Abuse Victims Are Suffering Brain Injuries at Rates Unseen in Some Sports, Study Reports

While the potential of brain injuries in athletics has gained widespread attention in recent years, the vulnerability of another high-risk population has gone largely unnoticed.

Victims of interpersonal violence are commonly dealt blows to the head and neck—many experiencing repeated hits over time—which puts them at an elevated risk for traumatic brain injuries.

A new Trinity College study of 135 women in Greater Hartford found as many as 60 percent of survivors had symptoms that were consistent with having a brain injury.

By comparison, in collegiate football, the reported lifetime prevalence of traumatic brain injury has ranged from 21 percent to 25 percent, according to one 2019 commentary, “The Epidemiology of Sport-Related Concussion” in the Journal of Orthopaedic & Sports Physical Therapy.

However, with sports as with interpersonal violence, brain injuries are notably difficult to estimate due to lack of standardization of injury definitions and methods used to collect and report data, underreporting, and underdiagnosis.

For the new study, Sarah Raskin, Charles A. Dana Professor of Psychology and Neuroscience, collaborated with recent graduates Olivia DeJoie ’17, U.S. Department of Veterans Affairs; Carolyn Edwards ’08, University of Leipzig Medical Center; and Chloe Ouchida ’21, Jocelyn Moran ’22, Olivia White ’20, Michelle Mordasiewicz ’22, Dorothy Anika ’22, and Blessing Njoku ’23.

Researchers worked with 50 survivors of interpersonal violence, 50 individuals who had not experienced interpersonal violence, and 25 victims of sexual assault. The results are published in the May 2023 issue of Clinical Neuropsychologist.

In the study, the average number of hits sustained to the head reported by survivors was 10, with a high of 100. In addition to blows, many of the participants had experienced nonfatal strangulation, which can also result in brain trauma, wrote the authors. Strangulation is defined as the application of external pressure to the throat either by hands or an object.

To determine the traumatic brain injury likelihood—this type of injury cannot easily be determined by scans or medical tests—researchers studied the cognitive performance of all participants.

Using Centers for Disease Control criteria, the researchers found 60 percent of the interpersonal violence survivors had potential traumatic brain injuries.

Women with a history of interpersonal violence demonstrated significantly lower scores on measures of verbal fluency, executive functioning, and memory recall as compared with women with a history of sexual assault. Among those, the women who had experienced strangulation demonstrated the lowest performance.

The interpersonal violence survivors also demonstrated significantly higher levels of depression, anxiety, and PTSD than the group not exposed to interpersonal violence.

Most previous studies of repetitive head injuries have looked at athletes who are physically fit, are diagnosed quickly, and receive immediate care. That is a dramatic contrast to interpersonal violence survivors. Only about half of the survivors studied had received medical treatment for their injuries, and those were primarily for emergency services.

The dearth of research on traumatic brain injuries in abuse survivors is likely due to the dual difficulty of low reporting to law enforcement and low levels of medical intervention due to fear of their attacker, fear of leaving children alone, and stigma, said researchers.

The study spotlights the need for health care providers, social service workers, shelter employees, lawyers, and others to screen for traumatic brain injury when working with victims of interpersonal violence.

Deficits from traumatic brain injuries could impede a survivor’s ability to respond and to extricate herself from the dangerous situation, the authors said.

More research is needed, the researchers said. The study was limited to women who are English-speaking, which does not represent the diversity of the country’s population. For example, immigrants may be particularly isolated by the factors related to their status, increasing their rates of traumatic brain injuries, they noted.

Further, while most interpersonal violence victims are women, much is unknown about the impact of traumatic brain injuries on women. And there is some evidence to suggest that women experience it differently than men.