Bringing to Light TBI and IPV Among Black Women

By Monique R. Pappadis, M.Ed., Ph.D.

Native American and Black women are affected disproportionately by domestic violence or intimate partner violence (DV/IPV), which may result in a traumatic brain injury (TBI). Estimates suggest that 31.5 million women receive at least one IPV-related TBI in the US. ¹ Blacks are not only at an increased risk for sustaining a TBI, but also tend to report poorer outcomes compared to non-Hispanic Whites following injury. Black women experience severe violence against them, with a significant portion resulting in femicide (homicide of women), mainly from use of firearms by the perpetrator. Black women are three times more likely to be killed by an intimate partner than Non-Hispanic White women.² Among those who survive IPV, the variety in symptom presentation of TBI makes it challenging to identify. In addition, there are no standardized screening tools to assess accurately and consistently for TBI among IPV survivors.³ Currently, some of the best researchers studying the intersection of brain injury and IPV among women are working diligently to create and standardize screening tools.

There are a number of theories on why Black women are disproportionally affected by IPV, which include but are not limited to both institutionalized and internalized historical oppression, systemic racism and poverty, masculinity of Black men, and the cultural mantra of the ‘Strong Black Woman’.^4,5 ‘Strong Black women’ are resilient, independent, emotionally controlled, self-sacrificing and endure much without complaint.⁴ The “Strong Black Woman” stereotype might prevent Black women from recognizing TBI-related signs, seeking medical or IPV services, or engaging with the criminal justice system against their perpetrators. We all must remember that within many Black communities, as with many other communities, discussion about IPV is still taboo – the Silent Abuse. We, as brain injury professionals, along with researchers, social workers or social justice advocates, should encourage change and open dialogue within the community to raise awareness about IPV and brain injury, as well as encourage women to seek care.

Due to lack of knowledge and inconsistent referral by health professionals, many women with TBI are not seeking services.⁶ When care is sought, Black women often use emergency departments for their care and report that their care is inadequate. In addition, healthcare professionals may struggle with noticing visible signs of violence when working with Black women who have darker skin tones. This is a concern faced across all areas of medicine and medical education. The inability to accurately diagnose a condition based on physical characteristics or signs exacerbates the disparities identified in access to care, receipt of care, and referral for appropriate services. When Black women access IPV services or shelters, many are faced with overt discrimination and racist practices and policies. Professionals may have conscious or unconscious biases that perceive all Black women as being able to handle the violence because they are used to it and can tolerate it longer. Shelters might relocate their services, modify practices when their ethnic minority make-up increases, or fail to provide outreach services for Black women. In addition, Black women may experience intentional or unintentional subtle forms of racism, better known as microaggressions. Examples include, “you are just being too sensitive,” “how can someone as strong as you be abused,” or “you are not like the Black women I typically see.” Shelters and IPV service organizations should consider how their practices, environment, and staff’s cultural sensitivity promote oppression in a place that should be a safe haven for IPV survivors.

Community engagement strategies and programs must be culturally appropriate for Black IPV survivors.⁷ A need exists for the development of culturally appropriate and culturally sensitive assessments and testing of IPV survivors. We should engage with IPV survivors to determine their specific access to care needs, explore their experiences with TBI and IPV, and evaluate current screening and treatment practices. Organizations should consider assessing the diversity among their staff and provide training related to use of Cultural Humility when working with diverse populations. Lastly, it is important to consider increasing outreach services and working with community organizations in the Black community to increase awareness of IPV and TBI, as well as create a transparent pathway to support their access to IPV services. Creating a safe, anti-oppressive and culturally humble environment to disclose IPV, assess for TBI, and seek and receive needed services is essential for ensuring social justice for Black women following IPV.

References

1. Valera EM, Campbell J, Gill J, Iverson KM. Correlates of brain injuries in women subjected to intimate partner violence: Identifying the dangers and raising awareness. Journal of Aggression, Maltreatment & Trauma. 2019 Jul 3;28(6):695-713.
2. Petrosky E, Blair JM, Betz CJ, Fowler KA, Jack SP, Lyons BH. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence—United States, 2003–2014. MMWR. Morbidity and mortality weekly report. 2017 Jul 21;66(28):741.
3. Haag H, Jones D, Joseph T, Colantonio A. Battered and brain injured: Traumatic brain injury among women survivors of intimate partner violence—A scoping review. Trauma, Violence, & Abuse. 2019 Jun 6:1524838019850623.
4. Romero RE. The icon of the strong Black woman: The paradox of strength. In: Jackson LC, Greene B, editors. Psychotherapy with African American women: Innovations in psychodynamic perspective and practice. New York: Guilford Press; 2000. p. 225–238.
5. Rice J, West CM, Cottman K, Gardner G. The intersectionality of intimate partner violence in the Black community. In: Geffner R, Vieth V, Vaughan-Eden V, editors. Handbook of interpersonal violence across the lifespan. Springer; 2019. p. 1-24.
6. Monahan K. Intimate partner violence (IPV) and neurological outcomes: a review for practitioners. Journal of Aggression, Maltreatment & Trauma. 2019 Aug 9;28(7):807-25.
7. West CM. (2018). Treatment interventions for intimate partner violence in the lives of African American women: A social justice approach. In: Gelberg S, Poteet M, Moore DD, Coyhis D, editors. Radical Psychology: Multicultural and social justice decolonization initiatives. Lanham: Lexington Books; 2018. p. 89-110.

This article was contributed by Monique R. Pappadis, M.Ed., Ph.D. University of Texas Medical Branch at Galveston.