A Mass General researcher is working to learn more about the traumatic brain injuries suffered by women in abusive relationships.

What comes to mind when you think of someone who has suffered a traumatic brain injury (TBI)?

An athlete who plays a contact sport such as football, perhaps? Someone who has served in the military? The victim of a car accident?

The incidents of repeated violence detailed by Dr. Valera’s study participants are brutal and difficult to comprehend.

While these are likely candidates, one Massachusetts General Hospital researcher has identified an often-overlooked segment of the population that frequently suffers repeated TBIs — women who have experienced intimate partner violence (IPV).

Brain Injuries and Everyday Functioning

Eve Valera, PhD, an investigator at the Martinos Center for Biomedical Imaging and assistant professor of Psychology at Harvard Medical School, along with Aaron Kucyi, PhD, now at Stanford University, recently completed the first study to use neuroimaging to examine the effect of TBIs on the brains of women who have been in abusive relationships.

What they have found may be cause for a global public health concern.

In a study of 20 women from the Boston area who experienced IPV, Dr. Valera found that the severity (number and frequency) of TBIs the women sustained as a result of violent encounters with their partners was associated with a reduction in the interaction between two areas of the brain that are key to everyday functioning.

Eve Valera, PhD
Eve Valera, PhD

The less interaction there was between these two regions, the more poorly the women performed on tasks of memory and learning.

Incidents of Repeated Violence

The results of the study suggest that as the severity and number of the TBIs increase, the brain may have more difficulty switching between the default mode network (DMN), which manages the brain when we are not focused on the outside world (such as during deep thought, daydreaming and memory recall), and the salience network, which supports more active task-specific functioning (i.e., paying attention, remembering a list).

While the patterns of diminished network interaction observed in Dr. Valera’s study are consistent with those of other TBI victims, there are significant differences in the way the women sustain their injuries.

The incidents of repeated violence detailed by Dr. Valera’s study participants are brutal and difficult to comprehend. Some of the women reported being punched, dragged, beaten or strangled as often as four times a week. “Once people realize the type and frequency of abuse these women experience, it is easier to understand why they sustain frequent TBIs,” Dr. Valera says.

“The reality is they are struggling to manage a complex and often dangerous situation with a possible brain injury that no one is acknowledging.

Since the abusive incidents are frequently repeated, the women often don’t have time to recover from one TBI before sustaining another.

“So the potential effects are getting compounded,” Dr. Valera explains. “To understand the potential consequences, some people might think that we can just extrapolate from other patient populations — but we can’t. The injuries just aren’t comparable.”

Alerting First Responders

“The sad part is that I am the only person, as far as I know, who has put women in the scanner for this purpose.”

Dr. Valera hopes her study will increase awareness of the potential for TBIs in such women, so that police and paramedics will know to check for these injuries when responding to a violent incident.

This awareness could also give counselors and advocates a better understanding of how TBIs can impair the efforts of women to seek help or leave an abusive relationship.

“Think of somebody who has just sustained a TBI [as the result of domestic violence], and you are telling them what to do: ‘Go to court, get an order of protection, and then do this and that,’” Dr. Valera explained. “You would never do that to a regular TBI patient, because you wouldn’t expect him or her to immediately take all that in.”

Dr. Eve Valera says there are other parts of the world where domestic violence against women is far more common, and even culturally sanctioned.

Funding and Commitment

When the women don’t respond to guidance from police or counselors following IPV, it can result in misplaced assumptions and victim-blaming, Dr. Valera explains. “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.”

Dr. Valera also notes that her research was conducted in the United States, which is generally considered a “safe” country for women. There are other regions of the world where domestic violence is far more common, and even culturally sanctioned.

While the stories of IPV survivors can be grim, and funding for this research has been difficult to secure thus far, Dr. Valera is committed to continuing her work.

“It puts things in perspective,” she says. “If you’re having a bad day, well, it’s not that bad. And it makes me want to fight even harder for change.”

To learn more about supporting Dr. Valera’s work, please contact us.

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