TBI and Domestic Violence

If YOU are in a domestic violence situation or you need immediate assistance: 

Contact 911 

Washington Information and Referral | (domesticviolenceinforeferral.org) 

National Domestic Hotline or Call 800 799 7233 

Wa211.org

Domestic Violence, Intimate Partner Violence and TBI 

Intimate Partner Violence (IPV) includes any behaviors that one intimate partner (current or former) uses over another to establish power and control. This can include physical or sexual violence, but not always. It can also be financial, emotional, psychological, cultural, spiritual, reproductive and other controlling behaviors. Some forms of IPV can be perpetrated electronically through mobile devices and social media sites, as well as in person. IPV can occur regardless of whether the individuals live together or not. This is usually what separates IPV from domestic violence.

Domestic Violence usually refers to violence occurring between residences within one single location. It is a pattern of controlling behavior used to maintain power in a relationship by one partner over the other. 

Domestic violence is a common cause of traumatic brain injury. While a disproportionate amount of these individuals are adult women, both adult men and children can be victims of the severe physical violence that causes these injuries in a domestic setting. 

What is a traumatic brain injury?  

A Traumatic Brain Injury (TBI) is an injury to the brain caused by physical trauma resulting from, but not limited to, incidents involving motor vehicles, sporting events, falls, and physical assaults. A TBI shall be of sufficient severity to result in impairments in one or more of the following areas: cognition; language memory; attention; reasoning; abstract thinking; judgment; problem solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; or information processing. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma. Acquired brain injury, stroke, or mental health issues with no TBI do not fall under this definition.  

A victim of DV or IPV may sustain a TBI without their knowledge, especially if there are no signs of obvious signs of trauma or other TBI-related symptoms. Many individuals may receive no medical care or intervention, thus dramatically increasing the likelihood of recurrent TBI(s), which may result in more severe neurological damage. 

Common causes of closed head injuries among DV or IPV victims: 

  • Objects striking the head or neck 
  • Pushed against a wall or other surface 
  • Pushed down a flight of stairs 
  • Violent physical shaking or strangulation

An individual that has sustained a TBI may not recognize they are experiencing issues related to a TBI because many of the associated symptoms are common in everyday life. The most widely reported TBI-related symptoms are headaches, severe neuro-fatigue, working memory issues, anxiety, depression, and impairments in social communication. Learn more about TBI Symptoms and Effects

Service Providers and Trauma-Informed Care 

Service providers who adopt a trauma-informed approach can aid in the healing process and allow for the best possible outcomes for survivors of DV and IPV. For a service provider to be trauma-informed in practice means establishing a pathway that will not further re-victimize the individual seeking their services. In accomplishing this goal, the service provider will be holistically supporting victims of DV and IPV in their recovery and healing trajectories.

Tips for service providers: 

  • Collaborate with the individual in establishing a safety and treatment plan. 
  • Establish a connection based on respect and focus on the individual’s strengths. 
  • Promote emotional safety by reducing potential trauma-inducing triggers. 
  • Help the individual understand the nature of their trauma symptoms.

The service provider would also benefit from incorporating active listening and validation of the individual’s emotional state. This strategy enables the service provider to foster trust and guide the DV and IPV victim through strategies to diminish extreme stress, everyday obstacles, and recurrent trauma. The goal is for the service provider to acknowledge the individual first and foremost, and not any potential diagnosis (i.e., behaviors and symptoms).

Service Providers and Screening Tools 

Individuals living with DV may find it difficult to recover from a TBI. The high probability of recurrent physical injuries without any medical intervention facilitates a situation where individuals are more likely to experience severe TBI-related symptoms over a prolonged period. Screening for TBI among individuals that experience DV can potentially reduce the physical, behavioral, and cognitive consequences of a TBI by identifying those individuals that require more extensive medical care. However, service providers need to remember that there are several obstacles for an individual that has sustained multiple TBI(s) as a result of DV.

A TBI can make it harder for a victim of DV or IPV to: 

  • Remove themselves from an abusive environment. 
  • Create and sustain a safety plan. 
  • Assess potential dangers and react appropriately. 
  • Engage in educational opportunities. 
  • Access service providers that can enable independent living. 
  • Adapt to living in a DV shelter. 
    • The victim may become anxious and confused or disruptive or have trouble understanding or remembering shelter rules and procedures.

TBI Screening Assistance 

Screening for TBI among victims of DV is essential. A brief assessment tool designed to be used by professionals who are not TBI experts is known as HELPS Screening Tool

Working with DV victims after a TBI 

Adopting the following strategies can aid a service provider in navigating an individual’s impairments in cognition, behavior, and executive functioning to optimize their well-being. 

  • During meetings, reduce unnecessary distractions, such as bright lights and noise. 
  • Break safety planning into sequences of smaller steps. 
  • Review safety planning frequently. 
  • Aid in the development of checklists, goal creation, and time management. 
  • Allow extra time for them to complete tasks (e.g., forms, phone calls, decisions-making, etc.). 
  • Be factual, realistic, and concrete in your statements; break information down into small pieces. 
  • If safety allows, write important information down in a journal or calendar, such as court dates, contact numbers, directions, order of protection information, to-do lists, etc. 
  • Coordinate with the individual to optimize the management of their lives, in terms of accessing benefits, rehabilitation and support services, assistive devices (voice recorders, timers, PDAs, post-its, etc.) service animals, and independent living. 
  • Provide respectful feedback on problem areas that affect the safety and possible consequences of long-term/short-term decisions.

Washington Domestic Violence Resources