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March Is Traumatic Brain Injury Awareness Month

outline of brain with clouds of pink and purple surrounding it with white text reading "March is Traumatic Brain Injury Awareness Month"

The National Indigenous Women’s Resource Center (NIWRC) and our STTARS Indigenous Safe Housing Center recognize March as Traumatic Brain Injury Awareness Month. Traumatic brain injuries (TBI) are commonly seen, discussed, and researched among combat veterans, football players, and other athletes. Yet, it is estimated that the number of women who have experienced TBI secondary to domestic violence is 11–12 times greater than those experienced by military personnel and athletes combined.[1] Given these disparate rates, the lack of education among health professionals, the criminal justice system, and even amongst domestic violence advocates of traumatic brain injuries of domestic violence survivors is devastating. 

Many survivors have multiple, unhealed, undiagnosed, or misdiagnosed TBIs, resulting in revictimization, lack of access to appropriate, integral services, and intensification of emotional, mental, and physical trauma. NIWRC and STTARS encourage everyone to take the opportunity this month to learn about TBIs’ intersection with domestic violence and ways to identify possible TBIs. Staying informed about resources to support survivors with TBIs should be commonplace within our field. Basic information and resources are provided below to assist this critical learning journey.

 

What is a traumatic brain injury?  

A Traumatic Brain Injury (TBI) is an injury to the brain caused by physical trauma resulting from, but not limited to, incidents involving motor vehicles, sporting events, falls, and physical assaults.

A traumatic brain injury (TBI) is defined as a specific type of damage to the brain that is caused by external physical force and is not present at birth or degenerative. A blow (or blows) to the head, shaking of the brain, loss of oxygen (anoxia), colliding with a stationary object, and exposure to blasts can cause a TBI. Based on this definition, the use of physical force by an intimate partner during incidents of domestic violence can cause traumatic brain injury, as abusive partners often cause injury to a victim’s head, neck (including strangulation), and face. In one study, 30% of domestic violence survivors reported a loss of consciousness at least once, and 67% reported residual problems that were potentially head-injury related.[2]

Domestic violence can lead to TBI through aggressive shaking, strangulation, a blow to the head (with a fist or heavy object), and falling/being thrown to the floor.[3]

While victims of intimate partner violence (IPV) are primarily adult women, both adult men and children can be victims of the severe physical violence that causes these injuries.

Unfortunately, the correlation between domestic violence (DV)/intimate partner violence and TBI is still not widely included in data and statistics.

A survivor of DV or IPV may sustain a TBI without their knowledge, especially if there are no obvious signs of trauma or other TBI-related symptoms. Many individuals may not receive medical care or intervention, which can dramatically increase the odds of recurrent TBIs. Too often, TBIs are ignored or misdiagnosed as a mental health issue, resulting in revictimization and more severe, long-term, and even permanent neurological damage. 

TBI often goes undiagnosed amongst domestic violence survivors. One reason for this is that domestic violence survivors who also have a TBI may exhibit symptoms that could resemble those of a mental illness, such as depression, anxiety, tension, and inability to adapt to changing situations. Additionally, DV/TBI survivors may appear to have behavioral issues, including problems with keeping appointments, following through, or completing tasks that require multiple steps.[4]

Some common causes of invisible head injuries among DV or IPV victims: 

  • Objects striking the head or neck; 
  • Being pushed against a wall or other surface; 
  • Being pushed down a flight of stairs; 
  • Violent physical shaking; and
  • Strangulation.


A TBI can impair cognition, language, memory, attention span, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual, and motor abilities, psychosocial behavior, physical functions, and information processing. 

A TBI can make it more difficult for a victim of DV or IPV to leave their abuser, and they may lack the ability to recognize or assess danger and respond to that danger. 

Some may not even realize they are experiencing issues related to a TBI because many of the associated symptoms are common in everyday life. The most widely reported TBI-related symptoms are headaches, dizziness, nausea, ringing in the ears, vision problems, severe brain fatigue, memory issues, anxiety, depression, and impairments in social communication.


This March, we invite you to learn more about TBI:

  • Attend: 
  • STTARS Hosts: Hidden in Plain Sight: The Intersection of Brain Injury, Strangulation, Gender-Based Violence, Housing Insecurity, and Homelessness
    Wednesday, March 13, 2024, 1 - 2:30 p.m. MST
    Gender-based violence often involves physical violence targeted at the head, neck, and face—through blows to the head or strangulation. Though this has been common knowledge for decades, brain injuries caused by violence are unacknowledged, rarely identified, and rarely immediately treated. Both survivors of violence and professionals who work with them have been largely unaware of brain injury as a significant consequence of violence. Brain injuries can cause physical, emotional, and cognitive consequences that can impact every area of a survivor’s life—including their ability to successfully access and participate in services, maintain employment, secure and sustain housing, and meet self-sufficiency goals. This webinar will introduce CARE (Connect, Acknowledge, Respond, Evaluate), Ohio’s evidence-based framework developed by the Ohio Domestic Violence Network and The Ohio State University. CARE is a brain injury-aware, trauma-informed approach focusing on accessibility and accommodations with practical, hands-on, free tools, strategies, and resources to support your work.
    Register here for this STTARS Webinar.
  • Watch: Traumatic Brain Injury and DV- What are the connections?
  • Read / Download: Traumatic Brain Injury and Battering booklet from the NIWRC Resource Library.

Resources:

Research Sources: 

  • Special Report from the CDC: Traumatic brain injury-related hospitalizations and deaths among American Indians and Alaska Natives — United States, 2008–2014; Alexis B. Peterson, Kelly Sarmiento, Likang Xu, Tadesse Haileyesus; Journal of Safety Research 71 (2019) 315–318
  • American Indians/Native Alaskans With Traumatic Brain Injury: Whitfield, Harold Wayne; Lloyd, Rosalind
  • Rehabilitation Counseling Bulletin; Apr 2008; 51, 3; Research Library pg. 190
  • Population-Level Epidemiology of Concussion Concurrent with Domestic Violence in Arizona, USA Rachel K. Rowe, Sean M. Murphy, Hirsch Handmaker, and Jonathan Lifshitz;  Journal of Neurotrauma 38:2301–2310 (August 15, 2021)
  1. Lifshitz, J.; Crabtree-Nelson, S.; Kozlowski, D.A. Traumatic Brain Injury in Victims of Domestic Violence. J. Aggress. Maltreatment Trauma 2019, 28, 655–659.
  2. Corrigan, Wolfe, Mysiw, Jackson & Bogner, 2003.
  3. Ralston, B.; Rable, J.; Larson, T.; Handmaker, H.; Lifshitz, J. Forensic Nursing Examination to Screen for Traumatic Brain Injury following Intimate Partner Violence. J. Aggress. Maltreatment Trauma 2019, 28, 732–743.
  4. Traumatic Brain Injury and DV: Understanding the Intersections - vawnet.org.