The last time Susan's husband lost his temper, he smashed her head against the kitchen wall so many times she lost count before she managed to flee with just the clothes on her back and some basic identification.
At the local women's shelter where she ended up, Susan was expected to accomplish a lot during a maximum 30-day stay: Attend counselling, secure employment or social assistance, meet with a lawyer and find permanent housing.
Women like Susan are on the radar in British Columbia right now as April 15-21 marks Prevention of Violence Against Women Week in the province.
The statistics are terrifying: In Canada, one woman is killed every week by her partner; globally, one third of women will suffer violence at the hands of someone they love in their lifetime.
But what if survivors like Susan are also dealing with the effects of a traumatic brain injury along with the fear and trauma of finally having escaped a long-term abusive relationship?
As a neuroscientist and professor at the University of British Columbia with expertise in traumatic brain injury, I know the impacts of this injury can be devastating —ranging from headaches, double vision and nausea to difficulty concentrating, remembering things and completing simple tasks.
It's also clear the effects tend to be worse when the trauma occurs repeatedly over time, with symptoms lasting for months to years.
Victims hesitant to seek help
Much of what we know about traumatic brain injury is the result of a large body of research and media attention over the last 10 to 15 years on athletes and sports-related concussion.
Until recently, the link between traumatic brain injury and intimate partner violence has been largely unexplored.
So, since June of 2017, my research team has been collaborating with Kelowna Women's Shelter in a community-based research project designed to examine the connection between traumatic brain injury and intimate partner violence.
Researching this population can be challenging. Victims are often hesitant to seek help because of the stigma associated with intimate partner violence.
This can lead to a survivor, seemingly paradoxically, returning to their abuser repeatedly over the course of months or years, thereby increasing the likelihood of multiple head injuries and chronic symptoms.
Unlike athletes who have suffered a sport-related concussion, survivors of intimate partner violence also quite often experience emotional difficulties such as post-traumatic stress disorder (PTSD), depression and anxiety.
Despite these challenges, an increasing number of researchers have recently started to examine traumatic brain injury in this vulnerable population. Part of the motivation for doing so is the large number of women thought to be affected.
In particular, the U.S. Centers for Disease Control and Prevention reports, each year, 2.3 per cent of women over the age of 18 experience severe physical violence including "being slammed against something" or "being hit with a fist or something hard."
Furthermore, up to 90 per cent of survivors of intimate partner violence report head, neck and face injuries at least once and typically on multiple occasions.
Assuming similar percentages in Canada, this translates into approximately 276,000 women per year who will suffer a traumatic brain injury as a result of intimate partner violence.
Memory and learning challenges
Research with this population to date shows survivors of intimate partner violence who suffer a traumatic brain injury report symptoms such as headache, difficulty sleeping and cognitive deficits consistent with the head injury.
In terms of brain function, it has been demonstrated the more severe the reported traumatic brain injuries in this population the larger the deficits in memory and learning. These deficits, in turn, are related to alterations in how different circuits in the brain communicate with each other.
Our research explores both the emotional and physiological disturbances which occur in women who have survived intimate partner violence, in order to develop a deeper understanding of this issue.
In one part of the study participants complete questionnaires assessing PTSD, depression and anxiety.
In a second part, we carry out cerebrovascular and sensorimotor assessments along with blood draws to assess for levels of various markers of brain injury.
Changing the conversation
So what does all this science mean for Susan and women like her? In addition to gathering more data on the incidence of traumatic brain injury in this population, our project aims to improve the lives of victims and those who support them.
The fact is, staff at women's shelters and many other women serving agencies generally don't have the knowledge, training or tools to screen for brain injury at intake.
This means many clients who have suffered a traumatic brain injury are not getting the support they really need to accomplish their goals and move forward into a life free of abuse.
We hope our research will help change the conversation around traumatic brain injury in this population, as it has for athletes, and shine a spotlight on the unacceptable problem of traumatic brain injury in women at the hands of the ones they love.
Explore further: Barrow finds correlation in TBI and concussions