The vast majority of domestic violence victims who show signs of traumatic brain injury never receive a formal diagnosis. 

 

On the night after Christmas 2012, Grace Smith remembers her ex-boyfriend broke into her house and attacked her with her children present. That’s the first version of her story.  In the second version, it is still the night after Christmas, but it could be 2013 and only her daughter is home.  She asks her daughter if she had thrown a half-eaten apple and missed the garbage can.  She also remembers thinking she had left the outside light on and then it was off.   

Grace describes the night in disorganized phrases.  She cries, then stops.  She spirals out from the story into another, taking some nudging to get her back to the original.  She remembers she somehow got wrapped in a cord, and she comes back to this over and over.  “I don’t know where that cord came from,” she says.  Then later, “I don’t know where he got that cord.”  Grace knows her hands were bound somehow. And then she fell to the ground.  She was inside, then she was outside.  She does remember that her ex-boyfriend punched her daughter in the face, blood spurting from her nose.   

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The police arrived when Grace was on the ground.  She was down, then up.  Maybe down again. Thrown against the car, hard. Punched.  Strangled.  She was trying not to black out. There was the blood, and that cord, and her daughter.  The night comes in flashes, an image at a time—apple, blood, cord—but the pieces never fit together into a whole.  Instead, they hang untethered in her mind.  “I don’t remember much of anything half the time,” she says. 

Grace has a mild brain injury from that night.  She also has vertigo, hearing loss, poor memory, anxiety, headaches, ringing in her ears, and a hip that causes her to limp at times.  She believes it came from being hurled against the car.  Her hip remains untreated.

  

Grace, her daughter, and her ex-boyfriend were taken to the same emergency room after the police arrived.  She remembers that the hospital was quite busy, and that her attacker was nearby.  Grace felt she was in shock.  She was sent home that night, but for the next two weeks, had neck pain, as well as head and throat pain and had difficulty breathing.  She was covered in bruises and her scalp ached.  

 

Days after the attack, Grace saw her primary-care doctor, had CT scans of her head and neck, and was given a lethality-assessment screening at the local crisis center, where she was deemed high-risk for domestic violence homicide.  Her attacker was found guilty of attempted murder and is in prison.  Grace’s life is a constant reminder of that night.  She forgets to do things, and when and how things happened:  when she lived where, when she moved, when she filed this or that paperwork.  Concentration sometimes gives her headaches.  She is able to work full time, in health care, but she spends most of her free time alone.  Knowing that her ex-boyfriend will be released in several years, she lives in terror of that moment, caught inside her own troubling anguish. 

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Approximately half of domestic violence victims are strangled by men at some point in the relationship, often repeatedly, over years. Those strangled to the point of losing consciousness are at the highest risk of dying twenty-four to forty-eight hours after the incident, from strokes, blood clots, or aspiration.  These incidents can cause brain injury (mild or traumatic) not only by cutting off oxygen to the brain but because they are often accompanied by blunt-force trauma to the head.  Victims of domestic violence are not routinely screened for strangulation or brain injury in emergency rooms, and the victims may not even be aware that they have lost consciousness.  So diagnoses are rarely formalized, the assaults and injuries are downplayed, and abusers are prosecuted under lesser charges. 

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A study reveals that strangulation dramatically increases the chances of domestic violence homicide, BUT, only fifteen percent of victims in the study had injuries visible enough to photograph for police reports.  As a result, officers often downplay the incidents, listing injuries like “redness, cuts, scratches, or abrasions to the neck.”  Emergency rooms tended to discharge victim without CT scans and MRIs.  Today, we understand that most strangulation injuries are internal, and that there is a significant chance it will end in homicide.