Almost one third of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner worldwide (WHO et al., 2013). Intimate partner violence (IPV) is defined as a pattern of physical and/or sexual violence in the context of coercive control by an intimate or ex-intimate partner (Humphreys and Campbell, 2004). It is a recognized public health issue that directly affects the victim and has consequences that extend to families, communities and society at large (Sinha, 2015). Women who have suffered from IPV report higher rates of a myriad of significant health problems (Figure 1) (WHO et al., 2013). The impacts of IPV on health are only beginning to surface in the fields of scientific research and healthcare.
Dr. Mohit Bhandari, an orthopaedic surgeon and professor at McMaster University, co-led a study that revealed that one in six women who come into fracture clinics have been abused by their partners in the last year (PRAISE Investigators et al., 2013). This number is likely to be greater in reality, since IPV incidents go unreported due to stigma and/or fear. Dr. Bhandari rightly believes that this research is critical because health-care professionals in injury clinics have the opportunity to identify patients experiencing domestic violence (Craggs, 2013). Furthermore, this research reveals the need for orthopedic surgeons to educate themselves and be trained to ask questions.
One significant outcome of IPV is the potential for victims to experience traumatic brain injury (TBI), a physiological disruption in brain function due to an external physical force. The areas that are most likely to be injured from IPV are the head, neck, and face, and roughly half of IPV victims also incur injuries from attempted strangulation (Kwako, Glass et al., 2011). Such injuries can all lead to TBI (Kwako, Glass et al., 2011). TBI research has previously primarily addressed athlete and military clinical populations. Nevertheless, current research suggests that TBI often accompanies IPV and is unlikely to be reported or treated in medical settings (Kwako, Glass et al., 2011).
In general, symptoms of post-concussive syndrome (PCS) following TBI include: disturbed sleep, anxiety or depression, dizziness or vertigo, apathy/lack of spontaneity, headache, personality changes, irritability, and becoming easily fatigued (APA, 2000). Women experiencing IPV display many PCS symptoms; however, PCS is rarely identified as an outcome of IPV (Kwako, Glass et al., 2011). These symptoms have significant functional implications in daily life in addition to placing an individual at risk for sustaining another TBI (Hunnicutt, Lundgren et al., 2016). This is because TBI can affect decision-making abilities, concentration, and judgment; thus, it may be difficult for such an individual to extract themselves from a violent situation or seek help (Hunnicutt, Lundgren et al., 2016). Repeated TBIs can further lead to chronic traumatic encephalopathy, a disease that involves progressive neurodegeneration (Hunnicutt, Lundgren et al., 2016).
There are several challenges in identifying TBI in people who have experienced IPV. One of these challenges is that many symptoms following TBI overlap with post-traumatic stress disorder (PTSD). As a result, it is difficult to parse whether the diagnosis should be psychiatric or neurological. Fortunately, many treatments and interventions work for both PCS and PTSD. Another challenge is presented by the culture of silence that surrounds IPV, which prevents accurate diagnoses and intervention for IPV-related TBI (Hunnicutt, Lundgren et al., 2016).
This issue is undoubtedly distressing; however, research on IPV-related TBI is an opportunity scientists have to impact society in a positive way.
Works Cited
Craggs, S. 2013. 1 in 6 women at fracture clinics have been abused, study shows. CBC.
Humphreys, J. and Campbell, J.C. 2004. Family violence and nursing practice. Philadelphia, PA: Lippencott.
Hunnicutt, G., Lundgren, K., Murray, C. and Olson, L. 2016. The Intersection of Intimate Partner Violence and Traumatic Brain Injury: A Call for Interdisciplinary Research.
PRAISE Investigators, et al. 2013. Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study. The Lancet 382(9895) 866-876.
Kwako, L.E. et al. 2011. Traumatic Brain Injury in Intimate Partner Violence: A Critical Review of Outcomes and Mechanisms. Trauma, Violence, & Abuse 12(3) 115-126.
Sinha, M. 2015. Section 3: Intimate partner violence. In S. Canada ed.
WHO, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council, 2013. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence.