Mild TBI in family violence
Introduction
Victims of family violence have a high risk of having a mild traumatic brain injury.
Women who are victims of family violence often suffer injury to their head, neck, and face.
Many people who are victims of family violence suffer a traumatic brain injury.
Severe, obvious trauma does not have to occur for brain injury to exist. A woman can sustain a blow to the head without any loss of consciousness or apparent reason to seek medical assistance, yet display sustain a brain injury and display symptoms of TBI.
Many women suffer from a TBI unknowingly and misdiagnoses is common
Many women suffer from a TBI unknowingly and misdiagnoses is common since symptoms may not be immediately apparent and may mirror those of mental health diagnoses. In addition, subtle injuries that are not identifiable through MRIs or CT scans may still lead to cognitive symptoms.
Women who are victims of family violence are more likely to have repeated injuries to the head. As injuries accumulate, likelihood of full recovery dramatically decreases.
Women who are victims of family violence are also negotiating a very complex set of life circumstances. Having a brain injury is likely to make negotiating this even more difficult than it would otherwise be.
A domestic violence survivor living with a brain injury must negotiate a very complex set of life circumstances. The brain injury is a temporary or permanent disability that serves as a constant and inescapable reminder of her batterer and the abuse suffered. In addition to the other physical and emotional consequences of the abuse, the survivor must also integrate a new set of challenges related to the brain injury. Along with navigating the real concerns for safety, autonomy, and independence, domestic violence survivors living with a brain injury may also cope with additional employment and economic concerns related to the BI.
Consider other challenges that domestic violence survivors face, for example, child custody proceeding or criminal court testimony. Successful utilization of the justice system often requires the ability to communicate incidences of abuse from memory using detailed, sequential, rapid, clear communication. These functions may be compromised by the brain injury. These challenges may diminish the survivor’s credibility in the courtroom, and have dire outcomes to the survivor’s life.
Increased risk of ongoing harm
Abused individuals typically lack the knowledge of the long-term consequences of a brain injury and therefore do not seek specialized services. In addition service providers are often unaware of the high risk of a traumatic brain injury in victims. As a result professionals fail to link the psychodynamic issues presented by the victims and the challenges emerging from an undiagnosed brain injury. Without linking domestic violence and brain injury, they fail to recognize brain injury so are unable to refer for appropriate brain injury services and related rehabilitation services. Thus the lack of knowledge about brain injury serves to increase the likelihood of failure in intervention and rehabilitation success. In addition, once individuals experience one TBI they have an increased risk of having another TBI. Several things may happen after a TBI; the person's reaction time may be slower, judgement may be off, she may be more impulsive and inattentive to what might increase her likelihood of a second injury. The risk of repeated TBI is even greater for individuals who are victims of domestic violence since the most common target of abuse is the head, neck, and face. Repeated brain injuries increase symptoms. Each time the domestic violence victim comes into the shelter they may be a less functional as a result of a traumatic brain injury.
Ways victims of domestive violence may sustain a brain injury
For victims of domestic violence, physical assault and/or use of violence are the assumed major causes of traumatic brain injury. The following are some ways in which victims of domestic violence sustain a brain injury:
• Blow to the head with any object
• Pushed against a wall or any other solid surface
• Punched in the face or head
• Strenuous shaking of the body
• Falling and hitting your head
• Being strangled
• Near drowning
• Being shot in the face or head
Symptoms of TBI
An individual sustaining a brain injury generally experiences a period of altered mental state or a brief loss of consciousness following the blow to the head. Some of the common initial symptoms are as follows:
• Headaches
• Dizziness
• Slowed processing of information
• Forgetfulness
• Fatigue
• Sensitivity to noise and lights
Most of the symptoms will disappear after a period of time.
However for some peole the symptons don't disappear and require management.
Risk of Repeat injury
Tisk of multiple TBIs in for victims of family violence population is a primary concern.
Repeat injury to the head, face or neck can cause:
- Second Impact Syndrome, also known as Subsequent Impact Syndrome (SIS)
SIS results from:
“Acute, usually fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion that causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control”.12
Repeat Brain Injury:
- Is typical of ongoing domestic violence
- Leads to increased cognitive, physical or emotional dysfunction over time13
- Is most damaging to the cognitive domain13
What happens when there are repeated blows to the head?
- Injuries accumulate, symptoms increase, and the person become less functional with a longer healing time14
- A survivor’s risk of continued harm is increased15
The risk of repeat TBI is high for individuals who are survivors of domestic violence since the most common target of abuse is the head, face and neck.16
- After the first TBI, the risk of second injury is 3 times greater.16
- After the second TBI, the risk of a third injury is 8 times greater.16
The risk of injury may increase proportionately with assaults because several things may be happening for a survivor as a result of TBI:
- Reaction time and judgment are compromised16
- Inability to tune in adequately to surroundings or cues
- Cognitive changes that cause impulsivity16
As a result, injuries to the head may become a regular occurrence from:
- An abuser taking advantage of the power to magnify cognitive injury
- Subsequent injuries as a result of cognitive damage
Brain Injury and Perpetrators
When a person in a relationship sustains and brain injury there is a high chance that the relationship will be strained by the intense frustration with personality changes caused by the brain injury.
Although there are few studies of the prevalence of brain injury among perpetrators of family violence, the evidence available indicates that rates of brain injury are disproportionately high in perpetrators of family violence, compared with matched non-violent community samples and the general population.
Studies have found that in a relationship in which one partner has a brain injury the chances of marital aggression are increased almost sixfold.
The correlation between acquired brain injury and a propensity for domestic violence has important implications for therapy interventions. The identification of acquired brain injury in men who commit domestic violence, would allow behavioural and cognitive strategies to be taught and thereby assist with inhibiting aggressive behaviours.
Note:
Studies have found that the rate of brain injury among samples of male perpetrators of intimate partner violence is around 60 per cent, and that this is double the rate found in matched community samples.
Similarly, the rate of brain injury among a sample of mothers at risk of child maltreatment is around 36 per cent, which is more than triple the rate found in in a community sample of women the same age.
While our analysis indicates that brain injury is a risk factor for family violence, it is not inevitable that a person with a brain injury becomes a perpetrator.
