At times, LJ finds herself struggling to find the right words. Sometimes her memory feels so impaired that she copes by making light of her situation. “I would semi-joke with my sister, like have I got a brain tumour, have I got Alzheimer’s?” she recalls. Yet, there was one connection LJ never made.
In recent years, significant advancements have been made in raising awareness and improving treatment for sports-related concussions. However, less frequently discussed are the chronic impacts of repeated concussions and strangulation among women who have experienced intimate partner violence. Now, an Australian-first study has uncovered evidence of long-term memory and learning difficulties in this group.
Exploring the Study’s Findings
The peer-reviewed study, led by Monash University researchers and published in the Journal of Neurotrauma, was based on cognitive assessments of 146 women. It compared a group of healthy controls with those who had experienced partner violence more than six months earlier. LJ, a 51-year-old survivor who participated in the study, expressed that the research offered an explanation for the memory changes she had dismissed as “a personal flaw.”
“Even [my sister and I] didn’t be like, ‘oh, do you think it’s because I used to get all these hits in the head?'” she said.
Understanding Concussions and Their Impact
A concussion is a type of brain injury where the brain moves inside the skull, causing damage. Medically, it is considered a “minor traumatic brain injury,” often linked with sports, but any head impact can cause a concussion. Symptoms such as dizziness, fatigue, headaches, and nausea are typically short-term. More severe brain injuries can lead to ongoing symptoms like behavioral or cognitive changes, seizures, or slurred speech.
Alfred Hospital clinical neuropsychologist and study author Dr. Jennifer Makovec Knight highlighted that strangulation, including consensual strangulation, can cause different kinds of brain injuries. “A hypoxic brain injury is caused by strangulation where you’re reducing blood flow and oxygen, creating cell death which is an injury to the brain,” she explained.
The Hidden Problem of Brain Injuries in Domestic Violence
There is no clear data on the prevalence of brain injuries among those who have experienced family violence. A 2018 study by Brain Injury Australia found that 40% of family violence survivors who attended Victorian hospitals over a decade had sustained a brain injury. However, this data only pertains to those who sought hospital treatment.
For various reasons, individuals experiencing partner violence may not engage with health services to get a diagnosis of a concussion or brain injury. This is why the Monash-led study focused on women with no formally diagnosed brain injury living in the community.
“If you ask a footballer how many concussions they have had, generally they will know,” Dr. Symons said. “But when asking a survivor of family violence if they had had a concussion, the typical answer would be no.”
Dr. Symons emphasized that changing the question could uncover the “disconnect” between a widely understood problem and one that remains hidden. “We would ask them, ‘have you been hit in the head? Have you been pushed into anything and hit your head?’ They would say, ‘oh yeah, many times.'”
LJ’s Personal Story
LJ’s story is emblematic of many. She has never been formally diagnosed with a concussion or brain injury due to family violence but suffered repeated head injuries from her ex-husband’s violence. She recalls an incident over a decade ago when he pushed her in a suburban car park, causing her to lose consciousness when her head hit the concrete.
Despite her awareness of concussion risks—having taken her children to the hospital for concussions—she never considered it in the context of her own experiences. “In hindsight, that’s surreal,” she said. Even without a formal diagnosis, she is convinced her history of head injuries contributes to her daily memory challenges. “I’m a hundred per cent convinced,” she stated.
Implications and the Need for Better Screening
The Monash-led study found that women who suffered more than six suspected brain injuries had worse scores on memory and learning tests, even after controlling for factors like age, mental health conditions, and substance use. Alarmingly, more than 80% of the cohort with repeated brain injuries had experienced both head hits and strangulation.
Dr. Makovec Knight stressed that the study results do not mean all women who experience intimate partner violence will face these difficulties. However, for those who do, the impacts can be significant and confusing. “They were saying things like they had escaped the relationship and now were safe and were trying to rebuild their lives and go back to university and weren’t able to concentrate,” she said.
Victoria’s Aboriginal truth-telling inquiry, the Yoorrook Justice Commission, heard anecdotal evidence that undiagnosed brain injuries negatively impact Aboriginal women who have experienced family violence.
University of Queensland professor and neurologist Karen Barlow, who was not involved in the research, called the study reputable and an important contribution to a rarely researched topic in Australia. She urged caution in interpreting results for the cohort with more than six brain injuries, noting that overall function remained relatively normal.
Dr. Makovic Knight hopes the study will prompt tailored screening and treatment for concussion and strangulation-linked brain injuries in women experiencing intimate partner violence. “This is potentially a cognitive disability that could impact people lifelong, and there is currently no treatment protocol, no rehabilitation,” she noted.
Outgoing CEO of Safe & Equal, Victoria’s peak family violence body, Tania Farha, emphasized the need for further investment to ensure health professionals and family violence workers are equipped to screen for brain injuries among women experiencing violence. “If we don’t take these steps, we’ll continue to see more chronic illness and injury resulting from family violence, which is a devastating consequence,” she warned.
For LJ, participating in the study has helped her build a new understanding of something that felt hard to explain. “I feel like doing this kind of stuff, it peels away the layers of shame,” she shared. “It’s oddly freeing.”
