Domestic Abuse and Brain Injury in Women

March 15, 2017
Taken from the March/April 2017 issue of The Women's Health Activist Newsletter.

TBI survivors are often told that they may have a headache and be a bit emotional for a few days. In fact, the consequences of even supposedly “mild” TBI can be disabling, and include: 1,2 

  • Problems with memory and vision, fatigue, headaches, and migraines;
  • Sexual dysfunction, including lost libido and infertility;
  • Sensitivity to light, sound, and motion;
  • Emotional swings, from depression to euphoria, from attention-deficit/hyperactivity disorder (ADHD) to explosive anger;
  • Sleep disturbances, including insomnia or an inability to stay awake for more than a few hours;
  • Slowed thoughts, word recall, and reaction times; and
  • Loss of skills, including the ability to read, learn, recognize faces, and organize everyday tasks like shopping and cooking.

TBI has gained public awareness thanks to advocates for athletes and service members. But these groups are just the tip of the iceberg. A larger population, which may be the most affected by TBI, remains largely ignored: women.

Even under normal conditions, women face greater risk of TBI than men, partly because of their more delicate cranial bones and neck muscles. Even minor car crashes injure women far more severely than men sitting in the seats right next to them.3

The current focus on TBI in sports began with Dr. Bennet Omalu’s discovery of severe brain deterioration revealed in autopsies of former football players, starting with his 2002 autopsy of Mike Webster. Omalu was struck by Webster’s brain abnormalities because he had seen them before — in a woman who was beaten into a coma by her husband.4 Like Webster, she had endured years of abuse to her brain. Unlike Webster, the media never mentions her. It’s as though she never existed.

According to the Centers for Disease Control and Prevention (CDC), in 2000, 4.8 million women were known to experience physical violence by an intimate partner each year.5 Actual numbers are probably much higher. New estimates suggest TBI from domestic violence may affect up to 20 million women, 6 percent of the population. This may dwarf the numbers from the military and athletes combined — yet TBI from domestic violence receives little attention.6

How little attention? A search on the National Institutes of Health’s search engine (PubMed) for “Traumatic Brain Injury in… sports” returns 2,653 titles; …military returns 1,624; …domestic violence returns 234; and …domestic abuse returns just 19 titles.

Clearly, we need more information on the connection between domestic violence and TBI. But, even when the connection is clear, many are skeptical, asking, “Why didn’t she just leave?” Often it’s because she can’t.

TBI impacts energy, decision-making, the ability to plan and function effectively—and financial independence. In these situations, leaving a domestic abuse situation becomes impossible. Even if the woman leaves, few physicians or social workers are trained to recognize TBI symptoms.7,8  In shelters, abuse victims affected by severe light and sound sensitivity, insomnia, and/or fatigue can be further traumatized by bright lights, noise, and bureaucratic requirements. If staff sees a woman as non-compliant, oppositional, or defiant, she faces expulsion — and the choice between going home or becoming homeless. Many of these women, damaged and financially bereft, have no choice but to remain with their abusers, putting themselves and their children at risk for continuing damage.9,10 

Arizona’s Sojourner Center, working with the Mayo Clinic, is one of the first to research domestic violence’s role in TBI. Sojourner’s Brain Recovery And Inter-professional Neuroscience (BRAIN) program conducts TBI screening interviews, which reveal nearly 90 percent of victims had been struck in the head by their abusers, some over a dozen times per year. Incidents of choking and strangling, which block the brain’s critical oxygen supply, are also common.

Because Sojourner recognizes the link between impaired impulse control and violence, it also screens abusers, with the goal of developing effective treatment and prevention programs for all.11

The best treatment begins with the best information. At Maryland’s Brain Wellness and Biofeedback Center, TBI treatment always begins by mapping the brain and recording the tiny electrical signals it produces. Modern quantitative EEG (QEEG) techniques compare these signals to a normative database that reveals abnormal brainwave slowing typical of TBI and other painful conditions like fibromyalgia.12,13  Mapping can reveal the reasons behind the patient’s dysfunction, leading to better treatment — and understanding.14. “Mapping alone has halted recriminations and divorce proceedings,” reports the Center’s Dr. Mary Lee Esty.

Articles dealing with disease and damage typically list the loss, in dollars, to society.15 But women’s contributions to society are inestimable. Women bear the children, feed and form the families, and make the holidays. They create the world and its future on a daily basis. Women are the master multi-taskers and, when they fall apart, families fall apart.

The first step in domestic abuse is recognition and rescue, whatever the situation. But a greater awareness of TBI, its symptoms, causes, consequences — and effective treatment — can only help our society and our world.

