Hope and Help: Resources for Traumatic Brain Injury and Domestic Violence

The Latino Center for Health is committed to promoting the health of the Latinx community, thus we are proud to help raise awareness of this silent epidemic. This past year the center has learned about leading expert, Dr. María E. Garay-Serratos’s work on the invisible epidemic of Traumatic Brain Injuries and Chronic Traumatic Encephalopathy linked to domestic violence cases in women. We have begun partnering with her with a focus on Washington state. In 2020, domestic violence offenses comprised 49.7% of all crimes against persons in WA state (Washington Association of Sheriffs and Police Chiefs Annual Report, 2020). Despite the prevalence of domestic violence in WA state, screening for traumatic brain injury is rarely conducted in our domestic violence shelters, neurology, hospital emergency rooms, or others in the system of care.

Dr. Maria E. Garay-Serratos holds a framed photograph of her mother, who died after suffering decades of domestic violence.

Dr. María E. Garay-Serratos, Founder and CEO of Pánfila Domestic Violence HOPE Foundation, shares her groundbreaking personal history and expertise on Traumatic Brain Injury (TBI) from Domestic Violence (DV). Dr. Garay-Serratos’ career studies in sociology, and social work are rooted in her personal history as the eldest child in an immigrant family from Mexico that experienced horrific DV-head trauma and TBI at the hands of her father.

One in three women will experience severe violence from a domestic violence in their lifetime, resulting in significant trauma to the head and neck. Over 75% of domestic violence survivors suffer single or repeated TBI, but most go unreported.

  • 60% of abused children suffer TBI
  • 60% to 90% of men with abusive histories report a history of TBI 
  • 68% of the LGBTQ+ community report IPV-TBI

Pánfila Domestic Violence HOPE Foundation, 2019 and the American Brain Foundation, 2023.

Understanding Domestic Violence: Traumatic Brain Injury Association to Progressive Neurodegenerative Diseases and link to Chronic Traumatic Encephalopathy

Victims, survivors, and thrivers of domestic violence often endure numerous types of TBI and head trauma, which can persist for decades or a lifetime. According to the Centers for Disease Control and Prevention (CDC), TBI is an injury that alters brain function and can be caused by an external bump, blow, jolt, or penetrating injury (like a gunshot) to the head(CDC Fact Sheet, link). There are three main types of TBI: mild, moderate, and severe.

A traumatic brain injury, or TBI, is an injury that affects how the brain works. It may be caused by a:

  • Bump, blow, or jolt to the head
  • Penetrating injury (such as from a gunshot) to the head

Center for Disease Control and Prevention, Facts About TBI, Link.

Domestic Violence TBI Prevalence

TBI symptoms such as severe headaches, nausea or vomiting, dizziness, sensitivity to noise and light, limb weakness, loss of coordination, speech and memory issues, confusion, and agitation, can greatly hinder daily activities.

Domestic violence rates, tracked in many countries, consistently show that 1 in 3 women experience domestic violence in their lifetime, with higher rates among marginalized females. The United States has limited data on TBI prevalence among female victims of domestic violence and men with abusive behaviors, highlighting a silent and often ignored epidemic of TBI within the domestic violence population.

TBI Associated with Increased Risk for Dementia

TBI has also been associated with an increased risk of several types of dementia, including, Alzheimer’s disease, Parkinson’s disease, and frontotemporal degeneration.

Nonconcussive Head Impacts linked to CTE

While concussions, a form of mild TBI, show symptoms, nonconcussive head impacts do not. Unfortunately, this type of head trauma can accumulate over time, potentially leading to CTE, a progressive neurodegenerative disease. CTE symptoms, including memory loss, confusion, impaired judgment, impulse control issues, aggression, depression, anxiety, suicidality, parkinsonism, and progressive dementia, can severely affect daily functioning. The asymptomatic nature of nonconcussive head impacts makes it challenging to track prevalence rates.

The Pánfila Domestic Violence HOPE Foundation (“Pánfila”) was established to ensure that brain injuries, head trauma, and their consequences in domestic violence victims, survivors, and thrivers are recognized and addressed. Just as society could not ignore the lung cancer epidemic caused by tobacco, we now demand action against the potential pandemic of domestic violence-related TBI and head trauma.

To learn more about CTE, TBI, Brain Initiatives, Services and Resources please visit Pánfila’s website.

Entendiendo la Violencia Doméstica y la Encefalopatía Traumática Crónica, Lesión Cerebral Traumática Vinculada a Enfermedades Neurodegenerativas Progressives.

Según los Centros para el Control y la Prevención de Enfermedades (CDC), una lesión cerebral traumática es una lesión que altera la función cerebral y puede estar causada por un golpe externo, un impacto, una sacudida o una lesión penetrante (como un disparo) en la cabeza (hoja informativa de los CDC, enlace). Existen tres tipos principales de LCT: leve, moderada y grave.

Los síntomas de las lesiones cerebrales traumáticas, como fuertes dolores de cabeza, náuseas o vómitos, mareos, sensibilidad al ruido y a la luz, debilidad de las extremidades, pérdida de coordinación, problemas de habla y memoria, confusión y agitación, pueden dificultar enormemente las actividades cotidianas. Mientras que las conmociones cerebrales, una forma de traumatismo craneoencefálico leve, presentan síntomas, los traumatismos craneoencefálicos no conmocionantes no los presentan. Por desgracia, este tipo de traumatismo craneal puede acumularse con el tiempo, lo que puede dar lugar a alteraciones neurológicas como la encefalopatía traumática crónica. Los síntomas de la encefalopatía traumática crónica incluyen pérdida de memoria, confusión, alteración del juicio, problemas de control de impulsos, agresividad, depresión, ansiedad, suicidio, parkinsonismo y demencia progresiva, que pueden afectar gravemente al funcionamiento diario.

Una lesión cerebral traumática, es una lesión que afecta al funcionamiento del cerebro. Puede estar causada por:

  • Impacto, golpe o sacudida en la cabeza
  • Una lesión penetrante en la cabeza (por ejemplo, un disparo).

Centro para el Control y la Prevención de Enfermedades, Facts About TBI, enlace. Para más información, visite https://panfila.org/

María Pánfila’s Story

Growing up, Dr. Garay-Serratos witnessed the domestic violence in her home and recalls, “My mom was hit a lot, there was choking, a lot of shaking, objects thrown at her, shoved against the wall, thrown against appliances, dragged by her hair in the yard.” She was a child when she first noticed that the abuse was impacting her mother’s brain. In her preteen years, she realized her mother was most likely suffering from the same brain disease as professional boxers while watching a professional boxing match on TV with her father.

One day, Dr. Garay-Serratos found María Pánfila, her mother, in a dire state, crawling from room to room because she could hardly stand. She immediately removed her mother to get her care. María Pánfila soon began seeing doctors, particularly neurologists, who repeatedly asked about her head trauma history. Dr. Garay-Serratos always responded, “Over 40 years of severe, ongoing trauma,” but the doctors focused solely on her physical symptoms, ignoring her history of abuse.

María Pánfila, a mother of seven, suffered decades of abuse by her husband and, by her mid-forties, experienced memory issues and other symptoms consistent with those caused by repeated brain trauma. María Pánfila passed away on June 20, 2015, from the debilitating effects of her abuse. Following a post-mortem analysis, Dr. Ann McKee, Chief of Neuropathology for the VA Boston Healthcare System and Director of the Boston University CTE Center and UNITE Brain Bank, diagnosed María Pánfila with severe CTE linked to repeated nonconcussive head impacts and Alzheimer’s disease. Dr. McKee could not ascertain if the Alzheimer’s was linked to her head trauma.

