Photo: Identifying TBI in Survivors

Identifying TBI in Survivors

Healthcare professionals can have difficulty identifying brain injury for many reasons, and in survivors of IPV it can be particularly challenging.

First, IPV survivors may not seek out care because they do not want to disclose their circumstances, may not be aware of their head injury and its consequences, or may not recall that they were hit on the head or strangled. They may also not be aware that violent shaking of the body can cause a brain injury.

Even if a survivor goes for medical care, traumatic brain injury can be difficult to detect, particularly if the woman has sustained multiple injuries. In such cases, signs of a brain injury may be missed, with visible injuries such as bruising and broken bones, being given priority.1

Secondly, signs of a traumatic brain injury may not appear immediately. They can present days, or even weeks later.2 These include symptoms such as depression, anxiety and impulsivity, among others.3 Healthcare professionals and survivors themselves may not know that these symptoms are the result of a brain injury.

Finally, the type of brain injury that affects women survivors of IPV most can be difficult to identify with certainty. Traumatic brain injury can be categorized by the severity of the injury as mild, moderate, or severe TBI. The type of traumatic brain injury that most often affects women survivors of IPV is mild traumatic brain injury (mTBI), also referred to as concussion,4 which may not involve loss of consciousness or amnesia, the more obvious indicators of a brain injury. A person does not need to be hit on the head or lose consciousness to have a concussion. It can be caused by a significant shake, jolt, or blow to the body. Symptoms can include confusion, delirium, or sleepiness, signs that may be mistaken as distress caused by the abuse itself.


1J. Brown, B. Luckhardt, L. C. Koss, and M. Cantu, “Traumatic Brain Injury (TBI) and Domestic Violence: a Beginner’s Guide for Professionals,” J. Forensic Sci. Crim. Investig., vol. 8, no. April 2018, 2018.

2Centers for Disease Control and Prevention, “Traumatic Brain Injury & Concussion Signs and Symptoms,” Centers for Disease Control and Prevention, 2017. [Online]. Available:

3D. K. Menon, K. Schwab, D. W. Wright, A. I. Maas, Demographics, I. Clinical Assessment Working Group of the, I. Interagency Initiative toward Common Data Elements for Research on Traumatic Brain, and H. Psychological, “Position statement: definition of traumatic brain injury,” Arch Phys Med Rehabil, vol. 91, no. 11, pp. 1637–1640, 2010.

4Y. Goldin, H. L. Haag, and C. T. Trott, “Screening for History of Traumatic Brain Injury Among Women Exposed to Intimate Partner Violence,” PM&R, vol. 8, no. 11, pp. 1104–1110, 2016.