Thousands of athletes returned to high school, college and professional football fields this fall, renewing discussions about the risk for and potentially devastating consequences of traumatic brain injuries (TBI) in contact sports. However, an even larger population of people affected by TBI will continue to go unrecognized and undiagnosed: women who are victims of domestic violence.
One in seven women has been injured by an intimate partner. Among women experiencing domestic violence, a handful of research teams across the U.S. have now documented alarming rates of head injuries, with studies suggesting that as many as 90 percent of women seeking emergency or shelter services for domestic violence report have had them.
Traumatic brain injuries occur when a blow to the head interrupts normal brain functioning. Those disruptions can include loss of consciousness, memory problems for the injury, muscle weakness and blurred vision. TBIs can range from mild to moderate or severe; most people experiencing mild TBIs won’t have lasting symptoms. However, more serious and repeated TBIs can lead to serious and costly problems involving physical health; attention and memory; depression; suicidality; and even dementing diseases later in life.
Because of the serious problems linked with repeated TBIs, researchers and journalists have focused on groups likely to experience multiple head injuries, such as athletes playing contact sports and combat veterans. Like football players, victims of domestic violence often suffer from brain trauma—but with much less attention.
In research published by one of us (DePrince) with Kelly Gagnon, we interviewed more than 200 Colorado women following police reports of domestic violence. The incidents varied in severity; some cases involved violations of protection orders where there were no physical injuries, while others involved serious physical injury. More than one in 10 women described being hit in the head or losing consciousness during the most recent domestic violence incident. That number went up to 20 percent when we included domestic violence incidents that occurred in the previous six months.
Lifetime rates were even higher: 80 percent of women reported a head injury in their lifetimes. More than half of those met screening criteria for a mild TBI because the head injury involved a change in consciousness or a period of being dazed and confused.
Domestic violence did not cause all of those head injuries. Some were caused by child abuse or other kinds of assault. Others were the result of accidents. This raises the intriguing question of whether persistent TBI symptoms, regardless of their cause, increase women’s risk of being victimized. For example, abusers might target women experiencing problems with attention, memory or depressive thinking that make them vulnerable.
We also don’t know much about the frequency of head injuries among women in chronically violent relationships. Like football players, some women may be exposed to regular blows to the head, increasing their risk for persistent cognitive and emotional problems as well as dementing diseases down the road.
Even in the short term, TBI-related symptoms can have serious, real-world consequences for women trying to get help after domestic violence. These women commonly need help from multiple sources, including police; legal services; and medical and counseling professionals. Attention and memory problems, as well as depression symptoms, can make it difficult or impossible to figure out whom to contact and where to go, and also to schedule visits and remember complex instructions.
To answer these crucial questions of how TBI increases the risk of being abused, and what short- or long-term consequences this might have, we have to start paying attention to domestic violence and TBI to the same degree that we have attended to TBI in contact sports and combat. A 2015 report to Congress by the Centers for Disease Control and Prevention titled “Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation,” for example, did not even mention domestic violence.
Researchers, policymakers, and the public have been slow to consider TBI in the context of domestic violence. Women surviving domestic violence need us to act quickly to understand the scope of this public health problem and to design effective interventions. Their lives depend on it.