
- Vol 39, Issue 4
Violence Against Women and Acquired Brain Injuries
Violence against women and resulting traumatic brain injuries increased during the COVID-19 pandemic.
Violence against women, which can result in traumatic brain injury (TBI) and other acquired brain injuries (ABIs), intensified during the COVID-19 pandemic. A comprehensive and long-term strategy is required to address this issue and to ensure the mental well-being of women.
The Case of Gabby Petito
In July 2021, social media influencer Gabby Petito and her fiancé, Brian Laundrie, embarked on a cross-country road trip captured on Instagram and YouTube.1 In September, Laundrie returned—alone. Weeks later, Petito’s remains were found. It was determined that she died from strangulation, and her case opened a national conversation about intimate partner violence (IPV).2
Tragically, Petito’s case is just 1 of many. There has been an increase in IPV, illuminating a shadow pandemic within the
The neurological consequences and IPV-related ABIs, including TBI, are devastating. Despite recent increased focus on sports-related TBI, little attention has been paid to TBI resulting from IPV.8 Yet, up to 90% of IPV survivors report head, neck, and facial injuries, which can result in TBI.9,10 One study found that 74% of the women who experienced IPV sustained at least 1 IPV-related TBI and 51% suffered repetitive IPV-related TBIs.11 The study also found higher brain injury scores were negatively associated with memory, learning, and cognitive flexibility and positively associated with a number of measures of psychological distress.11
IPV-related ABI also includes nontraumatic brain injuries. Research has shown that 1 in 10 women has been choked by an intimate partner,12 which can cause hypoxic-anoxic
After the Violence Has Ended
In addition, women who experience IPV also are more likely to suffer from anxiety, depression, posttraumatic stress disorder, suicidal ideation, and other health problems that can last after the violence has ended.4,14
There is also concern that repeated TBIs from IPV may result in chronic traumatic encephalopathy (CTE), a progressive and fatal neurodegenerative disease that cannot be diagnosed until postmortem.8,15-18 For instance, a 1990 report identified a case of a woman who apparently developed CTE from partner abuse.19 In 2021, during a postmortem examination of a young woman who died after a
Current Research
The neurological effects of IPV extend to the family and remain underresearched. A recent Brain Injury Australia report found that of 16,000 survivors of family violence attending Victoria hospitals over a decade’s time, 2 in every 5 had suffered brain injury.23 Further, nearly 1 in 3 of the survivors of family violence were children; of those, 1 in 4 had suffered a brain injury. Because this was not a study of IPV but of hospitalizations, it likely represents the tip of the iceberg. Another study across 5 domestic abuse shelters in Arizona found 9 in every 10 individuals reported a head injury with loss of consciousness from family violence in the preceding 12 months.24 Of those, 9 in 10 reported “too many head injuries to quantify.” Yet only 1 in 5 ever sought medical attention. Thus, community rates of IPV ABI remain radically underresearched.
Most domestic violence shelters and emergency department settings do not assess for TBI, nonfatal strangulation, or other brain injuries from IPV.13,15,25 Plus, many women do not seek medical care for their IPV-related ABI.26 However, even when women interact with health care and domestic violence advocates, there is a lack of training to adequately screen for and address IPV-related ABI.7,23
Further, a study of women in prison found that 78% had significant head injury; 84% had experienced repeated head injury largely due to domestic abuse.27 Yet screening and care for
The Brain Health Gap & Brain Capital
IPV-related ABI adds yet another injustice to the brain health gap, which highlights and frames the sex and
Likewise, the world is suffering a global brain capital collapse.30-32 Brain capital is a novel econometric asset that puts a premium on brain health and skills in our brain economy.30,31 This is a form of capital relevant to a complex, interconnected, and fragile global economy. Brain capital needs to be integral to a new narrative of growth and progress that puts individuals and their well-being, health, interaction with others, and psychological resilience at the center of our economic system. Female empowerment—which includes preventing and addressing violence against women and better identifying and caring for the neurological effects in survivors—is a public and brain health imperative as well as the most effective way to build brain capital globally.
Concluding Thoughts
Addressing gendered violence and related ABIs can be remedied by integrating the social, medical, political, policy, and diplomatic levels. Taking sex and gender into account—including structural and social determinants—is critical for equality in brain health and precision medicine. The Organisation for Economic Co-operation and Development (OECD) New Approaches to Economic Challenges Unit’s Neuroscience-inspired Policy Initiative (NIPI) seeks to tackle this issue.30,31,33 We aim to find new ways to reconceptualize and revitalize the economy and how it works, laying the groundwork to identify relevant metrics while building a transdisciplinary network of stakeholders. The effort draws on experts from medicine, neuroscience, gender analysis, economic policy, philanthropy, and business. The initiative will rapidly refine and advance women’s brain health via a series of research projects, seminars, and clear policy analyses and recommendations. We hope to help build a future in which al individuals are equipped with the support, resources, and care they need to thrive and in turn build a more resilient society and world.
