Intimate Partner Violence and Brain Injury

Intimate partner violence has been on the rise with the COVID-19 pandemic. One in four women and one in ten men experience violence in an intimate relationship. A common result of this violence is, unfortunately, traumatic brain injury.

Until recently, intimate partner violence research has focused on psychological and social trauma rather than on traumatic brain injury. Yet a 2018 study by Jacquelyn Campbell found that 50% of 901 women who experienced violence in an intimate relationship screened positive for a probable brain trauma. A 2021 article by Linda Oakley suggests that expanding screening and education on intimate partner violence and its connection to brain injury can prevent long term negative effects.

Yet only 1 out of 10 physicians screened their patients for partner violence. Physicians cite a fear of opening “pandora’s box” when asking about domestic violence, with patients announcing problems the providers do not know how to help. A review of screening practices for intimate partner violence found a lack of consensus from clinicians about who in a care team should screen patients, and how screening should be done. Even when physicians screen for violence, currently there is not a standard screening for brain injury related to intimate partner violence. A CDC sponsored study found that with systematic screening, rates of traumatic brain injury exceed expectations.

Repeated and untreated head injury due to domestic violence is associated with higher rates of anxiety, depression, and post-traumatic stress disorder. Research has also begun to show increased risk for “second impact syndrome” among victims of this violence. This occurs when someone receives subsequent head injuries before resolution of the first. The repeat injuries can culminate in chronic traumatic encephalopathy, with severe behavioral consequences. Preventing repeat injury is key to preventing long term damage.

Underestimates of brain injury occur in all communities. A self-screening questionnaire that can be used throughout an individual’s lifetime and applied when a person is asymptomatic can assess and document a history of brain injury. The CDC study recommends screening for all people at regular checkups with a primary care provider, which they call systematic screening. Systematic screening allows for identification of prior brain injury to prevent repeat injury. This system is ideal for identifying brain injuries from intimate partner violence even in individuals who do not appear to be at risk.

Implementing a consistent screening for partner violence, systematic screening for brain injury, or a screening specific to brain injury following partner violence could improve identification of those at risk or already experiencing symptoms.

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