal justice system, or live in a women’s shelter.In many cases of IPV, head injuries occur on numerous occasions, sometimes without time to heal between injuries. Athletes and military personnel who have experienced “multiple mild TBIs” – although perhaps with an opportunity to heal between injuries – have been studied at length, and such cumulative damage has been found to be particularly dangerous (e.g., associated with depression, suicidal thoughts, and Alzheimer’s-like symptoms).Individuals who experience recurrent brain trauma from repeated blows to the head can develop a neurological condition called Chronic Traumatic Encephalopathy (CTE), historically referred to as dementia pugilistica. Symptoms include impaired cognition, confusion, psychosis, motor dysfunction, and behavioural change. CTE can emerge several years after brain trauma has occurred. Research on this condition originally focused on boxers, and more recently on a wider range of athletes (e.g., American football and hockey players), as well as military personnel who may sustain repeated blows to the head. An autopsy examination of a physically- abused woman who suffered dementia-like symptoms revealed that her brain pathology resembled that of a boxer with dementia pugilistica.In fact, much of what is known about recurrent TBI has been discovered through research on these groups of individuals (namely, athletes such as boxers and football players, as well as individuals who have served in the military) who are prone to head injuries. Despite its prevalence, research on TBI specifically related to IPV is quite limited. Eve Valera, director of the Cerebellar Psychiatric Research Laboratory at the MGH Martinos Center for Biomedical Imaging and an assistant professor at Harvard Medical School, is one researcher who is trying to change that.Dr. Valera, along with her colleague Aaron Kucyi, conducted the first study to examine the effect of TBIs on the brains of women who had been in abusive relationships. The study involved 20 participants who had experienced IPV-related traumatic brain injuries, recruited mostly from women’s shelters. Using resting-state function magnetic resonance imaging (MRI), the researchers found that the severity (number and frequency) of TBIs was associated with reduced interaction between two areas of the brain essential for everyday functioning. Further, the less interaction that there was between those two areas of the brain, the worse participants performed on memory and learning tasks – evidence of impaired cognitive functioning. Their findings were published in the October 2016 issue of Brain Imaging and Behavior.“We hope that our research will help increase awareness of how common it is for women who have suffered from intimate-partner violence to have traumatic brain injuries, and encourage emergency service workers such as police and paramedics to watch closely for these injuries, which can easily be missed,” explained Dr. Valera. “Beyond that, we hope our work helps counsellors and advocates who work with abused women understand that TBIs can impair the efforts of these women to seek help or leave the abusive relationship.”“Our research is so important because these women are unique when it comes to their traumatic brain injuries,” Dr. Valera continued.“They sustain their injuries in often brutal and recurrent ways that are different from what athletes and military personnel experience. So, to really understand the consequences of their unique type of TBIs, we can’t just extrapolate from what we know about other patient populations. The injuries and their consequences just aren’t comparable.”Women experiencing IPV-related TBIs struggle to recover quickly or properly for a variety of reasons. First, their TBIs are typically unacknowledged, which means that they do not receive any treatment or rest to recover. Additionally, their TBIs are often repetitive, and frequently occur in the context of other bodily injuries, extreme psychological stress, and adverse psychosocial circumstances — all of which, collectively, slow down the rate of recovery.To better understand the unique nature of IPV-related TBIs, Dr. Valera and her colleagues have recently designed a new study that will involve a larger group of women and use a wider array of imaging techniques, as well as serum/blood measures. This larger study will allow her to investigate many questions that could not be fully addressed in the smaller study already completed. “We want to learn as much as possible about the consequences of repetitive mild traumatic brain injuries in women who’ve experienced intimate-partner violence so that we can recommend the most effective interventions to help these women,” said Dr. Valera.The new study will commence as soon as Dr. Valera and her colleagues are able to secure funding to support the research. Although she is currently seeking government funding, she is also open to other sources that may be accessible in a shorter timeframe. “Philanthropic support would be extremely helpful to get the project up and running quickly,” Dr. Valera explained. “There is quite a bit of funding that goes to support research on TBIs in NFL football players, and Iraq and Afghanistan military personnel but almost none that I know of to support IPV-related TBIs. This seems ironic since the number of women likely being affected by TBIs via intimate-partner violence dwarfs the combined number of people affected in these other groups. Clearly, this work is critically needed, and it’s needed now.”Source: MIND OVER MATTER V6