Caitlin Sannes

Background: Intimate partner violence (IPV) is defined as abuse or aggression that occurs in a romantic relationship and includes physical violence, sexual violence, stalking, and emotional abuse and manipulation¹. It is currently estimated that one third of women will experience some degree of IPV in their lifetime and that between 35 and 74% of IPV victims will experience at least one traumatic brain injury (TBI)². The current TBI research landscape has been largely male-dominated with a vast majority of clinical studies including male-only cohorts and only 23% of preclinical trials including female mice as of 2016³.

Methods: All references were found in PubMed using the search terms “TBI,” “intimate partner violence,” “sex differences,” “post-concussion syndrome,” “IPV prevention,” and “TBI detection.”

Results: Starkey, et. al. evaluated sex differences in mild TBI (mTBI) outcomes 8 years post-injury using self-report questionnaires designed to evaluate post-concussive symptom burden, depression, anxiety, and PTSD⁴. This study found that a significantly larger proportion of the female mTBI participants met criteria for post-concussion syndrome as well as depression⁴. One potential reason for these differences is differences in cortical thickness between male and female brains. Adamson et al found that following a TBI, female participants saw greater degrees of cortical thinning compared to male participants⁵. Additionally, Valera et al found the female patients with a history of IPV-TBI had decreased connectivity in the right anterior insula, which correlates with severity of the injury and negative performance on cognitive assessments⁶.  Women experiencing IPV are more likely to experience repeat mTBI compared to the average population and are less likely to receive care as their mTBI symptoms often go unrecognized in health care settings. In a retrospective study of 115 IPV head trauma patients at the Barrow Neurological Institute, 88% received multiple head injuries, 81% reported a history of loss of consciousness, and only 21% sought medical treatment at the time of injury⁷.

Conclusions: While it has been shown that sex differences are present in the brain’s ability to adapt to trauma, the exact mechanisms of these differences have yet to be fully elucidated. These sex differences are further exacerbated in the context of IPV because women experiencing IPV are more likely to experience repeat mTBI and are less likely to receive treatment. These gaps in care can be addressed through improved provider education on the intersection of TBI and IPV and advancements in IPV-TBI research, prevention and detection.

Work Cited:

1. Patra P, Prakash J, Patra B, Khanna P. Intimate partner violence: Wounds are deeper. Indian J Psychiatry. Oct-Dec 2018;60(4):494-498. doi:10.4103/psychiatry.IndianJPsychiatry_74_17
2. Valera EM, Joseph A-LC, Snedaker K, et al. Understanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions. The Journal of Head Trauma Rehabilitation. 2021;36(1):E1-E17. doi:10.1097/htr.0000000000000652
3. Blaya MO, Raval AP, Bramlett HM. Traumatic brain injury in women across lifespan. Neurobiology of Disease. 2022/03/01/ 2022;164:105613. doi:https://doi.org/10.1016/j.nbd.2022.105613
4. Starkey NJ, Duffy B, Jones K, Theadom A, Barker-Collo S, Feigin V. Sex differences in outcomes from mild traumatic brain injury eight years post-injury. PLoS One. 2022;17(5):e0269101. doi:10.1371/journal.pone.0269101
5. Adamson MM, Keith M, A. HO, and Kang X. Sex differences in cortical thickness and diffusion properties in patients with traumatic brain injury: a pilot study. Brain Injury. 2022/03/21 2022;36(4):488-502. doi:10.1080/02699052.2022.2034046
6. Valera E, Kucyi A. Brain injury in women experiencing intimate partner-violence: neural mechanistic evidence of an “invisible” trauma. Brain Imaging and Behavior. 2017/12/01 2017;11(6):1664-1677. doi:10.1007/s11682-016-9643-1
7. Zieman G, Bridwell A, Cárdenas JF. Traumatic Brain Injury in Domestic Violence Victims: A Retrospective Study at the Barrow Neurological Institute. J Neurotrauma. Feb 15 2017;34(4):876-880. doi:10.1089/neu.2016.4579