HEAD INJURY AND BATTERED WOMEN: An Initial Inquiry
Monahan, Kathleen, O'Leary, K. Dan, Health and Social Work
Approximately 2 to 3 million women are battered by their intimate partners each year. Severe injuries requiring emergency medical treatment of battered women have been noted, yet the prevalence of head injuries and the negative consequences emanating from such injuries have been noticeably absent from the literature. The descriptive study discussed in this article examined the case records of residents in a domestic violence shelter over a three-month period and found a 35 percent prevalence rate of battered women who had experienced head injury during a battering incident with their intimate partner. This study calls attention to the long-range difficulties that head-injured battered women may experience as a result of cognitive, emotional, and behavioral difficulties resulting from domestic violence and how social workers can intervene with this population.
Researchers have suggested that from 1.8 million to 3 or 4 million women in the United States are assaulted by their partner every year (Stark et al., 1981; Straus, Gelles, & Steinmetz, 1980; Sugg & Inui, 1992). Straus et al. (1980) indicated that violence will occur at least once during the litetime of approximately halt of all married women.
Spouse abuse has been cited as the leading cause of severe physical damage to women (Browne, 1987; Rosenbaum, 1991; Stark & Flitcraft, 1988). Injuries such as burns, stab wounds, broken limbs, and bruises frequently are cited as requiring emergency surgery and hospitalization (Browne, 1987). McLeer and Anwar (1989) indicated a 30 percent prevalence rate of injuries for women in emergency departments when a thorough trauma history was obtained. Despite this fact, physicians historically have been reluctant to diagnose abuse (Mehta & Dandrea, 1988; Rounsaville & Weissman, 1977-78; Sugg & Inui, 1992). Battered women rarely report abuse without being asked and instead describe vague, psychosomatic complaints rather than the actual physical violence (Blair, 1986).
BATTERED WOMEN AND HEAD TRAUMA
Women who enter domestic violence shelters frequently report that they have received numerous blows to the head, have been unconscious for unknown periods of time, and have been in comas as a result of head trauma. Although several authors (Jezierski, 1994; Murphy, 1993; Tilden, 1989) mention head trauma as a serious outcome of physical abuse by a male partner, the scope and residual effects of this particular type of battering have yet to be studied. In addition, emergency departments may be attuned to the high-risk behaviors (fighting, motorcycle accidents) of men between the ages of 18 and 30, that result in head injury (Marshall et al., 1991) and therefore, not expect to see this kind of injury in women.
Women from a nonbattered population who experienced head trauma identified loss of employment and autonomy as areas of concern along with mood disorders, particularly depression (Willer, Allen, Liss, & Zicht, 1991). In a case study of four women with traumatic brain injury (TBI), researchers identified psychosocial difficulty and personality changes as problematic areas (Stratton & Gregory, 1995).
STATEMENT OF THE PROBLEM
Although issues relevant to battered women have been studied extensively by social workers, (Abel & Suh, 1987; Aguirre, 1985; Burg, 1994; Davis, 1984, 1987; Davis, Hagen, & Early, 1994; Harris, Mowbray, & Solarz, 1994; McNeely & Robinson-Simpson, 1987) difficulties with health, particularly that of head trauma, have received little attention. Women who have incurred head trauma may be severely impaired in terms of entering the workforce as well as caring for themselves and their children, yet the vast majority of head injury literature remains focused on the difficulties of men with head injuries and subsequent family disruption and adaptation (Acorn, 1995; Acorn & Roberts, 1992; Resnick, 1994). Furthermore, domestic violence shelters, which historically have provided safe havens to battered women (Newman, 1993), may not be well-versed in dealing with these consequences and subsequently, appropriate referral may be compromised. …