Researchers now estimate that 90% of people with a history of interpersonal violence have signs and symptoms of traumatic brain injury. These injuries, which often include depression, impaired problem-solving ability, and difficulty concentrating, all put victims at risk for continued abuse and can make it harder to leave abusive relationships. The treatment of brain-injured domestic abuse victims is still in its infancy, but new findings and screening tools can help address this underreported and understudied problem.
“In a domestic violence situation, a lot of the abuse is focused on the head,” said Jonathan Lifshitz, director of the Translational Neurotrauma Research Program at the University of Arizona. Women, who typically have smaller heads and weaker necks than men, are at particular risk. Past research has focused mainly on professional male athletes and veterans.
Some researchers compare brains to jello: when it sustains damage it ripples, and when the brain tries to restore equilibrium, pathways and brain cells can be mismatched. Many domestic violence victims sustain multiple injuries over time leading to lasting physical, behavioral and cognitive damage which often goes untreated. Brain injuries can be caused by head trauma that include hits, falls and strangulation.
Concussions (a mild form of brain injury) can cause loss of consciousness, nausea, dizziness, memory loss, and long-term neurological problems that can cloud judgment and hinder speech. Depression, anxiety, and migraines are all common concussion symptoms. New studies show that health providers often don’t adequately screen for brain injuries as the cause of such symptoms.
More serious traumatic brain injury is often misdiagnosed as Post Traumatic Stress Disorder (PTSD). Short-term problems can include balance issues, confusion, difficulty concentrating, headache, lethargy, nausea, sensitivity to light and sleep disturbances. Lasting physical, cognitive and emotional problems can include mood swings, trouble managing money, seizure disorders, Alzheimer’s disease and Parkinson’s disease.
Police, brain researchers, advocates, care providers and prosecutors team up
In 2017, researchers at the University of Arizona College of Medicine, the Mesa Police Department, a Family Advocacy Center’s Forensic Lab and family violence unit of the County Attorney’s Office teamed up to train police officers answering domestic violence calls to screen for concussions. Officers used an small hand-held eye tracking device called ConQVerge that can gather data and help determine of domestic violence victims have received a concussion in about two minutes.
The device measures whether the eyes can converge near the face, balance and hand-eye coordination. Victims with apparent brain injuries were transferred to forensic nurse examiners who could do further tests. The prosecutor’s office is working on developing best practices for enhanced apprehension and prosecution of abusers who cause brain injuries. Although this program implemented the tests only with victims who stated they had been sexually assaulted or strangled, police screening for concussions or traumatic brain injury could have much wider application in domestic violence cases.
The main challenges thus far in the program relate to training and buy-in of police officers and availability of a sufficient number of the devices. Originally police training was done solely by video, without a demonstration and an opportunity to try administering the test themselves.
After 9 months in the field, the police department had 163 reported incidents. 36% of the time officers failed to offer victims the screening (they mentioned difficulty getting the device, lack of training and the chaos of the crime scene. 38% of victims refused any additional testing following the screening. Improved police training may improve the rate at which victims agree to a visit to the forensic nurse.
Staff at some domestic violence shelters use the HELP or ACE questionnaire screening tools as part of their initial screening of victims. Agencies can ease victim adjustments by reducing lighting and noise levels. Creating a circle of community care that ensures that a variety of professionals who interact with domestic violence victims are trained to screen for traumatic brain injury can help treat symptoms early and prevent additional injury.
(A number of journal articles on the subject of traumatic brain injury are available upon request from Laurie Duker, Court Watch Montgomery Executive Director, firstname.lastname@example.org).