Brain Donation Initiative

The DV-Related TBI Connection

Today, traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) conjure up several stark images of dramatic hits to the head from combat and collision sports, a downward spiral into depression, dementia, rage, and tragically, suicide.[i] There is also an emerging and frightening realization that repeated concussions have an enduring and potentially devasting effect on our children that participate in contact sports.[ii] In the United States (US), approximately 2.5 million head injuries are reported annually.[iii] However, these numbers underestimate the occurrence of TBIs because they do not account for those persons who did not receive medical care, had outpatient or office-based visits, or those who received care at a federal facility, such as persons serving in the US military or those seeking care at a veterans affairs hospital.[iv]

Women

While much of the focus on TBI has centered on athletes and military veterans, emerging data indicates that DV victims constitute an under-represented cohort. One in four women will experience DV in their lifetime[v] with higher rates among African American,[vi] immigrant,[vii] Native American[viii], and other ethnic minority and marginalized women due to social injustice issues.[ix] The COVID Pandemic resulted in even higher incidences of DV in the US and world-wide due to a variety of variables associated with confinement.[x] [xi]

The minimal research conducted among female domestic violence victims reporting TBI is telling. In 2002, a study of women in three domestic violence shelters found [xii]:

• 92 percent had been hit in the head by their partners, most more than once;
• 83 percent had been both hit in the head and severely shaken; and; and
• 8 percent of them had been hit in the head over 20 times in the past year.

It is important to note that it is unclear if women of color and other vulnerable categories of women where included in this study.

Together, these statistics amount to approximately 30 million women experiencing DV, of which 20 million demonstrate signs of TBI. Alone, this is 11-12 times greater than the published incidence of TBI.

Children

Moreover, in up to 60 percent of homes where women are beaten, children are also beaten.[xiii] As many as 15.5 million American children live in families in which DV has occurred during the past year.[xiv] It is estimated that of the children who suffer abuse, over 60 percent of them also experience TBI.[xv] Children have the highest rate of emergency department visits for TBI of all age groups. Traumatic brain injury is the leading cause of death in injured children.[xvi] Additionally, the most consistent predictor of domestic violence is having experienced abuse as a child[xvii], compounded with the enduring emotional symptoms of TBI is increased aggression, which further impacts future generations and communities at large. Further research will distinguish whether this pattern or perpetuated violence between generations is based on emotional effects or traumatic injury to the brain.

Men

Furthermore, one in seven men will experience severe physical violence by an intimate partner.[xviii], However, the incidence of brain trauma among men who have experienced domestic violence – whether from a parent/guardian or from an intimate partner — has not been studied in-depth. Among men who engage in domestic violence behavior, a study found that 61 percent had histories of head injury.[xix] A follow-up study found that an overwhelming majority, 93 percent, of head-injured domestic violence abusers had endured their head injury prior to the first occurrence of marital abuse, with 74 percent of these men receiving the head injury before the age of 16.[xx]

Thus, domestic violence intensifies the impact of TBI as a healthcare epidemic. However, this is just the tip of the iceberg as these low numbers do not account for the 75 percent of DV cases that go unreported.[xxi]

Pánfila Domestic Violence HOPE Foundation
Brain Donation Initiative

Pánfila and the BU CTE Center and VA-BU-CLF Brain Bank are responding to the urgent call for action with the Pánfila Domestic Violence HOPE Foundation Brain Donation Initiative, which will enable scientific research by encouraging brain donations and future pledges for brain donation. However, we are strategically seeking to collaborate with other institutions passionate about developing specific brain bank/s for DV-related TBI victims.  Advancing science is a foundational objective that is critical for launching a nationwide, comprehensive public health education campaign designed to improve quality of life for those impacted by domestic violence.

Pánfila’s highest scientific priority is to promote brain donation for research by domestic violence survivors. Additional research is needed to further characterize the relationship between domestic violence and the resulting neuropathology, including CTE.

Pánfila Domestic Violence HOPE Foundation is supporting this research by affiliating with the BU CTE Center and VA-BU-CLF Brain Bank to encourage brain donation. Brain donation will enable a comprehensive post-mortem brain analysis by a team of experienced neuropathologists at the VA Boston Healthcare System and Boston University School of Medicine. Currently, CTE and many other neurodegenerative diseases can only be diagnosed by post-mortem examination of brain tissue.

The Pánfila Domestic Violence HOPE Foundation will support the BU CTE Center, the VA-BU-CLF Brain Bank and other scientific institutions with the following efforts:

• Encourage brain donation by domestic violence survivors and facilitate future brain donation pledges
• Compile research-based evidence of connection between abuse and neuropathological injury
• Educate physicians and emergency room personnel to identify domestic violence and related brain injury
• Help develop potential treatments and prevention strategies for domestic violence-based neurotrauma
• Advance scientific knowledge and public awareness of relationship between domestic violence and brain pathology
• Advocate for survivors of domestic violence

The BU CTE Center and VA-BU-CLF Brain Bank conduct high-impact, innovative research on CTE and neurodegenerative diseases resulting from brain trauma in athletes, military personnel and survivors of domestic violence. Their mission is to conduct research on aspects of CTE and other neurodegenerative diseases including neuropathology, pathogenesis, clinical presentation, risk factors, genetics, biomarkers, detection during life and methods of prevention and treatment.

A Precious Gift

Without the gift of brain donation, research to understand the consequences of brain trauma would not be possible. The identity of donors is confidential and protected by IRB rules and HIPAA laws. Through this research, increased public awareness of the relationship between domestic violence and brain trauma will encourage efforts to end domestic violence. There is no cost to the families for brain donation to the BU CTE Center and VA-BU-CLF rain Bank. All funding to the BU CTE Center and VA-BU-CLF is through grants from federal agencies, private philanthropy and institutional support from VA Boston Healthcare System and Boston University School of Medicine.