The often-overlooked connection between traumatic brain injury and domestic violence

Traumatic brain injury, long linked to military service and sports, has another more insidious source: domestic violence, also known as intimate partner violence. In fact, the number of people who sustain traumatic brain injuries during domestic violence episodes may outstrip their combined incidence in athletes and military personnel.

Unfortunately, this connection isn’t often discussed.

High-profile cases, like the ongoing defamation trial involving Amber Heard and Johnny Depp or the killing of Gabby Petito, among other incidents, shine the spotlight now and then on domestic violence, but it largely goes under the radar. It can be physical, emotional, and psychological abuse, and even coercive behavior. Physical domestic violence can lead to traumatic brain injury, a significant public health issue linked to high long-term risk of disability or death. It occurs when the brain is directly or indirectly damaged, and can range from mild to severe.

In the United States, an estimated one in four women and one in ten men will experience some form of domestic violence in their lifetimes. It can happen to anyone, regardless of race, ethnicity, socioeconomic status, gender identity, sexual orientation, ability, or age. Although many studies of domestic violence center around women in heterosexual relationships, due to its higher prevalence in that group, men, nonbinary individuals, and queer people are also be affected by domestic violence.

Even mild cases of traumatic brain injury, like concussion, can impart significant and long-lasting impairments. A single incident in which traumatic brain injury occurs can result in long-term cognitive damage, or even increase the likelihood that a person who experiences domestic violence becomes an abuser. Repeated physical abuse can accelerate the development of neurodegenerative diseases such as Alzheimer’s or Parkinson’s and may even result in chronic traumatic encephalopathy, a fatal form of progressive brain degeneration that can only be diagnosed after death.

Traumatic brain injury should be of high concern if physical domestic violence is suspected, as the head, neck, and face are likely targets for physical abuse. Regardless of severity, a brain injury in the context of domestic violence has been linked to poor health outcomes for both individuals and future generations.

What can be done?

Linking traumatic brain injury and domestic violence is difficult. Due to stigma and perceived safety, many people cannot disclose they are experiencing domestic violence, and those with a traumatic brain injury do not always seek medical attention.

There are challenges to addressing traumatic brain injury even when domestic violence is known or suspected. Not all domestic violence screening tools mention traumatic brain injury, and those that do aren’t consistently used. Meanwhile, many screening tools specific for traumatic brain injury are not explicitly related to domestic violence and, unless they are developed using a trauma-informed approach, could lead to more harm. In addition, symptoms of traumatic brain injury, like slurring words or unsteadiness, may be mistaken for alcohol or drug use, and thus prevent individuals from receiving appropriate and timely treatment.

Much more research needs to be done, not only to gain a true understanding of how frequently traumatic brain injury occurs in the context of intimate partner violence but to identify prevention methods that might be more effective for specific affected populations. Both areas of research are particularly gendered and should be more inclusive: domestic violence research is often centered around people who identify as women and are in heterosexual relationships, while much of traumatic brain injury research focuses on those who identify as men. This may neglect people who have been historically excluded due to their race, sexual orientation, or gender identity, and could lead to difficulties in providing both appropriate treatment and prevention for the people who may be affected.

As research on this relationship trickles in, what has been found is extremely troubling. The Barrow Neurological Institute in Phoenix opened a center in 2012 not only to look specifically at traumatic brain injuries among domestic violence survivors but also to connect them with treatment and assistance in navigating health systems that can be challenging even on the best of days, regardless of a person’s health and resources. Although one published study from this center is small, it hints at what may emerge given the time and effort of research on a much larger scale. Of the 115 patients in this retrospective study, 92% of those who reported one or more brain injuries related to domestic violence reported “too many injuries to quantify.”

Finding proper funding to look into or address the connection between traumatic brain injury and domestic violence can be tricky. A quick scan of the 2022 reauthorization of the Violence Against Women Act introduced to the Senate shows no mention of traumatic brain injury in more than 300 pages. (It’s also an unreliable source of funding, as reauthorization has repeatedly stalled since its inception in 1994. Reauthorization through 2027 happened this year, but only after being grouped into the Consolidated Appropriations Act of 2022.) Funding from the federal Centers for Disease Control and Prevention (CDC) has allowed some states to look at this intersection: Nebraska, for example, used block grant funding from the CDC to call attention to improved domestic violence screening that addresses traumatic brain injury. According to its 2020 report, of the 255 brain injury screenings completed at domestic violence shelters in Nebraska during the four-year funding period, 61.2% of women were positive for a brain injury.

While the Protecting Survivors from Traumatic Brain Injury Act, introduced in the Senate earlier this year, seeks to collect better data on how often traumatic brain injury caused by domestic violence occurs, it has not progressed further. Without consistent data, the full extent of the problem, and what to do about it, remains unknown.

Domestic violence will not end overnight, yet progress can be made in preventing it, in helping those who are experiencing it, and in providing continued support for those who have broken free of it. While domestic violence must also be recognized beyond just physical abuse, the chances of an attack causing traumatic brain injury deserves more attention. The connection between the two may be obvious in retrospect, but until these injuries are consistently screened for in domestic violence cases and also more regularly discussed, they cannot be addressed as they need to be.

Cecille Joan Avila is a senior policy analyst at Boston University School of Public Health.

The National Domestic Violence Hotline is available 24 hours a day, seven days a week 800-799-7233.