Brain Injury and Concussion in Intimate Partner Violence

An estimated 230,000 women in Canada experience severe physical violence from an intimate
partner each year, with up to 92% reporting blows to the head or face. These injuries place
survivors at significant risk for brain injury, yet many cases remain unrecognized, undiagnosed,
and untreated.

Brain injury can result from direct physical trauma or from lack of oxygen, both of which may
lead to temporary or permanent changes in brain functioning. Despite the seriousness of these
injuries, their effects are often misunderstood or attributed solely to psychological distress.

Understanding Concussion

A concussion is a form of brain injury caused by a blow or jolt to the head, neck, or body. This
force causes the brain to move rapidly within the skull, disrupting normal neurological
functioning.

Symptoms of concussion can vary and are typically grouped into three domains:

• Physical: headaches, dizziness, nausea, sensitivity to light
• Cognitive: memory difficulties, slowed processing, “brain fog.”
• Emotional/behavioural: irritability, anxiety, mood changes

While most adults recover within approximately four weeks, up to 30% experience symptoms
that persist beyond this period.

Increased Risk Among Survivors of Intimate Partner Violence

For survivors of intimate partner violence, the risk is often cumulative. Repeated impacts to the
head can result in multiple concussions and more complex brain injuries over time. These
effects may significantly impair daily functioning and safety.

Survivors may experience increased difficulty with:

• recognizing and responding to danger
• physically defending themselves
• following safety plans
• leaving abusive environments
• accessing housing and support services
• tolerating stress or overstimulating environments

These challenges are not simply psychological; they may reflect underlying neurological
impairment.

Mental Health and Diagnostic Overlap

One of the primary challenges in identifying brain injury in this population is the overlap between
concussion symptoms and trauma-related conditions. Symptoms such as difficulty
concentrating, irritability, sleep disturbance, and emotional dysregulation are common in both
concussion and conditions such as post-traumatic stress, depression, and anxiety.

Additionally, approximately 30% of individuals experience depression or anxiety during
concussion recovery. This overlap can complicate diagnosis and delay appropriate care,
particularly in contexts where awareness of brain injury is limited.

Stigma and misinterpretation of symptoms may further contribute to isolation, frustration, and
barriers to support.

The Importance of Early Intervention

Early recognition and care are critical. Ignoring concussion symptoms can prolong recovery and
increase vulnerability to further injury. Individuals are up to three times more likely to sustain
another concussion before fully healing. In rare cases, a second injury during recovery, known
as second-impact syndrome, can result in severe, permanent consequences.

Symptoms that persist beyond one month may indicate prolonged recovery. Factors such as
prior mental health concerns, migraines, chronic stress, and limited social support can increase
this risk.

Supporting Recovery: A Trauma-Informed Approach

Recovery from concussion in the context of intimate partner violence requires attention to both
neurological healing and nervous system regulation. The following strategies may support this
process:

Gentle Cognitive and Physical Pacing
A helpful starting point is to slow things down more often than seems necessary. Breaking tasks
into smaller steps, scheduling rest before exhaustion, and reducing screen time or
overstimulation can prevent symptom exacerbation. External supports such as reminders,
written notes, and structured routines can also reduce cognitive load.

Body-Based Regulation
Because the nervous system is often in a heightened state, regulation strategies are essential.
Slow, diaphragmatic breathing particularly with a longer exhale—can help reduce physiological
arousal. Gentle movement, such as stretching or walking, may also support stabilization. Simple
orienting practices, like noticing one’s feet on the ground or the support of a chair, can reinforce
a sense of safety.

Grounding Techniques
Grounding can help reconnect individuals to the present moment when symptoms feel
overwhelming. Techniques such as the 5–4–3–2–1 sensory exercise, holding a comforting
object, or using temperature (e.g., cool water or warm tea) can be effective. Naming emotions
while simultaneously identifying cues of safety can further support regulation.

Emotional Support and Safety
Sharing symptoms with trusted individuals and seeking trauma-informed medical and mental
health care are key components of recovery. Environments that are predictable, calm, and safe
can significantly improve both neurological and emotional outcomes.

Self-Compassion in Recovery
Recovery from brain injury is rarely linear. Fatigue, frustration, and emotional variability are
common and expected. Approaching these experiences with self-compassion rather than
self-criticism can reduce additional stress and support healing. Recognizing incremental
progress is an important part of this process.

Conclusion

Brain injury in the context of intimate partner violence remains underrecognized despite its
prevalence and impact. A comprehensive, trauma-informed approach that integrates medical
care, psychological support, and practical coping strategies is essential. With appropriate
intervention and support, recovery is possible, and individuals can regain greater stability,
safety, and functioning.

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