CM Shifflett is the author of Migraine Brains and Bodies, and (with Dr. Mary Lee Esty) of Conquering Concussion: Healing TBI Symptoms With Neurofeedback and Without Drugs.

The continued availability of external resources is outside of the NWHN’s control. If the link you are looking for is broken, contact us at nwhn@nwhn.org to request more current citation information.

Resources

  • Brain Injury Association of America (BIAA): The country’s oldest and largest nationwide brain injury advocacy and support organization. (800) 444-6443; http://www.biausa.org
  • Brain Wellness and Biofeedback Center (Bethesda, MD): Dr. Mary Lee Esty studies and treats depression, headache, AD(H)D, PTSD and other debilitating conditions arising from concussion and traumatic brain injury. (301) 215-7721; http://www.BrainWellnessAndBiofeedback.com
  • National Domestic Violence Hotline: Confidential support for anyone experiencing domestic violence or seeking resources and/or information. (800) 799-7233; (800) 787-3224 (TTY); http://www.thehotline.org
  • Sojourner Center (Phoenix, AZ): Sojourner offers shelter and support services to adults, children, and pets affected by domestic violence and human trafficking. The Center also researches TBI’s prevalence and symptoms. (602) 296-3339; https://www.sojournercenter.org

References

1. Esty ML and Shifflett CM, “The Wounds of War,” Conquering Concussion: Healing TBI Symptoms With Neurofeedback and Without Drugs,” Sewickley, PA: Round Earth Publishing, 2014, pp, 147-164. Available at:

www.brainwellnessandbiofeedback.com/wp-content/uploads/2016/11/Wounds-of-War.pdf.

2. Dinse HR, Kattenstroth J, Lenz M, et al., “The Stress Hormone Cortisol Blocks Perceptual Learning in Humans,” Psychoneuroendocrinology. 2017; 77:63-67.

3. Shifflett CM, “Women & Concussion: An Under-Recognized Danger,” Women's Health Activist 2014; 39(6):6-7.

4. Fainaru-Wada M and Fainaru, League of Denial: The NFL, Concussions, and the Battle for Truth. New York City: Three Rivers Press, 2014, p. 151.

5. Tjaden P and Thoennes N, Extent, Nature, and Consequences of Intimate Partner Violence. Washington, DC: the National Institute of Justice and the Centers for Disease Control and Prevention, 2000. Available online at: https://www.ncjrs.gov/pdffiles1/nij/181867.pdf.

6. Jeltsen M, “The Women Who Face More Traumatic Brain Injury Than NFL Players,” The Huffington Post. June 6 2015 (updated September 8, 2015). Available online at: www.huffingtonpost.com/2015/06/02/domestic-violence-tbi_n_7488168.html.

7. Masferrer R, Masferrer M, Prendergast V, “Grading Scale for Cerebral Concussions,” Barrow Quarterly 2000; 16(1).

8. Corrigan JD, Wolfe M, Mysiw JW, et al., “Early Identification of Mild Traumatic Brain Injury in Female Victims of Domestic Violence.” Clinical Journal of Women’s Health 2001: 1:184-90. Online at: http://www.sciencedirect.com/science/article/pii/S0002937803003582

9. Harris NB, How Childhood Trauma Affects Health Across a Lifetime, TedMED, Filmed September 2014, posted February 2015. Available online (with transcript) at: www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime/transcript?language=en.

10. Centers for Disease Control and Prevention (CDC), Adverse Childhood Experiences (ACEs). Atlanta: CDC Injury Prevention & Control, 2016. Available online at: https://www.cdc.gov/violenceprevention/acestudy.

11. Knechtel J, personal communication, January 2016.

12. Institute of Medicine and the National Research Council of the National Academies, Sports-Related Concussion in Youth: Improving the Science, Changing the Culture, Washington, DC: National Academies Press, 2014.

13. Thatcher RW, Biver CJ, North DM. “Quantitative EEG and the Frye and Daubert standards of admissibility,” Clin Electroencephalogr. 2003; 34(2):39-53.

14. Esty ML and Shifflett CM, “The Wounds of War,” Conquering Concussion: Healing TBI Symptoms With Neurofeedback and Without Drugs,” Sewickley, PA: Round Earth Publishing, 2014.

15. National Center for Injury Control and Prevention, Costs of Intimate Partner Violence Against Women in the United States. Atlanta: Centers for Disease Control and Prevention, 2003. Available online at: https://www.cdc.gov/violenceprevention/intimatepartnerviolence.