An Overlooked Epidemic: Traumatic Brain Injuries In Women Survivors Of Intimate-Partner Violence

A new study explores the neural mechanisms of traumatic brain injuries in women who suffer intimate-partner violence

Intimate-partner violence (IPV) is a critical public health concern, impacting approximately a third of women over the age of 15 worldwide. And as many as 75 percent of sampled women who have experienced intimate-partner violence have suffered multiple partner-related traumatic brain injuries (TBIs). This can have serious negative consequences—among them, deficits in memory, learning and cognitive flexibility—that can impair a woman’s daily functioning. Unfortunately, these TBIs too often go unrecognized by the women themselves and by their caregivers.

Eve Valera, director of the Cerebellar Psychiatric Research Laboratory at the MGH Martinos Center for Biomedical Imaging and an assistant professor in Psychiatry at Harvard Medical School, wants to increase awareness of and knowledge about TBIs related to intimate-partner violence, and thus help provide appropriate care and treatment and ultimately improve health outcomes for the women. But to do this, she said, “we need to understand the neural mechanisms underlying TBIs sustained by women survivors of IPV, as well as to understand how these TBIs and their underlying neural mechanisms relate to cognitive functioning.”

In a recent study Valera and Aaron Kucyi, then a postdoctoral fellow in the Center, set out to do just that. Using resting-state functional MRI in a group of 20 participants recruited largely from women’s shelters, they examined the relationship between the severity of TBIs suffered and the strength of functional connectivity in the relevant regions of the brain, and then linked this connectivity with measures of memory and learning. They reported their findings in the journal Brain Imaging and Behavior in October.

Remarkably, given the intense focus on traumatic brain injury in recent years, this was the first study to explore such questions in this population. This is important, because the type and sequelae of TBIs that the women sustain—especially over time—may be unique, and they can even play a role in the women’s struggles to leave a relationship.

When asked why no researchers had previously reported on TBI in women who have experienced intimate-partner violence, Valera pointed to the unique challenges in working with this population. Women may not be able to safely participate because they might still be in stressful or vulnerable situations, for example. At the same time, she noted the relatively “invisible” nature of the injuries, especially in these cases. Even as the dangers of TBI in athletes and military personnel are making headlines, the potential for such injuries as a result of intimate-partner violence goes largely unrecognized. This is a population that is often misunderstood and overlooked, she said. Worse still, we often see “victim blaming” in cases of intimate-partner violence, and this could play a role in diminishing the perceived importance of the research.

The Brain Imaging and Behavior study helps to shine a light on the problem while contributing to better understandings of the neural mechanisms of the TBIs—understandings that could enable important advances in care. The results showed that the severity of traumatic brain injury was associated with a loss of functional connectivity between regions of the brain that are implicated in TBI in other populations. Importantly, functional connectivity between these same regions correlated positively with cognitive performance on indices of memory and learning.

“These data are a critical first step in trying to improve health outcomes as the data provide the first mechanistic evidence of TBI and its association with cognitive functioning in women sustaining IPV-related TBI,” Valera said. “As we get closer to understanding the neural and cognitive sequelae of IPV-related TBI, we increase our chances of being able to work more appropriately with these women and provide effective interventions.”

The investigators are already planning to follow up these findings. In studies they are now designing, they will recruit a larger group of women to better understand the likely complex relationship between trauma and TBI in those subjects, and employ additional measures to identify other potential biomarkers of TBI. Finally, they hope to gather data on the possible long-term effects of TBIs in women who sustain intimate-partner violence. Currently there are no data on these effects, Valera said, and thus no understandings of whether the TBIs lead to neurodegenerative changes such as chronic traumatic encephalopathy, which is often seen in athletes and others with repetitive traumatic brain injuries.