As for Dr. Garay-Serratos’ father, over the years she came to better understand much more about him. In moments of peace and clarity, they talked about the domestic violence he experienced throughout his childhood at the hands of his father. She now understands that his behavior was almost certainly rooted in the abuse he himself suffered as a child. She believes he had TBI and potentially CTE as a result of his own father’s domestic violence. And though she implored him to stop, Timoteo simply could not stop the violent outbursts and feared killing his wife or one of his children. He did real and lasting harm. He passed on July 30, 2013 from a tragic accident.

Today, Dr. Garay-Serratos grieves her parents’ untimely and difficult passing. However, she is inspired by her faith and hopes that understanding the link between traumatic brain injury and domestic violence will help other families avoid similar tragedies. Dr. Garay-Serratos runs a nonprofit in Southern California devoted to creating awareness to address TBI and CTE from domestic violence. The CDC now recognizes domestic violence as a leading cause of TBI but does not track data.

To learn more about Maria’s story, please visit https://panfila.org/maria-panfilas-story/ to read more information.

Raise Awareness

This Hits Home reveals the invisible and silent epidemic of permanent TBI in women devastated by DV in the US. Along with Dr. Garay-Serratos’ story as the backdrop, the intimate and compelling stories of courageous DV female victims, survivors, and thrivers, insights from lawmakers and DV authorities, and the shocking revelations from world-renowned experts at the Mayo Clinic, Harvard University, Boston University, and the University of Pennsylvania, join to paint a chilling portrait of brain injury that forever changes the lives of individuals impacted by DV. Supported by the National Football League Players Association (NFLPA) and the American Brain Foundation (ABF), this feature unearths a distressing truth, begins a global discussion, and sounds the alarm for a call to action. It is available here, free of charge. Content Warning: This film contains discussions, images, and personal stories of domestic violence.

To learn more information, check out these articles for a quick read. We encourage you to share them with loved ones, spread awareness, and have open conversations. Spreading awareness about DV-TBI requires active, empathetic listening, as talking about DV is difficult.

In 2023, 41.4% of the population reported domestic violence, ranking Washington state (WA) as the 9th highest state. Despite the prevalence of domestic violence in our state, screening for TBI is rarely conducted in our domestic violence shelters, neurology, hospital emergency rooms, or others in the system of care.

Washington State Coalition Against Domestic Violence

Additional Reads Including Key Information and Research Articles

  • Update on Domestic Violence and Traumatic Brain Injury: A Narrative Review. Brain sciences, 12(1), 122. https://doi.org/10.3390/brainsci12010122
  • Prevalence of Traumatic Brain Injury in Intimate Partner Violence Offenders Compared to the General Population: A Meta-Analysis, link.
  • CTE and Nonconcussive Head Impacts, link.
  • TBI Associated with Increased risk for Developing Dementia, link.

Keywords: Children, youth, neonatal, pregnant individuals

  • Increased mortality in very young children with traumatic brain injury due to abuse: A nationwide analysis of 10,965 patients. Journal of pediatric surgery, 56(6), 1174–1179. https://doi.org/10.1016/j.jpedsurg.2021.02.044
  • Prenatal Exposure to Domestic Violence: Summary of Key Research Findings, link.
  • The lasting impact of family and domestic violence on neonatal health outcomes, link.
  • Hope, Agency, and the Lived Experience of Violence: A Qualitative Systematic Review of Children’s Perspectives on Domestic Violence and Abuse, link.
  • Increased Mortality in Very Young Children with Traumatic Brain Injury Due to Abuse: A Nationwide Analysis of 10,965 Patients, link.

