Working with survivors of domestic violence and sexual assault can sometimes be overwhelming when we realize all of the issues with which a victim may have to deal. There are the immediate safety issues, the long term custody and financial issues, housing, parenting, trauma issues and the possibility of substance abuse and mental health issues related to trauma, and the ongoing systemic issues of oppression and lack of resources. Amidst all of this we have learned to recognize when the impact of trauma may be affecting the person’s ability to move forward and we have found ways to empower someone to make changes even in the face of these effects. However, often, because there is already so much, we forget the possibility that the survivor we are working with may be dealing with the effects of a minor or major traumatic brain injury.
The following information is gleaned from various resources that I will include at the end.
The head and face are among the most common targets of intimate partner assaults, and victims of domestic violence often suffer head, neck and facial injuries. Common forms of physical assault that can cause a brain injury include:
• Forcefully hitting partner on the head with an object.
• Smashing her head against a wall.
• Pushing her downstairs.
• Shooting or stabbing her in the head.
• Shaking her – which moves her brain in a whip-lash motion, smashing it against her skull.
• Obstructing her airway, causing loss of oxygen to her brain, through:
o Strangling her. (She will likely call it “choking.”)
o Trying to drown her.
o Forcing her to use drugs or eat foods to which she is allergic.
Because batterers seldom assault their partners only once, some victims suffer repeated head injuries.
One study of women in three domestic violence shelters found that:
• 92% had been hit in the head by their partners, most more than once.
• 83% had been both hit in the head and severely shaken.
• 8% of them had been hit in the head over 20 times in the past year.
• The more times individuals had been hit in the head or shaken, the more severe, and the more
frequent, were their symptoms.
What is Traumatic Brain Injury?
Traumatic brain injury (TBI) is an injury to the brain that is caused by external physical force.
· Penetrating injuries are caused when a foreign object (such as a bullet, knife, or blunt object) pierces the skull. This type of injury causes focal damage, limited to the specific parts of the brain that lie along the path that the object travels.
· Closed head injuries occur from blows to the head that do not fracture the skull, or from severe shaking. They can cause both localized damage and diffuse or widespread damage, due to bleeding, and to stretching, tearing and swelling of brain tissue – which can continue to damage the brain for hours or days after they originally occur. A DV victim can suffer a closed head injury when her partner hits her on the head with an object, smashes her head against a wall, pushes her downstairs or violently shakes her.
· Cutting off oxygen, as happens in strangulation, also injures the brain.
A victim of domestic violence may suffer a TBI without knowing it if she had no severe trauma or obvious symptoms at first, or if she did not lose consciousness, or received no medical care.
NOTE: While a TBI can lead to aggressive behavior, it does not cause or excuse the targeted pattern of coercive control usually seen in DV. If a woman thinks her partner is violent because he has suffered a TBI, she might want to try and get an evaluation for him, but she should also be helped to plan for safety.
Brain injury can make it harder for a victim of domestic violence to:
· Assess danger and defend herself against assaults.
· Make and remember safety plans.
· Go to school or hold a job (increasing her financial dependency on the abuser).
· Leave her abusive partner and live on her own.
· Access services.
· Adapt to living in a shelter. She may become stressed, anxious and confused or disruptive, or have trouble understanding or remembering shelter rules and procedures.
· Retain custody of her children.
Domestic violence service providers. Screen everyone who seeks DV services for TBI. A brief screening tool that was designed to be used by professionals who are not TBI experts is the HELPS.2
HELPS is an acronym for the most important questions to ask:
H = Were you hit in the head?
E = Did you seek emergency room treatment?
L = Did you lose consciousness? (Not everyone who suffers a TBI loses consciousness.)
P = Are you having problems with concentration and memory?
S = Did you experience sickness or other physical problems following the injury?
If you suspect a victim has a brain injury, or she answers “yes” to any of these questions, help her get an evaluation by a medical or neuropsychological professional – especially if she has suffered repeated brain injuries, which may decrease her ability to recover and increase her risk of death. If she wishes, reach out to the TBI service provider with information about DV, what support she needs, and what services are available to her. Look for ways to work together.
The National Brain Injury Association has links to the TBI associations in each state: http://www.biausa.org/