Ms Smith is an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI) (at the University of California, San Francisco and Trinity College Dublin), a Thiel Fellow at Stanford University and Steering Committee member for NIPI (OECD, Meadows Mental Health Policy Institute and the PRODEO Institute). Mr Rushworth is the CEO of Brain Injury Australia. Dr Valera is an associate professor in psychiatry at Harvard Medical School and a research scientist at Massachusetts General Hospital. Dr Chadha ishead stakeholder, Engagement for Alzheimer disease at Biogen and Pro Bono CEO and cofounder of the Women’s Brain Project. Dr Hynes is head of the OECD New Approaches to Economic Challenges Unit, senior advisor to the OECD secretary general and colead of OECD NIPI. Ms Kawaguchi is advisor to the chief of staff and gender advisor at OECD. Dr Wolfe is a senior clinical advisor for Cohen Veterans Bioscience’s trauma research programs. She serves as strategic advisor coleading CVB’s Suicide Strategy Initiative. Dr Eyre is colead of OECD NIPI, strategic advisor to the HEKA Fund (Newfund Capital and Fondation FondaMental), steering committee member for the Brain Health Nexus at Cohen Veterans Bioscience, and holds adjunct roles with IMPACT at Deakin University, GBHI, and Baylor College of Medicine.
References
1. Rosman K. How the case of Gabrielle Petito galvanized the internet. The New York Times. October 20, 2021. Accessed November 20, 2021.
2. Santucci J. Gabby Petito was strangled. Experts say such an assault is a red flag for intimate partner homicides. USA Today. October 12, 2021. Updated October 13, 2021. Accessed November 20, 2021.
3. Evans ML, Lindauer M, Farrell ME.
4. Valera EM.
5. Breiding MJ, Smith SG, Basile KC, et al.
6. United Nations Office on Drugs and Crime. Global study on homicide: gender-related killing of women and girls. 2018. Accessed November 20, 2021.
7. Mlambo-Ngcuka P. Gender-based violence: we must flatten the curve of this shadow pandemic. November-December 2020. Accessed November 20, 2021.
8. Pandaram J. Concussion in sport: domestic violence victims show same brain injury trauma as athletes with CTE. The Daily Telegraph. April 18, 2021.
9. St Ivany A, Schminkey D.
10. Liu LY, Bush WS, Koyutürk M, Karakurt G.
11. Valera EM, Berenbaum H.
12. Monahan K, Purushotham A, Biegon A. Neurological implications of nonfatal strangulation and intimate partner violence. Future Neurology. 2019;14(3).
13. Glass N, Laughon K, Campbell J, et al.
14. Lagdon S, Armour C, Stringer M.
15. Monahan K.
16. Monahan K. Intimate partner violence and traumatic brain injury: a public health issue. J Neurol Neuromed. 2018;3(3):3-6.
17. Stern RA, Daneshvar DH, Baugh CM, et al.
18. Baugh CM, Stamm JM, Riley DO, et al.
19. Roberts GW, Whitwell HL, Acland PR, Bruton CJ.
20. Danielsen T, Hauch C, Kelly L, White CL.
21. Leung FH, Thompson K, Weaver DF.
22. Livingston G, Huntley J, Sommerlad A, et al.
23. Brain Injury Australia. The prevalence of acquired brain injury among victims and perpetrators of family violence. 2018. Accessed November 20, 2021.
24. Zieman G, Bridwell A, Cárdenas JF.
25. Meyer JE, Jammula V, Arnett PA.
26. Valera E, Kucyi A.
27. McMillan TM, Aslam H, Crowe E, et al.
28. Aragam GG, Kawaguchi N, Hynes W, et al. Highlighting brain-based inequalities for women: from bedside and boardroom to policy. Psychiatric Times. May 5, 2021. Accessed November 20, 2021.
29. Smith E, Kawaguchi N, Chapman SB, et al. Closing the brain health gap: addressing women’s inequalities. Oxford University Press Blog. August 21, 2021. Accessed November 20, 2021.
30. Smith E, Ali D, Wilkerson B, et al.
31. Eyre HA, Ayadi R, Ellsworth W, et al.
32. Ellsworth W, Smith E, Chapman SB, et al. Move over data, brain capital is the new oil. Psychiatric Times. January 14, 2021. Accessed November 20, 2021.
33. Neuroscience-inspired policy initiative. Organisation for Economic Co-operation and Development. Accessed November 20, 2021.
Articles in this issue
over 3 years ago
Evaluating Every Patientover 3 years ago
What You Need to Know About the Civil Rights Complaint Processover 3 years ago
Clara Park’s Network of Correspondence About Autismover 3 years ago
APhA Conference Addresses Depression, Benzosover 3 years ago
Naloxone as a Tool to Fight the Opioid Epidemicover 3 years ago
Black Women in Sport and the Weaponization of Beauty Standardsover 3 years ago
Upon the Shores of Social ConstructionNewsletter
Receive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients.