Intimate Partner Violence and Traumatic Brain Injury: A Public Health Issue

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Monahan K. J Neurol Neuromed (2018) 3(3): 3-6
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Intimate Partner Violence and Traumatic Brain Injury: A Public Health
Issue
Kathleen Monahan
School of Social Welfare, Stony Brook University, 10 Bobilin Lane, Rocky Point, NY 11778, USA
Article Info
Article Notes
Received: April 20, 2018
Accepted: June 25, 2018
*Correspondence:
Director of the Family Violence Education and Research Center
School of Social Welfare, Stony Brook University, 10 Bobilin
Lane, Rocky Point, NY 11778, USA
Telephone: (631) 444-3152
Email: kathleen.monahan@stonybrook.edu
© 2018 Monahan K. This article is distributed under the terms of
the Creative Commons Attribution 4.0 International License
ABSTRACT
Inmate Partner Violence (IPV) remains at epidemic proporons in the United
States. Traumac Brain Injury (TBI) as an outcome of IPV is now being invesgated by
researchers, parcularly long-term sequelae. This review addresses underreporng
and lack of treatment, and the physical and psychological impact for vicms of IPV
who have received a TBI. Recent research has begun to invesgate professional
sports players who experience repeated concussions and their at-risk status for
Chronic Traumac Encephalopathy (CTE). Women who are in abusive relaonships
for long periods of me may also incur repeated blows to the head. Researching
the at-risk status for CTE is a much needed line of inquiry for this underserved
populaon.
Intimate Partner Violence (IPV) remains at epidemic proportion
in the United States with over 1 in 3 women experiencing, “…sexual
violence, physical violence, and/or stalking victimization by an intimate
partner during her lifetime”1. The National Intimate Partner and Sexual
Violence Survey (NISVS) as well as other research indicates that one in
four women in the United States experienced severe violence during
her lifetime1-4
         
        
        
players but has been largely overlooked in the female population.
          
         
warranted. Women may spend decades in an abusive relationship where
head injury frequently occurs but is not typically diagnosed or treated.
  
         
       
presented.
         
physical violence directed toward a current or former intimate partner.”1

or being shot1. IPV creates long-term health and disability issues for its
victims1-4 

between 2.3 billion and 7.0 billion dollars1,5. Workplace productivity and
absenteeism may also be affected by current and/or past IPV6.
             
the normal function of the brain” as a result from an external force to
the head7

Monahan K. J Neurol Neuromed (2018) 3(3): 3-6 Journal of Neurology & Neuromedicine
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
United States77-8
and when factoring in the lack of reporting and/or lack of
treatment, the incidence may be substantially higher7-8.


 
across disciplines as well as individual providers, making

 
interchangeably9. Practitioners may also look at symptom


to guide diagnosis10

assessment and referral for treatment may not occur.
        

      
usually directed at the woman’s face or head creating
   11-17. Mechanic, et
al.18, examined moderate-to-severe injuries among help-
seeking women who experienced IPV and nearly half
reported repeated blows to the head. While women may
seek medical intervention for their injuries and may go
on to leave the abusive relationship, others may not,
        
duration of the relationship18
   
affect psychological and physical outcome as well as social
and familial adjustment.
Identication and Underreporting
Universal Screening of IPV which includes attention
to head injury should occur in all health-care settings3,16.
Additionally, standardized guidelines to identify IPV and

However, this lack of uniformity across the variety of
  
       
collection.

immediate medical assistance present complex issues for
the practitioner. Appearing in the medical practitioner’s
       
        
84% of one sample experienced severe injuries, yet only
21% sought medical attention immediately following the
assault despite clinical symptoms15. The patient may not
associate current neurological symptoms with previous
      
current treatment.
Medical attention is not sought for a variety of reasons:
      
costs, lack of insurance, transportation issues, and shame,
resulting in under-reporting and lack of treatment19. When
women do seek treatment, they often attribute the assault
as “a fall down the stairs” thus intervention and safety
issues are not addressed, nor is the injury recorded as an
assault, particularly IPV20,21.
An exploratory study conducted in 1999 of domestic
violence shelter residents14 assessed the incidence of head

done to further this research until recently. Many domestic
violence shelters are only beginning to include questions
        

       
Injury Alliance of Iowa developed a project, along with 10
        
provide them with resources. Of the 148 female individuals
who were screened in 2012, 88 or 60% positively endorsed
 22         
variety of IPV populations,3, 12, 14,23 yet this information has
       
shelter intervention policy14-16. Anecdotal accounts from
shelter residents describe IPV assaults in which their head
was smashed into the dashboard of the car, hit with a closed
14, 16.
Short and long-term sequelae
       
anxiety to constant fear, hypervigilance, confusion,
      
       
present, yet practitioners often confuse the overlapping
   24-25. While comorbidity
        
symptomatology may be overlooked or underestimated.
Additionally, neuropsychiatric symptoms may be attributed
by the healthcare provider and the patient as, “sequelae of
the traumatic experience of IPV, menopause or aging and
do not suspect a connection to head trauma/s sustained in
the past”20.
Long-term outcomes for this population may result
in debilitating impairments. Goldin states, “The most

     
        
reported by women survivors of IPV”16  


26-27. There may also be sex-
      
premenopausal women28.

