Women who have experienced domestic violence were found to have suffered substantial damage in the brain – but no evidence of chronic traumatic encephalopathy, according to a major brain autopsy study.
The international research, carried out as part of the CONNECT-TBI project, which supports the investigation of the pathology of traumatic brain injury and its outcomes, examined the brains of more than 80 women with histories of intimate partner violence.
Writing in Acta Neuropathologica, the team say women who had experienced domestic violence had substantial vascular and white matter pathology damage in the brain and substantial medical comorbidities, including cardiovascular and cerebrovascular disease.
The researchers, led by a team from the Brain Injury Research Center of Mount Sinai and the New York City Office of the Chief Medical Examiner, USA, with teams from the University of Pennsylvania, USA, and the University of Glasgow, UK, say their findings demonstrate an urgent need to consider the broad scope of pathology that could influence domestic violence-related brain injury.
Domestic violence victims frequently report traumatic brain injury and, until now, there has been an assumption that the repeated head injuries sustained are comparable to those sustained by contact sports athletes.
The initial part of this research focused on the brains from 14 women with documented domestic violence, which were examined using brain imaging and pathology techniques.
They all had evidence of traumatic brain injury and while substantial vascular and white matter pathology was seen in some, there was no CTE pathology in any.
Findings from this initial case series were then pursued in 70 archival intimate partner violence cases identified in files of the Province of Manitoba forensic services and from the CONNECT-TBI collaboration.
The researchers found evidence of vascular and white matter pathologies, but only limited neurodegenerative pathologies in the oldest subjects. None contained CTE neuropathologic change.
Study co-author Professor Willie Stewart, consultant neuropathologist and honorary professor at the University of Glasgow, said: “As acknowledged in the House of Lords just a week ago, despite the prevalence of intimate partner violence associated traumatic brain injury, remarkably little attention has been paid to its lifelong consequences. This study begins to address this research gap and reinforces the need for more work in this high priority issue.”
Lead author Dr Kristen Dams-O’Connor, director of the Brain Injury Research Center of Mount Sinai, added: “Because our team has been conducting research and clinical care with survivors of partner violence for years, we strongly suspected that the neuropathology of brain injury may be far more complex than assumed.
“We were astounded by the burden of comorbidity carried by the women in this series. Approximately half had epilepsy, and chronic diseases such as diabetes, hypertension, substance use, and HIV were common.
“The findings clearly indicate that we should be casting a much wider net when it comes to characterising the neuropathology of partner violence-related brain injury and post-traumatic neurodegeneration.
“The consequences for intimate partner violence are enormous both on an individual and societal level, and it’s more common than most people realise. Our research suggests that it is a frequently unmeasured and under-recognised contributor to the brain health decline experienced by many survivors.”
Dams-O’Connor K, Seifert AC, Crary JF et al. The neuropathology of intimate partner violence. Acta Neuropathologica 28 October 2023
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