Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults
(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic v...
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MDPI AG
2025-05-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/15/5/524 |
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| author | Julianna M. Nemeth Clarice Decker Rachel Ramirez Luke Montgomery Alice Hinton Sharefa Duhaney Raya Smith Allison Glasser Abigail (Abby) Bowman Emily Kulow Amy Wermert |
| author_facet | Julianna M. Nemeth Clarice Decker Rachel Ramirez Luke Montgomery Alice Hinton Sharefa Duhaney Raya Smith Allison Glasser Abigail (Abby) Bowman Emily Kulow Amy Wermert |
| author_sort | Julianna M. Nemeth |
| collection | DOAJ |
| description | (1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (<i>n</i> = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered. |
| format | Article |
| id | doaj-art-8dbf7c6d97d54b51a218309bfb4af327 |
| institution | Kabale University |
| issn | 2076-3425 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj-art-8dbf7c6d97d54b51a218309bfb4af3272025-08-20T03:47:49ZengMDPI AGBrain Sciences2076-34252025-05-0115552410.3390/brainsci15050524Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic InsultsJulianna M. Nemeth0Clarice Decker1Rachel Ramirez2Luke Montgomery3Alice Hinton4Sharefa Duhaney5Raya Smith6Allison Glasser7Abigail (Abby) Bowman8Emily Kulow9Amy Wermert10College of Public Health, The Ohio State University, Columbus, OH 43210, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USAOhio Domestic Violence Network, Columbus, OH 43215, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USAOhio Domestic Violence Network, Columbus, OH 43215, USACollege of Public Health, The Ohio State University, Columbus, OH 43210, USA(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (<i>n</i> = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered.https://www.mdpi.com/2076-3425/15/5/524domestic violence (DV)strangulationhypoxic–anoxic brain injury (HAI)head traumatraumatic brain injury (TBI)intimate partner violence (IPV) |
| spellingShingle | Julianna M. Nemeth Clarice Decker Rachel Ramirez Luke Montgomery Alice Hinton Sharefa Duhaney Raya Smith Allison Glasser Abigail (Abby) Bowman Emily Kulow Amy Wermert Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults Brain Sciences domestic violence (DV) strangulation hypoxic–anoxic brain injury (HAI) head trauma traumatic brain injury (TBI) intimate partner violence (IPV) |
| title | Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults |
| title_full | Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults |
| title_fullStr | Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults |
| title_full_unstemmed | Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults |
| title_short | Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults |
| title_sort | partner inflicted brain injury intentional concurrent and repeated traumatic and hypoxic neurologic insults |
| topic | domestic violence (DV) strangulation hypoxic–anoxic brain injury (HAI) head trauma traumatic brain injury (TBI) intimate partner violence (IPV) |
| url | https://www.mdpi.com/2076-3425/15/5/524 |
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