Undiagnosed Brain Injuries Common in Survivors

Traumatic brain injury has gotten a lot of attention in recent years as professional football players have come forward about the devastating effects of sustaining repeated concussions. But what about domestic violence survivors? They sustain strikes and blows to their heads, too, and they don’t get to wear helmets.

A study by The Ohio State University and the Ohio Domestic Violence Network (ODVN) looked at the prevalence of traumatic brain injuries among survivors and the effects of such injuries. What they found was staggering. Out of the 49 study participants who reported having been physically abused by a partner:

• 83 percent said they’d been strangled at least once.
• 81 percent said they’d suffered at least one head injury.
• Half said they’d been hit in the head “too many times to remember.” 
• More than half had been choked or strangled “a few times.”
• One in five said they’d been strangled “too many times to remember.”

Of course, there’s no team doctor running from the sidelines to help domestic violence survivors when they’re injured. And that means many times, their brain injuries go undiagnosed and untreated. 

Serious Side Effects

Head injuries and strangulation can result in death if severe enough. But survivors shouldn’t assume they’re in the clear if they survive the incident. Brain injuries can lead to serious and long-term neurological problems that survivors might not know to attribute to the injury. And the effects are cumulative, meaning they build each time a head injury occurs. 

Second impact syndrome is when another brain injury occurs before the first has healed. It is extra dangerous given that a survivor may not exhibit serious symptoms—he or she may not even lose consciousness—but the second impact could cause extreme swelling in the brain, increasing the risk of death even if the second injury was far less severe. 

Side effects of traumatic brain injury and strangulation include cognitive (thinking), physical and emotional problems, including:

• Memory problems
• Difficulty concentrating
• Trouble understanding
• Problems with balance
• Trouble seeing or hearing
• Being very sensitive to noises or light
• Impulsivity
• Anxiety
• Depression 
• Hopelessness 
• Difficulty controlling emotions

What It Means for Survivors—and Advocates

The side effects of brain injury can be quite debilitating. They even can cause survivors difficulty in accessing services. 

“In general, what we found is the survivors that we were speaking to didn’t realize the symptoms that they have could be attributed to a brain injury, and those symptoms are actually preventing them sometimes from receiving the full benefit of services from organizations they seek help from,” says Julianna Nemeth, an assistant professor of health behavior and health promotion at Ohio State and lead researcher of the study. 

For example, survivors may have trouble following the steps needed to find help or follow through with it. 

“Before the research, we expected survivors to come in and complete all the steps of their case plan, and, if staying in shelter, to be able to get along with a roommate,” says Rachel Ramirez, ODVN’s director of training. “But the very real symptoms of brain injuries could be part of the reason a survivor might not be able to access our services, our services don’t work for them or them being asked to leave our services.”

Ramirez says she hopes this knowledge will help advocates better understand the challenges survivors face and how best to help them, even if that simply means being more patient and offering more guidance through the process. 

“We want to focus on changing the way that we work with survivors who might have brain injuries so that we’re not requiring them to fit into the way that we do things, which I think sometimes programs do unintentionally,” says Emily Kulow, ODVN’s accessibility project coordinator. “And so, it’s providing the accommodations to survivors that we can while they are accessing our services. That could be anything from changing the way we are meeting with survivors or where we’re meeting with them to how they accomplish their goals while they’re working with us. So, if a survivor is not able to remember meetings, perhaps we can set up a reminder system.” 

Ohio Domestic Violence Network built an intervention called CARE to help its advocates educate survivors on head injuries and more effectively serve them. The organization has made its CARE advocacy tools available in English and Spanish on its website for advocates and survivors to access. 

Are you interested in learning more about brain injuries among domestic violence survivors? Check out “How Strangulation Affects the Brain.”