BY: ALANA TIBBLES
Sports injuries are often the first thing that comes to mind when people think about brain injury. A close second, motor vehicle collisions.
As a brain injury researcher, I am ashamed to say I hadn’t considered another population of people which are at high risk of a brain injury: those who have experienced intimate partner violence (IPV).
It wasn’t until the Brain Injury Canada conference in September 2016 that I started to hear about research relating to women who had experienced brain injuries as a result of IPV.
I’d like to take a moment here to note that persons of any gender may be either perpetrators of or victims of IPV. The majority of the studies I will be summarizing are regarding female survivors of IPV perpetrated by males. As more research becomes available we may gain further insight into other relationship dynamics.
Survivors of IPV
Anyone who has experienced injuries to the head and/or neck (including being shaken), should be assessed for a brain injury.
This includes people who have experienced strangulation, since brain injury can occur from lack of oxygen to the brain. People who are living with brain injury are at an increased risk of depression or anxiety and tend to experience frequent headaches, fatigue and dizziness. Many experience cognitive issues such as impaired memory and concentration as well as difficulty planning and making decisions.
Understanding these symptoms are the effects of the brain injury, and getting help dealing with them, may help a survivor make decisions regarding their living situation and plan to gain independence from a violent partner. It may also validate their experiences, knowing there are real health issues going on, and they are not ‘just making things up.’
The good news is that research is starting to focus specifically on how females recover from brain injuries and how brain injuries from IPV and other forms of assault may be different from those sustained in other ways (such as a car accident).
As such, survivors of IPV who have sustained a brain injury (and feel they are able to so) may wish to participate in research in order to help further our findings with the goal of increasing the information base for other survivors.
Social Support is Crucial
Social isolation and loss of relationships are too common after brain injury, and those who have strong social support networks in place post ABI are more likely to have better outcomes than those who do not.
A reliable support system may be even more important for women with a brain injury as the result of intimate partner violence. Not only will they be dealing with the effects of a brain injury, but they may be leaving a violent partner, and / or dealing with the emotional and psychological impacts of having survived intimate partner violence.
Women may require financial support, legal information and a safe place to stay (with their children, if applicable) and temporary or ongoing caregiving.
While it is important to screen for brain injuries from IPV, it is complicated by issues regarding how safe a patient feels disclosing IPV. Some patients may fear retaliation if their partner finds out they’ve talked about the abuse and some may fear for the safety and custody of their children.
Survivors of brain injury from assault (including IPV) are much more likely to suffer from post-traumatic stress disorder (PTSD) and often have lasting psychological trauma. There is now an ongoing research project with the aim of introducing a toolkit for frontline workers serving women with IPV, to improve the experiences of both the women and the workers when discussing and addressing this sensitive topic.
Research findings from other studies often help direct future research. I would caution that while past studies can be helpful, the literature may be missing more than we realize when it comes to survivors of IPV, for the following reasons.
Some survivors may choose not to participate in research or discuss their experiences. Depending on how risky they feel disclosing the IPV may be, survivors may not be seeking out medical assistance after injuries or they may not be forthcoming with details about how it happened.
Loss of follow-ups
If survivors seek medical attention, they may not return for follow-ups depending on whether or not they are trying to avoid alerting their partner about their medical visits.
Lack of details about injury
Unlike traumatic brain injuries from sports injuries or vehicular accidents where there are witnesses or first responders to provide information about the incident, survivors of IPV may have to rely solely on their own memories of the event (which can be difficult for anyone with a brain injury). They may not know how long they were unconscious or how many blows to the head they have sustained. Having accurate details about an injury can be helpful for research, especially when it comes to understanding post-injury recovery patterns and outcomes. While definitely not the fault of the survivor, having missing data may make it difficult to reach conclusions about the recovery of this population.
Incomplete representation of population
A study by the World Health Organization (WHO) found there are different societal standards for what constitutes IPV in countries where women have fewer rights. Therefore IPV may be underreported in other cultures or countries where males are viewed as having the right to punish their wives. Ideally there should also be more representation in the research from other relationship dynamics, such as those with trans partners, same-sex relationships, relationships where the female is the perpetrator and the male is the victim and relationships where both partners are violent.
Now, this is not to discount the value of research being done in this area. It is a historically under-represented group in the brain injury literature and researchers are now making great strides to shed light on how brain injury may differ for this population. It is hopeful that with continued research, we can tailor rehabilitation and support for this group with the aim of improving their recovery and quality of life.
Alana is a researcher who recently completed her Master of Science degree at the Rehabilitation Sciences Institute at University of Toronto. She has been studying brain injury for several years in topics including but not limited to: substance misuse, recovery, neurofeedback, sleep, and hospital-to-school transitions. Her aim for her blog posts is to continue to learn about and promote learning about brain injury research, hopefully making it easier for interested persons (brain injury survivors, caregivers, loved ones, clinicians etc.) to access relevant information.