TBIs can affect the brain long after abuse ends : Short Wave At least one in four women — and a much smaller proportion of men — experiences intimate partner violence in their lifetime. For people in violent relationships, brain injuries are unfortunately common. But little is known about what exactly happens inside the brains of people dealing with domestic violence — and how these kinds of traumatic brain injuries may be different from those that come out of contact sports like football. Host Regina G. Barber talks with NPR brain correspondent Jon Hamilton about new research on the connection between domestic violence and traumatic brain injuries – and what makes these injuries unique.

Questions? Email us at shortwave@npr.org.

After domestic abuse ends, the effects of brain injuries can persist

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REGINA BARBER, HOST:

Hey, SHORT WAVErs. I want to give you a warning that today's episode includes some graphic descriptions of domestic violence.

EMILY KWONG, BYLINE: You're listening to SHORT WAVE...

(SOUNDBITE OF MUSIC)

KWONG: ...From NPR.

BARBER: Today, we have NPR's brain correspondent Jon Hamilton here to talk about how repeated head injuries can affect the brain.

JON HAMILTON, BYLINE: Right. And I'm not talking about the sort of injuries that occur in a boxing ring or a football field, either.

MARIA E GARAY-SERRATOS: My mom was hit a lot. There was choking. There was a lot of shaking. So shoved against the wall, thrown against appliances, dragged by her hair in the yard.

HAMILTON: Maria E. Garay-Serratos spoke with me about growing up in a household where her mother experienced repeated attacks that caused head injuries.

BARBER: Who was the person responsible for all these attacks?

HAMILTON: Maria's father. Over the years and decades, those beatings caused serious brain damage in Maria's mother. And that's not speculation. It was confirmed by an autopsy. But that's just one story. I have been reporting on this sort of domestic violence or intimate partner violence because it turns out it is a leading cause of concussion or more severe traumatic brain injuries both in the U.S. and around the world. And these injuries - they can lead to PTSD, memory loss, thinking problems, even dementia.

BARBER: This is heartbreaking. And the symptoms you just described are the sort of things we've heard about in, like, contact sports or the military. How widespread are traumatic brain injuries in domestic violence?

HAMILTON: Well, they appear to affect more people than either people in sports or in the military. The data isn't great on domestic violence, in part because so many incidents go unreported. You know, there's stigma. But the best estimates are that at least 1 in 4 women and a much smaller proportion of men will experience intimate partner violence in their lifetime. It's a problem you see in every country, every culture, every socioeconomic group. And among people who have a history of this sort of injury, the majority have had symptoms that are consistent with a traumatic brain injury.

BARBER: So today on the show, domestic violence and traumatic brain injury.

HAMILTON: And how these brain injuries may be different than the ones experienced by athletes in contact sports.

BARBER: I'm Regina Barber, and you're listening to SHORT WAVE, the science podcast from NPR.

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BARBER: OK, Jon, tell me more about Maria. Like, what happened to her mother?

HAMILTON: Her mom came to California from this tiny town in central Mexico, didn't have much education. She got married to Maria's father when she was 18. And they had seven children. Maria was the oldest. She told me she was 4 years old the first time that she remembers seeing her father assault her mother. And after that, Maria says, she tried to protect her mother by staying near her. But the violence kept happening.

BARBER: Yeah, and I'm assuming her mother didn't leave because she had nowhere to go. Psychologically, things are happening.

HAMILTON: Yeah, I mean, she was very isolated, very devoted to her kids. And she was part of a community that was, sadly, pretty tolerant of this behavior.

BARBER: So did Maria realize that all the shaking and hitting and pushing and throwing affected her mother's brain?

HAMILTON: Eventually, she did, even though she was still a kid. Maria says she kind of figured it out one day while the family was watching TV.

GARAY-SERRATOS: My father was a very avid fan of boxing, professional boxing. And I remember vividly watching some of those fights and seeing some of the symptoms that these boxers exhibited while they were in the ring. And I thought, oh, my God, that's my mom.

BARBER: So do you know what symptoms she's talking about?

HAMILTON: Well, these are things you see in boxers who've taken a big punch. You know, they're unsteady. They're disoriented, groggy. Maria also says her mom had headaches a lot and would spend long periods in a quiet, darkened room. And those are classic symptoms of concussion or what doctors call a mild traumatic brain injury, or TBI.

BARBER: OK, so do you know how long this went on?

HAMILTON: Decades. But eventually, Maria did grow up and was able to have her mom move in with her, you know, away from her dad. By that time, though, the damage was pretty much done. Her mom was having memory problems and went on to develop Alzheimer's. She was 69 when she died. And that was in 2015. And by then, Maria had become a Ph.D. social worker who was working in the field of domestic violence. So a colleague suggested an autopsy to look at her mother's brain, and she agreed.

BARBER: What did the autopsy find?

