Domestic violence causes brain injuries, and advocates say not enough people are talking about it

In the face of growing public awareness around sport-related brain injuries and concussions, advocates say domestic violence also carries a significant risk of brain injury, yet receives far less attention.

Survivors like Julie Waters carry the damage with them for years after leaving violent relationships. Waters says she spent two years dating a man who, by the end of their relationship, hit her "four or five times a day."

Since then, she's lived with memory problems that she says were never an issue for her before. Still, no one has ever suggested she be screened for a brain injury.

Waters said she now wishes someone had.

"When I was playing sports, and then, if I got injured, [I think of] how seriously it was taken. I was injured more seriously when I was in this relationship than I did in any of my years playing rugby or hockey," said Waters, a former athlete.

Research suggests that between 19 and 75 per cent per cent of domestic violence survivors suffer a brain injury at the hands of a partner, although statistics differ based on the population studied.

But public knowledge around brain injuries caused by domestic violence lags behind, some advocates say.

"I am surprised at the numbers [of women] that continue to say, 'Nobody asked me about the headaches, about the vision problems,'" said Kathy Lawrence, a clinical psychologist who works with the Haven House and Anselma House women's shelters in Waterloo region.

Even those who work directly with survivors may be unaware of the signs of traumatic brain injury, according to a recent survey of frontline workers by the Acquired Brain Injury Research Lab at the University of Toronto.

"There is a huge amount of education and knowledge that needs to be done," said researcher Angela Colantonio.

Injuries make leaving more difficult

Part of the problem is that brain injuries are often invisible. Research shows that domestic violence injuries often involve the face, head and neck, and Lawrence said abusers often hit their victims around the hair as a way to hide an injury.

"You don't see the bruise, and you don't see the swelling," she said.

Lawrence said she makes a deliberate effort to ask patients about possible brain injuries.

She watches them carefully for symptoms such as headaches, vision problems, forgetfulness and extra sensitivity to light and sound, before referring them for further screening by a doctor. 

Dealing with a brain injury can also make it more difficult for women to reach out for help in the first place, advocates say.

Leaving a violent relationship isn't as simple as just opening the door and going. Instead, it involves creating a detailed safety plan, which is much harder when remembering something as simple as a phone number becomes difficult.

"Their executive functioning can be impaired from the head trauma and then it's harder to make decisions," said Jen Hutton, CEO of Women's Crisis Services of Waterloo Region, which runs Anselma House and Haven House. 

"It's just another layer that really complicates an already very complicated situation."

'Huge amount of education' needed

Lawrence said shelters can help women with possible brain injuries by providing quiet spaces to rest and by trying to give them extra time to fill out forms and make appointments.

But she said change also needs to happen at a broader level in the healthcare system. 

Lawrence said she'd like to see material about brain injuries and domestic violence incorporated into various healthcare curriculums and for healthcare providers to develop clinical guidelines on the subject. 

She also wants treatments for brain injury — such as physiotherapy — to be covered by provincial healthcare plans.

Colantonio's research group is hoping to improve public awareness through an online toolkit with information on what brain injuries look like and how common they are. 

As for Waters, she said she wishes she'd had more information about domestic violence, before getting into a serious relationship.

She also wants all survivors coming out of these situations to have a medical exam — including screening for brain injuries — to keep women like her from slipping through the cracks.

"Because you don't really know what they have gone through, and they're probably not going to tell you everything right away," she said.