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Domestic Violence’s Untold Damage: Concussion And Brain Injury
Hundreds of survivors of domestic violence have come through the doors of neurologist Glynnis Zieman's clinic in the past three years.
"The domestic violence patients are the next chapter of brain injury," she said.
Zieman begins every new patient visit with a simple question: "What are the symptoms you hope I can help you with?"
For most, it's the first time anyone has ever asked — even how they may have gotten injured in the first place.
"I actually heard one patient tell me the only person who ever asked her if someone did this to her was a paramedic as she was being wheeled into an ambulance and the husband was at the foot of her stretcher," she said.
Studies of traumatic brain injury have revealed links to dementia and memory loss in veterans and athletes, and it's been linked to PTSD in some service members. Another group may be suffering, still largely in silence — survivors of domestic violence.
About 70 percent of those seen in the ER for such abuse are never actually identified as survivors of domestic violence. It's a health crisis cloaked in secrecy and shame — one that Zieman is uncovering through her work at the Barrow Concussion & Brain Injury Center in Phoenix. She runs the first program dedicated to treating traumatic brain injury for survivors of domestic violence.
"About 81 percent of our patients had so many hits to the head, they lost count, which, you compare that to athletes is astronomical," Zieman said.
Zieman said it’s not just the sheer number of injuries that makes these patients so complex.
"About 81 percent of our patients had so many hits to the head, they lost count."
— Dr. Glynnis Zieman, Barrow Concussion & Brain Injury Center
“One single athletic concussion is hard enough to treat,” she said. “These patients are beyond that. Unlike athletes, they do not have the ‘luxury,’ if you will, of recovering after an injury before they are injured again.”
Domestic violence is estimated to affect 10 million people each year. Head and neck injuries are some of the most common, and Zieman is showing how much traumatic brain injury is a part of that. She said the lack of recognition has left many survivors without a diagnosis — often blamed for their cognitive impairment.
"They have been labeled for so long with all these horrible things. And in the end, it's not only not their fault but there is a true medical reason behind these issues and there are some things that can be done," says Zieman.
Data on domestic violence and traumatic injury are sparse because it’s so underreported, but Zieman said their initial findings indicate it’s even more prevalent than previously thought.
A 2016 retrospective study of patients in their program — almost all women — discovered only one fifth of the women had seen a physician for their injuries and 88 percent had more than one head injury from their abuse.
Zieman works with local domestic violence shelters to identify women who may be suffering from brain injuries. Workers will send women to Zieman's clinic where their physical symptoms like headaches or dizziness can be treated — along with the cognitive and emotional effects of their abuse. Because of grants and private donations, Zieman says the cost of care is free, whether or not patients have insurance.
Ashley Bridwell, a social worker at Barrow, works hand in hand with Zieman to help survivors manage life with a brain injury.
"Some of these simple things like filling out an application or remembering an appointment, or being able to give a solid social or medical history — it's close to impossible considering what they are experiencing," Bridwell said.
Bridwell helped start the program six years ago after doing outreach to the homeless community and realizing many had traumatic brain injuries because of domestic violence.
"These long histories of emotional and physical abuse and then you couple that with the cognitive impairment that a lot of these survivors face as the result of the cumulative effect of mild traumatic brain injury," she said.
Patients will sometimes arrive at their clinic with a constellation of seemingly inexplicable symptoms. Bridwell remembers one who lost her job because of her difficulties with memory. The woman thought she had Alzheimer's.
"And for her to come in and get some information about head injury, and about how multiple hits to the head can impact your memory, your attention, your concentration, your speed of processing, it was incredibly validating for her," said Bridwell.
The diagnosis gave her a new way to talk about and understand her private struggle.
“They realize it’s not their fault,” Bridwell said.
While many patients initially seek out the clinic because of physical symptoms, Dr. Zieman says their research shows anxiety, depression and PTSD usually end up being the most severe.
"The significance of the mood symptoms in this population far exceeds what we see in our other patients," she said.
Zieman says we're still in the early stages of understanding the effects of repetitive brain injury and how we can better treat it. The trauma of domestic violence only complicates the picture, but the survivors she sees remain her favorite to treat.
"I feel that we can make the biggest difference for these patients," she said.