Intimate partner violence & brain injury

Intimate partner violence (IPV) is physical, emotional, and verbal abuse by a significant other or intimate partner. IPV is a global public health issue, and it can happen to anyone.

According to the World Health Organization, one in three women will experience intimate partner violence in her lifetime. Most may also suffer one or more brain injuries as a result, since IPV often involves blows to the face, head, and neck.  Brain injury in IPV can also happen from a loss of oxygen to the brain caused by strangulation. Often times, these injuries result from repetitive episodes of IPV occurring over many months or years.

While there’s traditionally been a strong focus on sports-related concussion, brain injuries caused by intimate partner violence receive much less attention.

Statistics about intimate partner violence

  • In Canada, every two and a half days, a woman or girl is killed violently, usually by a male partner or family member [1], and each night, more than 6,000 women and children find refuge from gender-based violence in shelters [2]
  • 35-80% of women affected by IPV experience symptoms of traumatic brain injury [3]
  • Up to 92% of IPV incidents involve hits to the head and face, and strangulation [4]
  • Strangulation is one of the most dangerous forms of IPV, increasing the risk of death in following assaults [5]
  • Some victims can die weeks after being strangled because of the underlying brain damage, even if there is no visible injury [6]

Statistical information about intimate partner violence (IPV) as collected and reported by the Government of Canada.

An invisible and underreported issue

Intimate partner violence (IPV) tends to happen behind closed doors, and there may not be signs obvious to people outside the household. Brain injury is often just as invisible, causing lifelong symptoms and challenges, but with no outward signs of disability. Clinicians may also not ask about intimate partner violence in their practice.

IPV is also extremely underreported. This happens for a variety of reasons, including:

  • Shame and stigma associated with IPV;
  • Fear of not being believed;
  • Desire to keep the family together, and;
  • A lack of recognition as to what constitutes abuse, causing victims to think it’s normal

Many women who have experienced a brain injury from IPV aren’t even aware that the challenges they face are related to a brain injury, which makes it much harder to receive a diagnosis or timely treatment. Also, research in Canada and elsewhere has shown that front line service providers lack knowledge and training/awareness about brain injury [7]. It’s a difficult, terrifying situation. Support from friends, family, and local resources can make all the difference, although in some cases, women may lack family support..

Effects of intimate partner violence (IPV) and brain injury

Intimate partner violence (IPV) and brain injury can each cause significant, long-term challenges, but when someone experiences both, the effects may intensify, and become more complex.

IPV is linked to lasting psychological trauma. Emotional disturbances such as complex post-traumatic stress disorder (PTSD), anxiety, and depression are common.

Brain injury survivors can suffer some of the same issues, along with a range of cognitive, physical and behavioural changes.

Effects of brain injury can include:

  • Difficulty communicating
  • Memory problems
  • Reduced judgement and problem-solving skills
  • Shortened attention span and inability to concentrate
  • Inability to initiate tasks or activities
  • Headaches
  • Fatigue

This is a small example of the kinds of effects people with brain injury can experience. And it can further be compounded by the cause of the brain injury (or injuries). In a study of female veterans, results found that women with persistent IPV-related TBI symptoms were nearly 6 times more likely to have probable PTSD compared those with no IPV-related TBI history [8].

Both brain injury and IPV can have an impact on activities of daily living (ADLs), parenting, and court appointments/proceedings. This can be discouraging and scary, particularly for women who are single parents or engaged in custody negotiations. The more survivors; family members and friends; health care workers; and other service providers (such as lawyers and social workers) understand the effects of brain injury, the more appropriate support can be provided. 

Unfortunately, survivors of IPV and care providers commonly mistake brain injury symptoms for the emotional distress brought on by the abuse [9]. That’s why research and educational resources on brain injury and IPV are so important.

Increased risk of intimate partner violence (IPV) towards people with disabilities

Overall, women and men with disabilities have a higher risk of abuse, including from intimate partners.

According to Statistics Canada, “Canadians with a disability were more likely to be victimized in their own home, as close to 30% of violent incidents against a person with a disability occurred in their private residence.” [10]

The study dives deeper, indicating that 23% of women with a disability “experienced emotional, financial, physical or sexual violence or abuse committed by a current or former partner” in a 5-year period. This is 2 times higher than the rates of those without a disability. Women with disabilities were also more likely to experience physical violence leading to injury [11].

For individuals who have a disability (brain injury or otherwise), the increased risk of physical violence can lead to further or new injury. This could lead to an even higher risk of violence – and the cycle goes on.

This is yet another indicator that supports for women with brain injury and experiencing IPV are essential.

Assessment by a physician

If you, or someone you know, have been hit on the head, face, or neck, or have been choked or strangled, it is important to access medical care as soon as possible, and request that health care providers look for indications of brain injury. If you are not able to see a medical professional, speak to a social worker, support worker at a shelter or a brain injury support worker.

The earlier a brain injury is diagnosed, the earlier a treatment plan can be put in place. When you do meet with a doctor, it’s important to tell them if you have ever been struck on the head or neck. 

Signs of a recent or more serious injury include:

  • Loss of consciousness
  • Neck pain
  • Seizure
  • Vision changes
  • Weakness or feelings of tingling or burning in the arms or legs [12]

Additional signs of brain injury may include, but are not limited to:

  • Balance problems
  • Headaches
  • Emotional lability
  • Fatigue
  • Memory issues
  • Sleep disturbances
  • Trouble speaking

Treatment of brain injury

Treatment for brain injury and its effects can be challenging not only because it is often misdiagnosed, but individuals who are in temporary shelters or transitional housing may not be able to access the supports and services they need for effective rehabilitation. Rehabilitation is a long-term process that involves regular appointments with various therapists and checkups with physicians.

It’s important for the person’s health and wellbeing that they access appropriate supports and services available to help them with their brain injury recovery. A good place to start is at your local brain injury association.

Support for survivors 

Resources