Keywords: Immigrant populations, ethnicity, Latino/a/e/x, Black, Indigenous, Asian, Minorities, LGBTQ+, Women, Mental Health

  • Characterizing Intimate Partner Violence-Caused Brain Injury in a Sample of Survivors in the Two Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning Community. Journal of interpersonal violence, 8862605241256390. Advance online publication. https://doi.org/10.1177/08862605241256390
  • Battered and Brain Injured: Traumatic Brain Injury Among Women Survivors of Intimate Partner Violence—A Scoping Review. Trauma, Violence & Abuse, 23(4), 1270-1287. https://doi.org/10.1177/1524838019850623
  • Impact of Sources of Strengths on Coping and Safety of Immigrant Survivors of Intimate Partner Violence. Affilia, 37(1), 118-135.Impact of Sources of Strengths on Coping and Safety of Immigrant Survivors of Intimate Partner Violence
  • Intimate Partner Violence and Barriers to Help-Seeking Among Black, Asian, Minority Ethnic and Immigrant Women: A Qualitative Metasynthesis of Global Research, link.
  • Characterizing Intimate Partner Violence-Caused Brain Injury in a Sample of Survivors in the Two Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning Community, link.
  • U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study, link.

Keywords: Military, Veterans, Men, Firefighters

  • Are men with a history of head injury less responsive to cognitive behavioral therapy for intimate partner violence? Violence and Victims, 32(3), 493–505. https://doi.org/10.1891/0886-6708.VV-D-16-00005
  • Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study, link.
  • Report to the Committees on Armed Services of the Senate and the House of Representatives Report on Child Abuse and Neglect and Domestic Abuse in the Military for Fiscal Year 2022, link.
  • Identifying Frequency of Mild Traumatic Brain Injury in Firefighters, link.

Keywords: Gender, Firearms, Survivors, Police Officers

  • The punch-drunk boxer and the battered wife: Gender and brain injury research. Social Science & Medicine, 245, 112688. https://doi.org/10.1016/j.socscimed.2019.112688
  • Domestic Violence and Firearm Safety Survivor Safety Planning Around Firearms, link.
  • Head Injuries Common Among Police Officers, with Links to Mental Health Issues, link.

Getting Help

Formal Resources

National Domestic Violence Hotline, in English, in Spanish.

Text “START” to 88788

1.800.799- SAFE (7233)

Love is Respect – navigating healthy relationships, personal safety, resources for mental health/dating/relationships, partner quizzes, etc. In English, and in Spanish.

Washington State Domestic Violence Information & Referral – find local domestic violence programs

Brain Injury Resources

Although some organizations and groups are focused on providing help and support for contact sports and veterans with TBI, head injury, and potential CTE, there are few specifically focused on domestic violence victims, thrivers, and survivors. When contacting these groups, you might find yourself advocating for yourself or your loved one. These are some groups that can offer support for domestic violence victims, survivors, and thrivers living with TBI, brain trauma, or potential CTE, their families, caregivers, and loved ones:

Domestic Violence Brain Injury Resources

United States

  • Washington – Washington State Coalition Against Domestic Violence (WSCADV). There are local domestic violence organizations across WA state that support survivors, check here for local programs.
  • Arizona – Brain Injury Center at Banner – University Medical Center Phoenix is located in Arizona. They provide services for primarily professional athletes and other individuals with brain injuries including female victims and survivors of domestic violence.
  • Virginia – Brain Injury Association of Virginia – Domestic Violence and Traumatic Brain Injury. If you suspect you or a loved one is suffering from DV-TBI and live in the state of Virginia, please get in touch with these services and resources.
  • DV hotline for Military Personnel – Family Advocacy Program. The Family Advocacy Program, or FAP, is the Defense Department program designated to address child abuse and neglect, domestic abuse, and problematic sexual behavior in children and youth. This is the link to find the appropriate FAP depending on the location of the victim.
  • Connecticut – Trinity College – Pioneering the study of brain injuries experienced by survivors of domestic violence, the ReMIND Lab at Trinity College brings attention to the effects of domestic abuse that are invisible to the eye. The ReMIND Lab focuses on providing feedback on any possible brain injury, resources, and care to women in the Hartford area, who are the participants of its current study. Charles A. Dana Professor of Psychology and Neuroscience Sarah A. Raskin, PhD, and her student researchers diagnose participants and provide them with proper care and resources. If you want further information and want to be part of this study, you can contact raskinlab@trincoll.edu.

