Eric Gay/AP Photo
An advocate works at the National Domestic Violence Hotline facility in Austin, Texas, June 2016.
Strange things started to happen to Kerri Walker when she was in her mid-twenties.
She had trouble with new projects and would frequently get dizzy and disoriented. Sometimes, she would drive on the wrong side of the street, not knowing that anything was amiss.
Eventually, Walker’s headaches led her to the hospital, where she learned she had suffered a traumatic brain injury. She only recently realized why: She’d sustained repeated hits to the head while in an abusive relationship.
“I sustained many, many different hits on the head, and blows to the head, and shoves to the ground and against the wall,” Walker, now 56, says. She now works at a shelter in Phoenix where she screens people experiencing the same types of brain injuries that she suffered.
The few studies exploring the intersection of traumatic brain injuries and intimate partner violence (IPV) suggest that Walker’s experience is both common and largely ignored. Researchers have estimated that between 75 percent and 90 percent of people experiencing IPV sustain brain injuries of some kind. In a country where an estimated one in three women experience abuse—perhaps more during the pandemic—that likely means millions of Americans suffer from these injuries. Few of them know to get help or are told they can.
To confront those problems, first responders, from law enforcement officers and EMTs to shelter staff and other workers, need to make the connection between concussions and IPV. But with little research on the incidence of these injuries in the pipeline, treating survivors remains challenging.
Halina Haag, a social worker at Wilfrid Laurier University in Waterloo, Ontario, says she estimates that roughly 90 percent of violent encounters between intimate partners include hits to the head, face, or neck. That force can take a variety of forms, she adds: a direct punch, a shove against the wall or down the stairs, a violent shake.
But the worst injuries involved strangulation, suffered by about half the women Haag interviewed. Given enough time, even a light touch on someone’s throat, one that doesn’t leave a mark, can cut off the flow of oxygen and blood to the brain. “It takes about the same amount of pressure or force as it does to open a pop can,” Haag said.
Such injuries are uncommon for the more visible, male faces of brain trauma, such as football players and soldiers, but they have a severe impact on thousands of women injured in their own homes. Research on the connection between IPV and brain injuries is too limited to tell whether they might cause the long-term effects commonly associated with sports-related injuries. But available studies suggest that such injuries may be more frequent. More than 50 women interviewed by Harvard psychiatrist Eve Valera said they had experienced repetitive brain injuries at the hands of an abuser. Many of them had been injured “too many times to count,” meaning they often spent years quietly dealing with repeated head trauma.
Studying intimate partner violence and brain injuries means confronting a number of challenges: the private nature of these injuries; the difficulties women experiencing violence face when heading to a research facility or participating in a study; and the lack of funding for research on women’s health compared to men’s among them. Valera just recently received the first-ever federal grant to scan the brains of women who have experienced IPV.
But researchers say the issue needs more attention, because of both the potential medical consequences and the ways brain injury–related complications permeate survivors’ daily lives. The symptoms of brain injuries reflect the worst thoughts that women experiencing domestic violence have about themselves—and that unsympathetic health care workers and others have about them.
Repeated head trauma can lead to memory loss, causing patients to tell the same story with different details on two different days. It can mimic intoxication, leading a police officer to conclude that a woman is drunk. It can cause confusion and belligerence, frustrating shelter staff. It can underline the lies women’s abusers tell them—that they are stupid, that they are unreliable, and that no one will believe them.
Rachel Ramirez, who heads the Ohio Domestic Violence Network, said that after learning about the prevalence of brain injuries among the people she serves, she remembered a woman who would get lost each day coming back to the shelter where Ramirez worked. “We were thinking, ‘What’s wrong with this person, that they can’t figure out how to get home?’” Ramirez says. “But what’s she thinking? ‘What’s wrong with me that I can’t figure out how to get home. I must be that dumb, stupid loser that my abuser told me I was.’”
The symptoms of brain injuries reflect the worst thoughts that women experiencing domestic violence have about themselves—and that unsympathetic health care workers and others have about them.
A small number of shelters have made the connection between these injuries and domestic violence. Phoenix’s Sojourner Center, the shelter where Kerri Walker works, received a $1 million grant to launch a project to identify traumatic brain injuries among the women it serves. In just over a year and a half, the program has helped roughly 75 women who show signs of brain trauma on a screening test seek free medical treatment at a nearby neurological center. The center also maintains apartments for participants who don’t have a safe place to stay.
The past few years have also seen a slight increase in funding for research on brain injuries and IPV, despite the issue “falling in between” research grants for brain injuries and for domestic violence, University of Denver psychologist Anne DePrince says. Still, domestic violence services are often underfunded at both the state and federal levels—in 2020, Ohio provided just $1 million to nearly 50 programs including the Ohio Domestic Violence Network.
In June, at the request of several members of Congress, the Government Accountability Office examined whether federal programs collect enough data on the connection between domestic violence and brain injuries. The researchers found a dozen initiatives, including eight that received funding from the Department of Health and Human Services or the Department of Justice. But officials at those agencies said the funding was not limited to brain injuries and involved other domestic violence–related work.
The GAO report recommended that HHS maintain better data on the prevalence of brain injuries among people experiencing intimate partner violence. HHS did not respond to a request for comment on whether they have pursued that plan.
Rep. Rosa DeLauro of Connecticut, who chairs the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, said she views HHS funding of IPV services as essential, particularly during the pandemic. “The need for the data has intensified with the spread of the coronavirus,” she says. “You’ve got the mix of the fears around COVID, anxiety, job loss, financial instability, seclusion.”
But despite the recent increase in reports of domestic violence, the reauthorization of the Violence Against Women Act (VAWA), the legislation that has done the most to protect survivors, remains stalled in the Senate. After its initial passage in 1994, the rate of IPV that women suffered declined by more than 50 percent.
Democrats have also proposed funding IPV programs. The HEROES Act would allocate $50 million for Family Violence Prevention and Services, $2 million of which would go to the National Domestic Violence Hotline. DeLauro’s committee has recommended millions in funding increases for shelters, Centers for Disease Control projects centered on women, and the Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) program.
Researchers have estimated that between 75 percent and 90 percent of people experiencing intimate partner violence sustain brain injuries of some kind.
Notably, Joe Biden, the presumptive Democratic presidential nominee, is one of VAWA’s original sponsors. His campaign’s plan to combat violence against women does not include brain trauma–specific measures. If Biden is elected and the measure is enacted, it would transform the system women must navigate by guaranteeing paid leave for women experiencing IPV; ending the national rape kit backlog; and making it easier for women to bring civil claims against their abusers.
For the women Ramirez and Walker serve, such reforms are overdue.
“There is a survivor that I work with regularly whose brain injury was diagnosed 11 years after her strangulation,” Ramirez said. “She suffered for a decade and was in psychiatric hospitals, attempted suicide several times, developed addictions, had a ton of health problems. It could have all been avoided if somebody had said, ‘Hey, do you know when you’ve been strangled, it can do things like impact your memory and concentration and your balance and your senses. If you’re having problems, those could be connected.’”