HAMILTON: There were actually several autopsies, which all found damage. And ultimately, her mother's brain was examined by Dr. Ann McKee, who's at Boston University. She is an expert on CTE, or chronic traumatic encephalopathy, which causes areas of the brain to sort of waste away as brain cells die. Alzheimer's also causes brain cells to die but in a kind of a different pattern, which is why it took a few autopsies to get the diagnosis. Maria says Dr. McKee is the one who confirmed that her mom had both Alzheimer's and CTE.

GARAY-SERRATOS: She's the one that said, you know what? Your mom had an immense amount of trauma to the head. She had the worst brain impacted by this that she had ever seen.

BARBER: Wow, that's awful. And I guess I'm wondering how many other people who've experienced domestic violence also have brain damage, be that traumatic brain injuries or CTEs or something else.

HAMILTON: So a number of scientists have been trying to figure that out. And at the end of 2023, some researchers published this really interesting paper. It looked at the brains from women in New York who had died with a documented history of intimate partner violence. And these scientists - they were wondering whether the brains from these women would show signs of CTE, like Maria's mother.

BARBER: So, like, parts of their brain wasting away, something like that.

HAMILTON: Right. The lead author of this paper was Kristen Dams-O'Connor, who directs the Brain Injury Research Center at Mount Sinai. She told me she wanted to do the study in part because some researchers were suggesting that brain injuries from intimate partner violence were really no different than those from sports.

KRISTEN DAMS-O'CONNOR: We have heard several people make these comparisons and say, oh, well, intimate partner violence is the female equivalent of football. And that seems to be such an unbelievably, dangerously off-base comment. But we couldn't know until we studied.

HAMILTON: It, because you can't just assume that brain injuries from domestic violence would be the same as when you get them from, say, football.

BARBER: So what did they find, then?

HAMILTON: Kristen says they found some obvious similarities with sports injuries. For example, typically, a woman in a violent relationship has experienced a traumatic brain injury.

DAMS-O'CONNOR: That same individual may also experience repetitive blows to the head that many have compared to the types of repetitive head impacts that male contact football players experience. But on top of those patterns, we also see very high rates of nonfatal strangulation.

BARBER: OK, high rates of strangulation. So it isn't just blows to the head. It's also oxygen being kept from the brain for too long.

HAMILTON: Yeah, like a stroke. The brain starts to die when it's deprived of oxygen. And the act of strangulation can damage blood vessels in the neck and brain. Also, intimate partner violence isn't limited by, say, a game clock or, you know, concussion protocols on the sideline. That means the person's brain doesn't necessarily have a chance to heal between injuries. So Kristen worked with a team that included Dr. Rebecca Folkerth. She's a neuropathologist in the office of the chief medical examiner in New York City. And they studied the brains of 14 women who died in 2020 and 2021. Median age at death was only 35.

BARBER: Wow.

HAMILTON: All of these women had a history of head injuries, but Rebecca says none of them had CTE.

REBECCA FOLKERTH: Some had acute changes which we recognize, you know, contusions or bruises on the brain, bleeding and so on. Some had evidence of old contusions. And we did find that almost all the women had something that would indicate that they'd had prior trauma.

HAMILTON: Like damage to the veins and arteries in the brain or to the connections between brain cells. Those findings were confirmed, by the way, in a separate analysis of 70 other women that they did. And these women had died before the study began.

BARBER: So even though Maria's mother had CTE, apparently, that might not be typical in domestic or intimate partner violence.

HAMILTON: Right. CTE was actually what the researchers expected to find in at least some of the women, but that wasn't what they found at all. Instead, there was this different sort of signature in the brains of these women. And if it's confirmed by other studies, it could offer doctors a way to identify changes in the brain that suggest that a woman and perhaps also a man or anyone is experiencing this sort of violence.

BARBER: But wait. This was an autopsy study, right? Like, do you have to wait until a person is in the morgue to find out what happened to their brain?

HAMILTON: An autopsy is the only way to diagnose CTE definitively. But many of the signs these researchers identified - they relied on technologies like MRI, which can also be used on living brains.

BARBER: Good.

HAMILTON: Rebecca says the idea is to find what's known as a biomarker for brain injuries that are caused by intimate partner violence or domestic abuse.

FOLKERTH: If we have a biomarker where you don't actually have to look in the tissue with a biopsy or wait till the person's dead, for God's sakes, to make the diagnosis, this is what we're ultimately all trying to do.

HAMILTON: And if they succeed, it might offer a way to detect and stop domestic violence before it causes a severe brain injury or even death.

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BARBER: Thank you so much, Jon, for talking to us about this.

HAMILTON: You are welcome.

(SOUNDBITE OF MUSIC)

BARBER: This episode was produced by Margaret Cirino, edited by our showrunner, Rebecca Ramirez, and fact-checked by Jon himself. Maggie Luthar was the audio engineer. Beth Donovan is our senior director, and Colin Campbell is our senior vice president of podcast strategy. Edith Chapin is our chief content officer. I'm Regina Barber. Thank you for listening to SHORT WAVE from NPR.

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