Concussions and other traumatic brain injuries are enough of a health concern that in Canada, provinces have passed laws, conducted public health campaigns and educated coaches and others on the importance of protecting athletes from concussion.
But athletes aren’t the only ones suffering brain injuries.
With all the focus on sports, researchers say, we’re missing a huge group of injured people: abused women.
Estimates of how many women have had traumatic brain injuries inflicted by their partners vary quite a bit, as it’s a hard group to research and most studies in this emerging field have been comparatively small or draw from different populations, according to Halina (Lin) Haag, a social worker and PhD candidate at Wilfrid Laurier University.
But worldwide, around one third of women have experienced domestic violence, according to the World Health Organization. Depending on which studies you look at, between 20 and 75 per cent of women who have experienced intimate partner violence have also had a traumatic brain injury as a result, she said.
Even using conservative estimates, that could translate to around one in eight Canadian women potentially having this experience, which is the same rate as breast cancer, Haag said, though she emphasizes that these are estimates only, and not all victims of domestic violence are women.
The vast majority of violent encounters in domestic relationships include hits to the head, face and neck, she said. “Almost all of the exposure that they’re getting is putting them at high risk of injury, of head injury.”
“Each particular incident isn’t necessarily going to cause catastrophic results,” she said. “But when you build them over and over and over on top of one another, over a long period of time, which is often the case, you can get a really significant problem quite quickly.”
“Basically it’s extremely common, far more common than I think most people would ever imagine or realize,” said Eve Valera, a professor of psychiatry at Harvard Medical School.
Valera’s research examines brain injury among women who have experienced domestic violence. In one of her studies, of 99 abused women she interviewed, three-quarters had sustained some type of brain injury from their partner. Many of them showed impaired cognitive function, when measured on standard tests.
Another smaller study she conducted found that many abused women showed post-concussive symptoms and MRI scans showed problems with connectivity in their brains.
Most of the women in that study had suffered multiple injuries. Many had more than 20 separate incidents.
The effects add up, researchers said.
Paul Van Donkelaar, a professor in the School of Health and Exercise Sciences at the University of British Columbia Okanagan, has spent most of his career studying the brains and cognitive function of athletes who experienced concussions.
He recently started looking at victims of intimate partner violence. “It’s safe to say that it’s worse,” he said.
“In many ways, it’s like athletes in collision sports, whether it’s a football lineman or a hockey player who get hit on every play.”
“And so that happens hundreds or potentially thousands of times over the course of the season. I think in many ways that’s kind of like what we’re seeing in this population. And it’s horrible to think about.”
What’s more, most of the athletes he’s seen were tested just days after their most recent injury. On average, the women he saw were injured around a year before they were tested — meaning their symptoms had persisted.
Researchers like Van Donkelaar and Haag are even beginning to wonder whether there are links between repeated incidents of domestic violence and longer term deterioration, like dementia and early-onset Alzheimer’s disease, though this hasn’t yet been studied.
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Symptoms of traumatic brain injury range from headaches and dizziness, to difficulty organizing thoughts or trouble concentrating, to irritability and sadness, according to a toolkit set up by researchers at Wilfrid Laurier and the University of Toronto.
These symptoms can even compound a woman’s situation, making her testimony seem unreliable because she can’t keep her story straight and is too emotional, or even making it harder to plan to leave her abuser, Valera said.
“If they want to get out of the relationship, you need a lot of cognitive reserve and a lot of mental capabilities to try to really safely navigate your way out of what is often a very challenging and dangerous situation. That could be seriously compromised if you have repetitive concussions, which a lot of these women do.”
Karen Mason, former executive director of the Kelowna Women’s Shelter, said that even front-line workers at shelters don’t recognize when their clients may have suffered a brain injury.
“It’s become abundantly clear that we see signs of it on a regular basis, but we didn’t necessarily know what we were seeing.”
“So front-line staff in shelters, many shelters that I’ve been in including Kelowna Women’s Shelter, will often complain about residents who don’t do their chores while staying in the shelter, who rage at their children, who are difficult and oppositional with staff, who are up all night because they can’t sleep, who don’t remember their appointments and can’t seem to fill out forms.”
In some cases, she said, women have even been moved out of shelters because of this kind of behaviour.
“When we step back and realize that brain injury is a factor that we’ve never considered, it becomes a really big ‘aha’ moment.”
“What if many of these women, if not all of them, who have to date been seen as difficult, forgetful, oppositional, just a problem, are in fact the women who need us the most? And we just haven’t known how to serve them or known what to look for?”
Mason, who co-founded the Supporting Survivors of Abuse and Brain Injury through Research (SOAR) project with Van Donkelaar, said a key goal of the research is to better educate front-line workers on recognizing and accommodating the “invisible epidemic” of women with brain injury.
The SOAR team is working on a tool, building on previous tools used to assess athletes, to help people assess survivors of abuse for signs of brain injury. Another team in Ontario has built an educational website to help people understand brain injury in this population and is conducting workshops for people in the field.
The goal, Haag said, is to raise awareness and ultimately to connect injured women and other sufferers of intimate partner violence with the help they need.
“There seems to be a lot of support, and I do feel really positive about that.”