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/
Other resources:
