Abused & Brain Injured

Understanding the Intersection of Intimate Partner Violence and Traumatic Brain Injury

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Every year thousands of Canadian women experience intimate partner violence (IPV) potentially causing disabling permanent traumatic brain injuries (TBI). This connection, and its implications, is still left largely unexplored.

Abused and Brain Injured: A Toolkit

  • Intimate Partner Violence

    (IPV)

  • Traumatic Brain Injury

    (TBI)

Abused & Brain Injured was created to draw attention to the widely unrecognized intersection of intimate partner violence and traumatic brain injury. In order to improve the lives of survivors as well as the working environment for front-line workers, this toolkit serves to provide information, resources, research and practice recommendations for providing trauma-informed service delivery.

This toolkit is currently part of a research project and is incomplete.

The Intersection of Intimate Partner Violence and Traumatic Brain Injury

Intimate partner violence (IPV) is a significant social issue. It is a leading cause of non-fatal injury experienced by women globally, and women are more at risk from their intimate partners than anyone else.1 The impact of IPV is even greater when it is combined with another major public health concern – traumatic brain injury (TBI). Prevalence rates of possible brain injuries in women survivors of IPV range from 19 to 100%, depending on sample characteristics.2

We call this the intersection of TBI and IPV.

The head, neck, and face are the most common sites of injury in IPV,3-5 with up to 92% of IPV incidents involving hits to the head and face, and strangulation.3 Such assaults can result in brain injury, and they often do.6

In Canada, IPV accounts for over one fourth of all violent crimes reported to police. Most of these incidents involve physical assault such as pushing, hitting, and choking (77%), and most of the physical assaults target women (76%).7 These numbers are likely underestimates, due to the sensitive nature of reporting abuse by an intimate partner. In fact, it is reported that less than one-third of women disclose incidents of IPV.8

Intimate partner violence is characterized by a repeated pattern of abuse over time. It is rarely an isolated event. As a result, women are at serious risk of permanent disability caused by repetitive injury to the brain, if they are hit or strangled regularly.9 Because survivors are often unaware they have sustained a brain injury, they are unlikely to seek care. It is reported that up to 75% of women do not seek medical care for suspected brain injury.6Survivors and care providers can also mistake brain injury symptoms for the emotional distress brought about by the abuse itself.10

Brain injury has been referred to as a silent epidemic, and this is especially true for women survivors of IPV. It is difficult and sometimes impossible to see the injury with the naked eye. Understanding the connection between IPV and TBI is essential. This knowledge will help frontline workers meet the specific needs of clients who may have sustained a brain injury and ensure they receive appropriate care.

Who is this toolkit for?

Survivors and their friends and families

If you are a survivor, or a survivor's friend or family member, use this toolkit to learn about:

  • TBI 101
  • Survivor stories
  • Regional service providers
  • Mental health & TBI
  • Communication & TBI
  • Strategies to cope with TBI

Front-line workers

We want to help make your job easier. If you are a service provider, use this toolkit to learn about:

  • Communication challenges & how to adapt
  • Strategies for working with TBI/IPV clients
  • Barriers & facilitating factors
  • To screen or not to screen
  • Care guidelines
  • Referral resources

The purpose of this toolkit is to

This toolkit is provided as a source of information, not training.

  • Educate front line workers and survivors about the impact of brain injury in women survivors of IPV.

  • Help identify survivors with possible brain injury.

  • Give service providers suggestions to help them support women survivors with a TBI.

  • Provide referral resources.

NOTE: This toolkit is meant for educational purposes only. The information within it should not be used to diagnose or treat brain injury in your clients

Commonly Asked Questions

  • Where can I go to get treatment for my brain injury?

    If you have recently been hit on the head, neck, or face, have been forcefully shaken, or strangled and are experiencing symptoms such as neck pain, loss of consciousness or are going in and out of consciousness, confusion or irritability, a bad or worsening headache, vomiting, behaviour changes, seizures or convulsions, double vision, weakness or tingling/burning in the arms or legs, it is imperative that you receive emergency medical care – call 911 or go to the nearest emergency department.

    If you believe you may have sustained a brain injury at some time in the past, and are not experiencing the red flag signs and symptoms listed above but have concerns about your health, make an appointment to visit your family doctor or other healthcare provider for assessment and referral to a brain injury specialist.

  • It has been years since I sustained a brain injury. Is it too late to seek treatment or support?

    It is never too late to seek treatment if you believe you sustained a brain injury and are experiencing symptoms that are affecting your quality of life. While years down the line it may be difficult to link your symptoms to a brain injury, an assessment by a doctor can answer important questions and get you the help you need.

    There are also programs offered by agencies and advocacy groups that provide support such as peer mentoring programs.

  • Are there programs in my community to help women with brain injury?

    There exist regional brain injury associations in ten provinces in Canada (AB, BC, MB, NB, NL, NS, ON, PEI, QB, SK), whose mission is to advocate for survivors of brain injury, educate about brain injury and its consequences, and to provide support to survivors and their families and caregivers. These associations may run support groups, peer support programs, recreational activities and workshops, among other services for survivors, their families, and caregivers. For a list of the nearest brain injury associations and other programs, visit the ‘Community Resources’ page.

  • Can I apply for special funding to help me to cover the costs of treatment?

    Community programs such as support groups and activity clubs offered by brain injury associations can be free to access. The cost of medically necessary treatment at publicly funded inpatient rehabilitation centres is free for Canadian citizens and permanent residents, covered by public health insurance, which may also cover care at an outpatient clinic, home- or community-based care. Additional coverage for services that would not otherwise be covered by public health insurance is provided to certain groups, such as seniors, children, and low-income residents.

  • How common is it for women who have experienced violence to have a brain injury?

    There are no reliable numbers available at this time on the incidence of brain injury in survivors of intimate partner violence. This is due to a number of reasons, among them the sensitive nature of reporting of intimate partner violence by survivors, as well as the lack of awareness about the risk of sustaining a brain injury in an abusive relationship. Up to 92% of incidences of intimate partner violence involve hits to the head, neck, or face, or strangulation, all of which can result in brain injury.

  • How long does a brain injury last?

    The impact of a brain injury varies from person to person and depends on a number of factors related to the person (e.g., genetic vulnerabilities, previous head injury, etc.), their circumstances (e.g., living situation, economic status, etc.), and the details of their injury (e.g., severity, mechanism, etc.). When a person sustains a first-time concussion, a mild traumatic brain injury, the recovery period can be relatively short, lasting a few days or weeks before the person is back to their pre-injury self. However, in some cases, symptoms of a concussion can persist. Symptom persistence depends on the factors listed above. A person who has had a previous head injury, or has a history of neurological or psychiatric problems or physical limitations, who is older, or is dealing with life stressors at the time of injury, can experience a longer recovery from concussion than is typical. With more severe traumatic brain injury, the recovery period can last even longer, and reflect more significantly on the person’s health and well being, and they may not be able to return to their pre-injury level of functioning.

    Traumatic brain injury was at one time regarded as an event, but is now recognized as a disease process, with the course and recovery determined by factors unique to each person. Visit the ‘Long-Term Effects’ page for more information.

  • How do I get a medical diagnosis for a brain injury?

    Diagnosing brain injury can be challenging, particularly in survivors of intimate partner violence, as a woman may not be aware that she has sustained a brain injury, or that the symptoms she is experiencing are symptoms of brain injury. She may likewise choose not to seek immediate medical attention for her injuries for a number of reasons, and so may carry on without proper care, with possibly debilitating symptoms. The only way to receive a diagnosis is to see a doctor for assessment. In cases where time passes before a survivor seeks medical care, a diagnosis can still be established. Oftentimes, in the case of concussions, the most common type of traumatic brain injury affecting survivors of intimate partner violence, assessment and diagnosis relies on the account of the event and symptoms experienced by the person. If you believe you sustained a brain injury recently or at some time in the past, it is important that you see a doctor to be assessed and to receive treatment if needed.

  • Where can I go to find the appropriate resources?

    Visit our ‘Community Resources’ and ‘Resources’ pages for educational resources as well as information on programs and services.

  • Are there other women out there that have experienced something similar?

    You are not alone. Visit our ‘Stories’ page to hear the stories of women survivors of intimate partner violence.

  • What is a traumatic brain injury?

    Traumatic brain injury is a brain injury that results when a significant force is applied to the head, face neck, or body, disrupting brain function.

  • How can I tell if I may have had a traumatic brain injury?

    If you have been hit on the head, neck, or face, been violently shaken, or strangled, and are experiencing any of the signs and symptoms listed here, you may have sustained a brain injury. If such an injury is recent and you are experiencing red flag signs and symptoms,it is imperative that you receive immediate medical attention. If your injury happened some time ago and you are not experiencing red flag signs and symptoms, you should still see a doctor for assessment to determine whether you have sustained a traumatic brain injury and need treatment.

  • What happens after a traumatic brain injury and in what ways can it impact my life?

    The aftermath of a brain injury will differ from person to person, and will depend on a number of different factors that are unique to each individual. These include factors related to the person (e.g., genetic vulnerabilities, previous head injury, etc.), their circumstances (e.g., living situation, economic status, etc.), and the details of their injury (e.g., severity, mechanism, etc). Traumatic brain injury can affect many different aspects of a persons life, including but not limited to memory and other thinking skills, physical functioning, ability to communicate, to control feelings, and a person’s sense of self.

Thank you to our partners, funders and supporters

  • Department of Justice Canada
  • Canadian Institutes of Health Research
  • Women at the Centre
  • Women's Habitat
  • The Cridge Centre for the Family
  • DAWN-RAFH
  • Laurier
  • Rehabilitation Sciences Institute
  • University of Toronto

Acknowledgements

Members of the research team:

Halina (Lin) Haag, Wilfrid Laurier University & University of Toronto, ABI Research Lab

Nneka MacGregor, WomenatthecentrE

Silvia Samsa, Women’s Habitat

Geoff Sing, The Cridge Centre for the Family

Dr. Nora Cullen, West Park Healthcare Centre

Noel Natalia Smith, University of Toronto, ABI Research Lab

Shirin Mollayeva, University of Toronto, ABI Research Lab

Dr. Angela Colantonio, Principal Investigator, University of Toronto, ABI Research Lab

We would like to thank the following individuals for their material contributions:

Candace Stretch, The Cridge Supportive Housing & Family Services

Janelle Breese Biagioni, The Cridge Centre for the Family Brain Injury Services

Reema Shafi, Krembil Research Institute

References

1C. Garcia-Moreno, H. A. Jansen, M. Ellsberg, L. Heise, and C. H. Watts, “Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence,” Lancet, vol. 368, no. 9543, pp. 1260–1269, 2006.

2H.L. Haag, D. Jones, T. Joseph, and A. Colantonio, “Battered and Brain Injured: Traumatic Brain Injury Among Women Survivors of Intimate Partner Violence—A Scoping Review,” Trauma, Violence, Abus., Jun. 2019.

3A. St. Ivany and D. Schminkey, “Intimate partner violence and traumatic brain injury: State of the science and next steps,” Fam. Community Heal., vol. 39, no. 2, pp. 129–137, 2016.

4V. Wu, H. Huff, and M. Bhandari, “Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: A systematic review and meta-analysis,” Trauma, Violence, and Abuse, vol. 11, no. 2. pp. 71–82, 2010.

5O. A. Arosarena, T. A. Fritsch, Y. Hsueh, B. Aynehchi, and R. Haug, “Maxillofacial injuries and violence against women,” Archives of Facial Plastic Surgery, vol. 11, no. 1. pp. 48–52, 2009.

6E. Valera and H. Berenbaum, "Brain injury in battered women," J. Consult. Clin. Psychol., vol. 71, no. 4, pp. 797-804, 2003.

7M. Burczycka, “Section 3: Police-reported intimate partner violence,” 2015; Available from: https://www150.statcan.gc.ca/n1/pub/85-002-x/2018001/article/54893/03-eng.htm

8Ontario Ministry of Children Community and Social Services, “Statistics: Domestic Violence,” 2015. [Online]. Available: http://www.women.gov.on.ca/owd/english/ending-violence/domestic_violence.shtml.

9J. Brown, “Traumatic Brain Injury (TBI) and Domestic Violence: a Beginner’s Guide for Professionals,” J. Forensic Sci. Crim. Investig., vol. 8, no. 2, 2018.

10K. M. Iverson, C. Dardis, and T. K. Pogoda. “Traumatic brain injury and PTSD symptoms as a consequence of intimate partner violence,” Compr. Psychiatry, vol. 74. pp. 80-87, 2009.