Domestic violence

Domestic violence survivors commonly suffer repeated blows to the head and strangulation; trauma that has lasting effects that should be widely recognized by advocates, health care providers; law enforcement and others who are in a position to help, according to the authors of a new study. In the first community-based study of its kind; researchers from The Ohio State University and the Ohio Domestic Violence Network found that 81 percent of women who have been abused at the hands of their partners; and seek help have suffered a head injury and 83 % have been strangled.

However, the research suggests that brain injury caused by blows to the head and by oxygen deprivation; are likely ongoing health issues for many domestic violence survivors. Because of poor recognition of these lasting harms; some interactions between advocates and women suffering from the effects of these unidentified injuries were likely misguide; said the authors of the study, which appears in the Journal of Aggression, Maltreatment & Trauma.

Brain injury as a product of domestic violence

“One in three women in the United States has experience intimate partner violence. What we found leads us to believe that many people are walking around with undiagnosed brain injury, and we have to address that,” said lead researcher Julianna Nemeth, an assistant professor of health behavior and health promotion at Ohio State.

However, previous research has acknowledged brain injury as a product of domestic violence. But this is the first study to gather this kind of detail information from the field. It’s also the first to establish that many survivors have likely experience repeat head injury and oxygen deprivation; a combination that could contribute to more-severe problems including memory loss; difficulty understanding, loss of motivation, nightmares, anxiety and trouble with vision and hearing, Nemeth said.

But almost half of the women in the study said they’d been hit in the head or had their head shove into another object “too many times to remember.” More than half were choke or strangle “a few times” and one in five said that happened “too many times to remember.” However,in some cases, the survivors lived through both experiences multiple times.

But the reports from women in domestic violence programs throughout Ohio already have prompte changes; to how the statewide advocacy group and the programs it works with are helping the survivors they serve. They have created a model called “CARE” for “Connect, Acknowledge, Respond and Evaluate.”

Traumatic brain injury

But they have adjusted their training and developed materials that address the “invisible injuries” to the brain. However, they are encouraging providers at agencies to tailor care plans to the specific needs of women who’ve had traumatic brain injury; and to help them seek medical care to get an appropriate diagnosis and treatment.

“Brain injury was not something we really talked about much until now. However, it wasn’t part of any routine training and we’re trying to address; that now because of what we learned from these survivors,” said Rachel Ramirez, a study co-author and training director for the Ohio Domestic Violence Network. She’s been exploring ways to ensure better diagnosis and treatment for women with brain injuries; and said there’s a long way to go.

“Almost all of the best-practice recommendations for TBI are focused on athletes and soldiers; and some of the guidance is impractical for our population,” she said. “These women could be having trouble being able to plan for the future; to make decisions about their safety, to come to appointments, to do their jobs. Many have likely been wondering for years what’s going on with them.”

Poor mental health may arise

Emily Kulow, accessibility project coordinator for the Ohio Domestic Violence Network; said that it’s likely some of the survivors who’ve suffer from severe head trauma and oxygen deprivation; have been slipping through the cracks because their symptoms aren’t well-understood.  “Regardless of why we’re seeing these behaviors; we should be serving all the women who have survived domestic violence and a one-size-fits-all approach won’t work.” Added Nemeth, “The survivors who have severe brain injury are likely some of those with the greatest unmet need.”

However, in addition to memory problems and cognitive impairment; poor mental health may arise or be exacerbated by brain injury and addressing the mental health needs of survivors is an ongoing challenge for agencies; Kulow said. But they also recognize the challenges faced by advocates and survivors, particularly in areas where residents have poor access to counselors, psychologists and psychiatrists.