Illuminating Hidden Trauma: The Prevalence of Traumatic Brain Injury in Cases of Intimate Partner Violence

Traumatic brain injury

Every 20 minutes, someone in the United States experiences intimate partner violence (IPV).

According to the Centers for Disease Control (CDC), the term “intimate partner violence” describes physical, sexual, or psychological harm by a current or former partner or spouse. Some may think of physical harm in terms of what is visible to the naked eye, but one of the hidden dangers is the risk of traumatic brain injury (TBI).

Eve Valera, PhD, an Assistant Professor at Harvard Medical School, and a researcher at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital, uses neuroimaging to make the hidden trauma of TBI visible while studying the impact of TBI on female IPV survivors.

What is a TBI?

The CDC defines a traumatic brain injury as “disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.” Symptoms can include headache, feeling lethargic, nauseous, and having difficulty remembering new information.

TBI is most talked about in regards to football players, where it has been linked to chronic traumatic encephalopathy (CTE). CTE is a degenerative brain disorder linked to dementia, suicidal behavior, memory decline and changes in mood and decision making.

The long-term impact of TBIs on victims of IPV is understudied. However, there are similarities between the TBI survivors and NFL players in that they commonly endure one or more mild TBIs over an extended period of time.  A critical difference however, is that IPV survivors do not have the same access to treatment that football players do and may not have adequate time to recover between TBIs.  

The impact of TBI on IPV survivors

It can be difficult for some people to understand why a person would remain in an abusive relationship, but there are several barriers that may prevent them from doing so. Disability, immigration status, poverty, and fear of violence are a few common barriers that prevent people from leaving, which makes IPV survivors particularly vulnerable to multiple TBIs.

Valera first became interested in studying the impact of TBIs in women experiencing IPV while volunteering in a domestic violence shelter. After witnessing IPV’s effects firsthand, she decided to devote part of her research to raising awareness about the long-term health implications of suffering repeated injuries to the head in the context of an abusive relationship.

“The number of women sustaining unrecognized and unacknowledged TBIs is likely staggering when considering the global population of victims of IPV.”

Eve Valera, PhD

In one of her studies, Valera evaluated women both in and outside of shelters to better understand the prevalence of IPV. She found that three quarters of the women suffered from at least one TBI, and about half suffered from multiple TBIs.

Another of her studies found that TBIs are associated with degree of brain connectivity that was also associated with measures of learning and memory.

Since leaving an abusive relationship can be challenging and sometimes dangerous, Valera is looking to find new ways of intervening that could better support IPV survivors.

“The reality is they are struggling to manage a complex and often dangerous situation with a possible brain injury that no one is acknowledging. These difficulties only get worse with multiple TBIs.”

Eve Valera, PhD

Possible interventions to prevent long term damage from TBI

One intervention she has suggested involved first responders and how they may be able to help.

First responders and police can sometimes misinterpret the signs of TBI, says Valera.

In an interview with WCVB TV, she explained, “They may see a woman who’s disoriented and  giving an inconsistent story. Instead of thinking, ‘She may have a TBI,’ they may think ‘She’s lying because she said one thing a minute ago and now she’s saying something else.’”

Valera believes educating police, emergency room staff, and first responders about the risks and frequency of undiagnosed TBI in IPV survivors could be a good first step to better supporting their health and recovery.

“It is also critical that we inform the women themselves, that repetitive hits to the head sustained via IPV, may be affecting their short and long-term cognitive, psychological and physical health.  Repetitive TBIs are not just a football or military problem.”

Eve Valera, PhD

If you or someone you know has experienced intimate partner violence, here are some resources that can help. If you are in immediate danger, call 911.


  1. National Domestic Violence Hotline
    1. 1-800-799-SAFE (7233)
    2. Online Chat
  2. National Coalition against Domestic Violence
  3. Intimate Partner Violence Resources from the Centers for Disease Control
  4. Massachusetts Domestic Violence Help, Programs and Resources

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