Understanding Traumatic Brain Injury, Concussion and Strangulation in Domestic Violence



Health Cares about Domestic Violence (HCADV) Day aims to reach members of the health care community to acknowledge the critical importance of assessing for domestic violence, as well as the long term health implications of domestic violence and lifetime exposure to violence.

“I know I’m only one survivor of domestic violence with brain injury.  I’ve had many injuries that were not noticeable at first glance, however very few people know what I need to do every day in order to function and manage my life. The injury that I will never be able to forget is the brain injury.”*

How common is Traumatic Brain Injury (TBI) in acts of domestic violence? Domestic violence assaults can cause TBI as a result of punches or strikes to the head or face or from strangulation. Just imagine how often someone might be grabbed by the arms and slammed against the walls.  Can you picture someone being hit in the forehead abruptly with the heel of an abuser’s hand, jerking their head back violently?

In situations where the abuse continues, the injuries accumulate, compounding the effects, and the likelihood of recovery is dramatically decreased. Sustaining further head injury before complete healing of the original trauma will likely cause more serious injury and possibly a fatal outcome.

“We had 3 children at home and I was working 40 hours a week at a local mill.  We were working on putting a cellar in a house that we purchased.  I wasn’t working fast enough and he hit me in the head with a crowbar.  For a time I couldn’t move.  I stood there in my own little space and tried to get my mind and body to react.  He watched and laughed.  When I was able to speak, I wanted to be checked out.  He was unwilling to do so.  I awoke from a stupor the next morning and saw my kids.  The only difference there was from any other day was that I couldn’t remember their names.”*

Whether a victim loses consciousness or not, a concussion is defined as a mild brain injury.  Visible trauma does not have to occur for brain injury to exist. A victim can sustain a blow to the head without a loss of consciousness or another apparent reason to require medical attention. Studies have shown that as many as 70% of women who are seen for domestic violence concerns demonstrate findings consistent with TBI. There may not be any immediate physical sign that TBI has occurred, however: the effects of the injury have the potential to change someone’s life forever.

“Throughout the last 20 years there have been many things I’ve had to relearn or find a way around tasks that were once mundane.  I once was able to either read or hear directions and carry out a project with ease.  Not so now. I can not put together a puzzle.  I’ve lost the ability to do many of my favorite things like reading music, knitting or crocheting intricate patterns, cooking, or following directions to meetings.  Replacing batteries is even difficult for me. Shopping became extremely difficult.  Spelling was something I had down pat.  However, when I first tried to rebuild my life it took me 3 tries before I could write a list (toilet tissue) remember to take that list and actually purchase said toilet tissue.  I have had a savings account for a couple years.  I’ve used my card many times and knew my pin number, however sometimes I forget that pin and had to go home and look up that number.”*

How is strangulation associated with TBI? In the past, not enough attention has been placed on this issue, possibly because it “only” accounts for 2-5% of domestic violence homicides. But non-fatal strangulation is not only a cause of brain injury: it should be viewed as one of the most significant “red-flags” of an abuser’s escalation to more lethal behavior. When oxygen flow to the brain is cut off for even a short time, loss of consciousness can occur, and the risk of death can continue for days after the attack.

“I feel that I’m so frustrated at times and I feel like I am lesser than life.  I am at times ashamed when I have to ask directions or time and date for an appointment since I’ve forgotten them before the conversation was done. I may meet you today, have a proper introduction and learn of your name.  It may be weeks before remembering your name.  For years I could not read a book.  I would read a paragraph.  I’ve learned to overcome that to a certain degree by reading only a few pages at a time.  I do, however have to remind myself what it’s about, by going back a few pages or sometimes even a chapter”*

It takes a mere eleven pounds of pressure for only ten seconds, to cut off the blood flow through the carotid artery. And it only takes four minutes to kill someone.

“By the way, my name is Nancy, but you put any person’s name that has gone through years of abuse, even a child’s name or your mother’s name.”* 

“It’s hard to not feel stupid.  It’s hard to speak about what used to be.”*

Can you put a BAND-AID on a brain injury? For the external wound, for the obvious trauma; yes, you can apply a BAND-AID. But, for the wide range of acquired brain injuries it is most often the internal, non-visible injury that causes the greatest and longest lasting problems. Survivors of domestic violence with head injuries should have the same intensely focused evaluation for the head injury as they have for any other injuries sustained in the assault.

Health cares about domestic violence today and each and every day throughout the year.

Mayo Regional Hospital runs a state-of-the art concussion evaluation and management program through their outpatient rehabilitation services.  You can call 564-4273 to learn more about meeting with their staff.


Arthur Jette, Rural Outreach Advocate, Spruce Run Womancare Alliance, (SRWA) Penobscot and Piscataquis Counties: David McDermott, MD, MPH, CPE, FAAFP, FAAPL ,Medical Director of Inpatient and Emergency Services, Medical Director, MRH Concussion Clinic, Mayo Regional Hospital Dover-Foxcroft, ME:  and *Nancy Spencer, DV TBI survivor, longtime Womancare and SRWA volunteer,, all contributed to this.