Monahan K. J Neurol Neuromed (2018) 3(3): 3-6 Journal of Neurology & Neuromedicine
Page 5 of 6
Chronic Traumatic Encephalopathy (CTE)
      
       
       
particularly as they age. However, little is known regarding

     
      

29-30. Individuals in this cohort have been diagnosed

Roberts, et al., described an elderly woman admitted
to the hospital with multiple injuries.31 She suffered years
of physical abuse by her husband and exhibited physical
      
Post-mortem evaluation revealed brain pathology
that, “have only been reported in dementia pugilistica,
      
factor in this case”31   
investigation is whether women who are in long-term,
      
      
       
dialogue regarding brain donation from women who have
      
violence shelter staff and victims highlights this issue.
Discussion
      
        3,16. It
is reasonable to assume that neurologists are treating
IPV victims without direct knowledge of their trauma
history and therefore not associating symptoms with

sought treatment for head injuries, nor associated their

confusion, and memory loss, by a patient or a family
member, a thorough history of head injuries that include
IPV victimization, should be conducted. It is imperative
that information regarding IPV be gathered without the
batterer present or with a trusted family member. Asking
for this information in front of the batterer will not only
provide false information (the victim will, in all likelihood
– not answer truthfully) but will put the patient at further
risk for violence. It is also important to note that IPV does
not decline with age, so assuming that an older adult’s
abuse is in the past would be erroneous32.
Intake forms that query for IPV as well as previous
head injury create the atmosphere that the healthcare

          
list of local resources should be posted in the examination
       
the county domestic violence shelter, how to contact a
     
       
practices and safety for the IPV population.
Attention to the short and long-term issues of post-
      
safety issues are the primary concern along with the
cessation of IPV. Long-term issues may include attention to
     
      

over from situation to situation. These issues may best be
treated by an interprofessional health care team that can
address neurological, physical, and mental health issues as
well as rehabilitation needs.
Research needs to address the scope of IPV and
         
population to address disability needs. Additionally,
sex and gender equity in research is often overlooked in
    
and the primary rationale for the development of the
SAGER guidelines33      
of various risk factors and the treatment guidelines for
        
male patients”28      
  inquiry and will assist patients
in the process of recovery, adjustment and well-being. The


also needs extensive inquiry.
Conclusion
Purposeful injury to the brain deprives a victim of
individuality and the right to live an independent and
autonomous life. IPV is considered a public health issue yet
it continues to remain at epidemic proportions. Universal
      
serve to identify this public health issue and provide
much-needed secondary prevention. Professional schools
dealing with the health of the public should highlight the

IPV and post-IPV neurological issues. Research should also

We now understand how physical and psychological
traumas, including neglect, affect psychosocial adjustment
and, most importantly, the architecture of the brain.
However, the issues of brain health, brain diseases and
disability emanating from IPV have not been included in
     
        
further research and assist health-care professions to
understand the long-term neurological consequences of
violence toward women in the United States.

Monahan K. J Neurol Neuromed (2018) 3(3): 3-6 Journal of Neurology & Neuromedicine
Page 6 of 6
Acknowledgment

for her thoughtful review of this manuscript
References
1.      
Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA:


2.           
     
Retrieved from. 2015. https://www.cdc.gov/violenceprevention/
pdf/intimatepartnerviolence.pdf
3.         
        
Nervous System Symptoms. J of Women’s Health. 1-7.
4. et al, The National Intimate Partner
and Sexual Violence Survey (NISVS): 2010 Summary Report. National

and Prevention. Atlanta GA. 2011. www.cdc.gov/ViolencePrevention/
pdf/NISVSExecutiveSummary-a.pdf
5.          
expenditures attributable to intimate partner violence. J Inter Vio.

6. 

7. 
J Head Trauma
Rehabil
8.            
     
 

9. 
Arch Phys Med Rehabil
10. Kristman V, Godbolt A, Salmi, L, et al. Methodological issues and
research recommendations for mild traumatic brain ijury: the WHO
         J
Rehabil Med. 43: 113-125.
11.          
Identifying a triad of post-injury disorders. J. Trauma Nurs. 
21(6): 300-308.
12. 
violence. Emerg Radiol.
13.           
radiological examination of acute intimate partner violence injuries:
A retrospective analysis of an Italian cohort of women. Violence Vict.

14. 
inquiry. Health & Soc Wk
15. 
injury. Fam Community Health. 39(2): 129-137.
16.           
Injury among women exposed to Intimate Partner Violence. Physical
Med & Rehabil. 2016. http://dx.doi.org/10.1016/j.pmrj.2016.05.006
17. 
An Invisible wound of Intimate Partner Violence. Medical Care. April

18.   
among help-seeking battered women: An exploration of multiple
abuse dimensions. Violence Against Women 12: 1148-1165.
19.       
violence among women seeking care in the primary healthcare
International J of Gynaecology and
Obstetrics
20.          
victims of intimate partner violence: An underappreciated source of
neurological morbidity. Future Neurol
21.       
Soc Wk
22. Traumatic brain injury in domestic violence programs in Iowa:

23. 
in intimate partner violence: A critical review of outcomes and
mechanisms. Trauma, Violence & Abuse
24.           

15(1): 22-33.
25.  
wellbeing: Impacts, risk factors and responses. Contemp Nurse. 46(2):
170-182.
26.         
survivors: A shelter-based intervention. Occupa Therapy in Mental
Health
27.         
independence in women experiencing domestic violence and possible
brain injury: An assessment of an occupational intervention. Occupa
Therapy in Mental Health
28. 
with severe head injury: Greater susceptibility to brain swelling in
   
98: 32-36,
29.  
exposure predicts later-life depression, apathy, executive dysfunction,
and cognitive impairment in former high school and college football
players. J Neurotrauma
30. 
of chronic traumatic encephalopathy in players of American football.
JAMA.
31.            
drunk wife. Lancet
32. 
adults: Analysis using data from the National Elder Mistreatment
Study. J. of Interpersonal Vio. 32(3): 311-330.
33.              
Research: Rationale for the SAGER guidelines and recommended use.
Research Integrity and Peer Review