Brain injury is one of the most unrecognized consequences of domestic violence—and is perhaps far more common than people realize. According to a recent study from Barrow Neurological Institute in Phoenix, 88 percent of domestic violence survivors suffered more than one brain injury, and 81 percent reported “too many injuries to count.” Women are disproportionately affected, and new estimates suggest that as many as 20 million women each year suffer from a traumatic brain injury as a result of domestic violence.
The Centers for Disease Control and Prevention (CDC) recognize domestic violence as “…a serious, preventable public health problem that affects millions of Americans.” The health consequences of domestic violence are severe and wide-ranging, including physical injuries, reproductive complications, and psychological disorders such as depression and post-traumatic stress disorder. Additionally, survivors of domestic violence are highly at risk of displaying harmful health behaviors in the future, such as substance abuse and unhealthy diet-related habits. Despite these known public health consequences, scarce research has been committed to studying domestic violence in the realm of public health, and brain injury is largely missing from the conversation.
“…about 70 percent of people seen in the emergency room as a result of their abuse are never identified as survivors of domestic violence.”
A Research Gap and Its Consequences
In several populations, including veterans and football players, medical professionals and researchers have made major strides in prevention, diagnosis, and treatment of traumatic brain injury (TBI). Despite this progress, brain injury research in domestic violence survivors, by contrast, is egregiously lacking.
Because of the lack of understanding about the severity of abuse-related injuries—a lack that has been further complicated by the frequent conflation of the terms “intimate partner violence” (IPV) and “domestic violence” in research and advocacy—many domestic violence survivors do not receive a definitive brain injury diagnosis. Furthermore, about 70 percent of people seen in the emergency room as a result of their abuse are never identified as survivors of domestic violence. And in many cases, medical professionals are not equipped with the research and support to care for domestic violence survivors.
The result is that many survivors do not recognize they could be suffering from a brain injury. Without the proper medical care, survivors may experience cognitive impairment that impedes their ability to carry out daily tasks. Oftentimes, survivors are blamed for their cognitive impairment, not recognizing the true medical reason behind their condition. They may suffer from memory loss, severely impacting their ability to work, live independently, and make sound decisions. In some instances, survivors have lost their jobs because of their cognitive inability to work productively.
Furthermore, if survivors choose to pursue a lawsuit against their abuser, their cognitive impairment could cause them to misunderstand legal documents, miss court hearings, and face other serious obstacles. This is in addition to the many other barriers survivors face in the justice system, including retraumatization, victim-blaming, and the threat of angering an abusive partner. These immense obstacles can prevent survivors from utilizing legal assistance to safely leave an abusive relationship.
The consequences of domestic violence-related brain injury can be permanently damaging to a survivor’s livelihood. As it currently stands, this population is largely suffering in silence.
Mobilization from Government and Health Professionals
Government officials and medical professionals have taken steps to address the connection between domestic violence and brain injury. The Congressional Brain Injury Task Force hosted a Congressional briefing in October 2017 entitled, “The Silent Epidemic in America—Brain Injury and Domestic Violence.” The briefing was intended to raise awareness about TBI in survivors of domestic violence and shed light on the unique challenges they face in their recovery.
During this briefing, Dr. Javier Cardenas of the Barrow Neurological Institute called on the government to address this issue with more urgency. He pressured Congress to increase federal funding for domestic violence-related concussion research and called for the National Institute of Health to fund research in this area in order to aid the medical community in addressing this public health issue. Dr. Cardenas also stressed the importance of providing health care coverage and legal support for brain injury victims.
Following this briefing, Senator Patty Murray re-introduced the Security and Financial Empowerment Act (SAFE Act), first introduced in 2015. The SAFE Act is intended to help survivors access medical attention and legal assistance by providing job protection provisions, unemployment compensation, and other financial protections. Many survivors sustain multiple brain injuries without seeking medical care, and removing financial barriers to accessing such care is a critical step to promote recovery.
The Brain Injury Association of America (BIAA) is an advocacy organization that serves as the voice of brain injury on Capitol Hill. BIAA is involved efforts to address this public health problem; for example, the BIAA co-sponsored the October 2017 Congressional briefing. In the realm of research, a recent BIAA study advocates for early screening for traumatic brain injuries to increase the likelihood of treatment for survivors and to prevent further injury.
Some medical facilities are working to specifically care for domestic violence-related brain injury. In Phoenix, Arizona, the Barrow Concussion and Brain Injury Center established a program specifically designed to address traumatic brain injury in domestic violence survivors—the first program of its kind. This clinic works with local domestic violence shelters to identify potential brain injury patients and help get them the medical care they need.
“…upholding the domestic violence protections established by the Affordable Care Act is a top priority.”
Need for Further Action
While these are a few promising initiatives, brain injury in domestic violence survivors remains a largely unexplored public health issue, one that is unlikely to receive the attention and funding it needs without dedicated federal support.
As a basic requirement, survivors need to be supported with the resources and financial capacity to access health professionals and receive comprehensive health coverage. To this end, upholding the domestic violence protections established by the Affordable Care Act is a top priority. The ACA requires most health plans to cover certain preventive services, including domestic and interpersonal violence screening and counseling, with no cost sharing. The Medicaid expansion under the ACA also made health coverage more affordable, improving access to primary care for survivors and thereby expanding access to the domestic violence protections provided for by the ACA. The Family Violence Prevention and Services Program further details the many ways the ACA assists survivors of domestic violence in ways that were not previously available; this information merits greater dissemination than it has thus far received. Beyond health care-specific laws, other legal protections will help to support survivors in getting the medical help they need. The SAFE Act, one such example, promotes the health of survivors by providing financial stability.
However, such laws will only have a limited effect unless domestic violence-related brain injuries are viewed as the public health problem they are. Specifically, the federal government should prioritize research on domestic violence and brain injury. For example, more funding could help to identify useful diagnostic tools, determine effective rehabilitation strategies, and disseminate information on best medical practices; a collaborative study with this aim was recently launched in Arizona and could serve as a foundation for further research at the federal level.
With greater understanding and awareness of this widespread issue, doctors and caretakers will be more equipped to properly identify patients as domestic violence survivors suffering from brain injury, ensuring that survivors will receive the care they desperately need.