Traumatic Brain Injury and Domestic Violence
What is the connection between domestic violence and brain injury?
A cause of brain injury that has been under-reported and under-researched is domestic violence. Domestic violence, also known as intimate partner violence, is a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner. Domestic violence can be physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person. Domestic violence can happen to anyone - it affects people of all ages, genders, races, and socioeconomic classes. Traumatic brain injury (TBI) is common in people who are victims of domestic violence because of the high frequency of head and neck injuries inflicted through abuse. Brain injuries are often sustained over many years and lead to lasting physical, behavioral, and cognitive consequences.
How big is the problem?
Current data on the intersection between domestic violence and TBI is limited in part because little research has been done on this population and because many instances of abuse go unreported by victims. The research we do have consistently indicates widespread problems:
Why is the connection to TBI and domestic violence often overlooked?
In domestic violence situations, due to emotional and physical trauma, survivors often experience depression, anxiety, tension and/or inability to adapt to changing situations. Survivors may also appear to have behavioral issues, including problems with keeping appointments, following through, or completing tasks that require multiple steps. Sometimes these problems are the direct result of a brain injury. Determining whether these symptoms and behaviors are due to a TBI or the result of emotional trauma, or BOTH, can be difficult.
The intersection of TBI and domestic violence is also complicated by the fact that violence is not only a cause, but a consequence of TBI. Specifically, TBI-related cognitive and behavioral problems can also result in aggressive behavior that leads to perpetration of violence, or a lack of insight and judgment, and resulting vulnerability, that can lead to victimization. While a TBI can be a contributing factor to aggressive behavior, it does not cause or excuse patterns of abuse.
Because domestic violence is a pattern of abuse, victims are typically exposed to repeated instances of violence, which includes traumatic brain injuries. The effects of repeated brain injury are cumulative and not unlike those experienced by athletes who have had multiple concussions.
To treat the whole person and not just one symptom or behavior, service providers across health and social services need more education, training, and resources to recognize that the pattern of symptoms following abuse may include a brain injury.
What are some noticeable signs of (mild/moderate) TBI and domestic violence?
Remember, sometimes there are no visible or obvious signs of TBI or domestic violence. Signs of TBI and domestic violence can include:
- Loss of consciousness for a few seconds to a few minutes
- No loss of consciousness, but a state of being dazed, confused or disoriented
- Nausea or vomiting
- Fatigue or drowsiness
- Problems with speech
- Difficulty sleeping
- Sleeping more than usual
- Dizziness or loss of balance
- Memory or concentration problems
- Mood changes or mood swings
- Feeling depressed or anxious
- Substance abuse
- Suicide attempts
Service providers should keep in mind that brain injury can make it harder for a victim of domestic violence to:
- Assess danger and defend against assaults.
- Make and remember safety plans.
- Go to school or hold a job (increasing financial dependency on the abuser).
- Leave an abusive partner
- Access services
- Adapt to living in a shelter/residential program for victims of violence. The person may become stressed, anxious and confused or disruptive, or have trouble understanding or remembering shelter procedures.
- The signs and behaviors associated with TBI and domestic violence can look very similar – the impact of physical and emotional violence on the body and mind is complex. That’s why practicing trauma-informed care when interacting with survivors is key.
Where can I get help?
Brain Injuries can be life threatening.
If you have been injured, Seek medical help immediately.
Dial 911 or seek emergency care.
Virginia Sexual and Domestic Violence Action Alliance: 800.838.8238
 U.S. Department of Justice
 2017 Annual Report Domestic and Sexual Violence in Virginia, Virginia Office of Attorney General. http://www.oag.state.va.us/files/2017-DV-SV-Annual-Report.pdf
 Assessment and Treatment of Brain Injury in Women Impacted by Intimate Partner Violence and Post-Traumatic Stress Disorder, The Professional Counselor. Trish J. Smith, Courtney M. Holmes. 2018.
 Breaking the Silence: Violence as a Cause and a Consequence of Traumatic Brain Injury. Brain Injury Professional Magazine. Jean Langlois, ScD, MPH
 Domestic violence often leads to traumatic brain injury. Dr. Ann Marie Warren. http://scrubbing.in/domestic-violence-often-leads-traumatic-brain-injury/
 National Coalition Against Domestic Violence
 Breaking the Silence: Violence as a Cause and a Consequence of Traumatic Brain Injury. Jean Langlois, ScD, MPH, Brain Injury Professional Magazine
 New York State Office for the Prevention of Domestic Violence. Domestic Abuse and Traumatic Brain Injury Information Guide