Canada

Chronic Traumatic Encephalopathy Information

  • Concussion Legacy Foundation (CLF)– CLF is based in the United States and has chapters in Australia, Canada, and the United Kingdom. It primarily supports athletes, veterans, and others affected by concussions and CTE. It aims to promote smarter sports and safer athletes through education, and innovation, and to End CTE through prevention and research. Although they do not serve victims or survivors of domestic violence -head injury, they provide excellent information about CTE.
  • Boston University’s Chronic Traumatic Encephalopathy (CTE) Center conducts high-impact, innovative research on chronic traumatic encephalopathy and other long-term consequences of repetitive brain trauma in athletes, military personnel, first responders, victims of physical violence, and others affected by head trauma. The mission of the CTE Center is to conduct state-of-the-art research on CTE, including its neuropathology and pathogenesis, clinical presentation, genetics, and other risk factors, biomarkers, methods of detection during life, and methods of prevention and treatment. They are an excellent resource to learn the latest brain science on CTE.

Servicios en Español

Línea directa nacional contra la violencia doméstica, en español.

Envía «START» al 88788

1.800.799- SAFE (7233)

Love is Respect – navegar relaciones saludables, seguridad personal, recursos para salud mental/citas/relaciones, cuestionarios para parejas, etc. En español.

Washington State Domestic Violence Information & Referral – encuentre programas locales de violencia doméstica culturalmente específicos.

Programas de Violencia Domestica en Washington – Las organizaciones destacadas tienen un enfoque cultural.

Informal Support

We recognize that communities affected by domestic violence, traumatic brain injuries, and potential chronic traumatic encephalopathy (CTE) have been marginalized and excluded from formal care systems due to discrimination, racism, and other social justice issues. If you are seeking help from your clergy, pastor, local community advisor, a curandero (healer), or a trusted friend (comadre), please inform them about your head injury so they can assist you in finding the necessary resources and services. You can direct them to the Pánfila website for information on the DV-TBI and DV-CTE issues if they are not familiar with them. Additionally, feel free to reach out to Pánfila, they have experience supporting minority communities affected by domestic violence, head injuries, and related conditions like CTE. Don’t hesitate to get in touch with them @ contact@panfila.org

Remember by not acknowledging it, we are not demonstrating a deeper understanding of the culture.

Safety Planning

SAFETY PLANNING TIPS: If you want to leave your abusive relationship or are planning to help someone leave an abusive environment, please develop a safety plan. The following are things to consider as you develop the safety plan:

  1. You can call the National Domestic Violence Hotline for help developing your safety plan tailored to your particular situation 1-800-799-7233 or 1-800-787-3224 (TTY).
  2. For immediate emergencies, please call or text 911
  3. Informal Systems of Support. Immigrants, minority women, and other disenfranchised communities are distrustful of formal support networks and instead, turn to their informal network for help. Please ensure you consult with someone you trust such as a friend, acquaintance, spiritual guide, or counselor who can help you develop a safety plan. It is vital that this trusted individual has experience developing safety plans or knows where to seek information to assist you with it.
  4. Undocumented – Fear of Deportation. Do not let this deter you from leaving your violent relationship. Many immigrants are fearful of admitting that are DV victims because they believe they will be removed (deported) from the US if they report the crime. U.S. law provides several protections for legal and undocumented immigrants who are DV victims and other crimes. There are specific protections for victims of DV and other specific crimes. Please read the Immigration Options for Victims of Crime brochure carefully to get informed about your rights as DV victims. It is available in English, Arabic, Bengali, Chinese (Simplified), French, Hindi, Portuguese, Russian, Somali, Spanish, and Urdu. You can also get more information by visiting the Immigration Options for Victims of Crime website.