Rethinking Traumatic Brain Injury from Intimate Partner Violence: A Theoretical Model of the Cycle of Transmission

ABSTRACT

Despite growing evidence of the repeated nature of traumatic brain injury (TBI) in women experiencing intimate partner violence (IPV), there is no theoretical model depicting TBIs as a cyclical process throughout a lifetime. Situational analysis methodology was used on interviews with 10 women who self-reported passing out from being hit in the head during an episode of IPV to create a theoretical model depicting the cycle of transmission of TBI. We define the cycle of transmission of TBI as the way that women experience multiple TBIs over the course of their lifetime and how TBI can be perpetuated in a family or community. The cycle begins in childhood or adolescence, when women receive a TBI from abuse, sports, or motor vehicle accident. They enter into abusive relationships with men who are also described as living with a TBI and the women receive other TBIs during this relationship. With repeating head trauma, women described increasing TBI symptoms: problems with memory, cognition, executive functioning, depression, and concentration. If they do seek help, they must choose between healthcare and protective shelter. With either choice, the element of instability could be introduced and the cycle of transmission continues. This theoretical model shows that it is necessary to move beyond individual behaviors to think about how TBIs are transmitted through communities and how untreated symptoms can impact help-seeking behavior and perpetuate other risk factors for receiving a TBI.     

Considering and Navigating New Relationships During Recovery From Intimate Partner Violence

Few researchers have explored women's experiences of considering and navigating romantic relationships after leaving abusive partners. Findings from this phenomenological investigation suggest that survivors of intimate partner violence (IPV) experience both challenging and facilitative experiences, including reclaiming themselves through dating, learning to trust self and others, negotiating boundaries and control, communicating with new partners, engaging in sexual exploration, and protecting children. Implications include viewing post‐IPV dating as an important aspect of survivors' recovery.     

Child Support Enforcement and Father Involvement Among Victims of Intimate Partner Violence

The focus of this article will be intimate partner violence among custodial parents receiving welfare benefits and their required cooperation with the child support enforcement system to encourage the financial involvement of the noncustodial parent. The majority of the mothers in the study encouraged the father's continued emotional involvement with their child despite the violence. This article will illustrate through the use of a case study the desire of these mothers to encourage both a financial and emotional relationship with their child's father, with safety always a priority.     

Understanding Gender and Intimate Partner Violence from an International Perspective

This paper reviews the international literature on intimate partner violence with a focus on gender differences in perpetration and victimization rates. A total of 35 studies from 21 countries are discussed that report prevalence or incidence rates of men’s and women’s involvement in physical and/or sexual aggression against an intimate partner. In addition, evidence on risk factors as well as consequences of intimate partner violence for men and women is presented. Conceptual and methodological differences between the studies and the lack of comparable databases within countries are discussed as limitations of the evidence, and perspectives for future research are outlined in the framework of cross-cultural psychology.     

Exploring Women's Expectations of Recovery From Intimate Partner Violence: A Phenomenological Study

Occupational therapy literature related to intimate partner violence primarily focuses on clients' pragmatic concerns. The purpose of this study was to explore women's recovery needs for the first six months after leaving the abusive relationship. Specifically, the focus explored how women experiencing intimate partner violence anticipate their recovery process to progress and explored their perceptions regarding the obstructions and challenges that influence that process. As part of an ongoing, multiyear study, in-depth interviews based on Kawa Model river drawings were conducted at a domestic violence center with eight women. Multiple themes were identified highlighting pragmatic and personal objectives.     

The Protective Functions of Social Support and Coping for Women Experiencing Intimate Partner Abuse

This study evaluated two alternate models exploring protective factors in the relationship between intimate partner abuse and health: one in which social support was proposed to mediate the violence-health relation, and a second in which coping was proposed to mediate this relation, while social support would moderate the abuse-coping relation. Women were administered questionnaires measuring coping, social support, violence, and health status. Relationship violence predicted mental health status only, although mental health did predict physical health. Coping was found to serve as a mediator between abuse and health. Implications for future research and clinical applications are discussed.     

Coercion in Intimate Partner Violence: Toward a New Conceptualization

For decades, battered women’s advocates have placed coercive control squarely at the center of their analysis of intimate partner violence. Yet, little work has been done to conceptualize and measure the key construct of coercive control. In this article, we apply French and Raven’s social power model to a conceptualization of coercive control in intimate partner violence relationships. Central elements of the model include: social ecology; setting the stage; coercion involving a demand and a credible threat for noncompliance; surveillance; delivery of threatened consequences; and the victim’s behavioral and emotional response to coercion. These elements occur in spiraling and overlapping sequences to establish an overall situation of coercive control. The implications of this model for theory and practice are discussed.     

Attention After Pediatric Traumatic Brain Injury: A Multidimensional Assessment

Attentional disturbance is a common complaint after TBI in children and adolescents, however, few studies have assessed post-traumatic attentional functions. The attentional constructs proposed by Mirsky, Anthony, Duncan, Ahearn, and Kellam (1991) provided a multidimensional framework for prospective assessment of late attentional disturbance after mild-moderate (n = 34) and severe (n = 57) traumatic brain injury (TBI). Attention was evaluated from 5 to 8 years after TBI in children ages 0 to 15 years at the time of injury. Children with severe TBI performed more poorly than children with mild-moderate TBI on tests comprising the focus/execute and shift constructs. Younger children scored below older children irrespective of injury severity on the Digit Span subtest and interstimulus interval scores from an adaptive rate continuous performance test reflecting the encode and sustain constructs of Mirsky et al. (1991). Age × Severity interaction effects were found for speeded perceptual-motor tests; scores were reduced following mild-moderate and severe TBI in younger children and following severe TBI in older patients. Results are discussed in terms of the vulnerability of skills in a rapid stage of development to disruption by acquired brain injury.     

Children's Spatial Behavior is Differentially Affected After Traumatic Brain Injury

Spatial behavior in 20 children with severe traumatic brain injury (TBI) and 20 healthy controls was investigated using the Kiel Locomotor Maze. Children had to remember defined locations in an experimental chamber with completely controlled intra- and extra-maze cues until learning criterion was reached. In a second experiment, spatial orientation strategies were assessed. Children with TBI were shown to be impaired in spatial learning and spatial memory. Spatial orientation was found to be deficient even in cases where spatial learning and memory proved to be unimpaired, especially in tasks that demanded the use of relational place strategies. Children who suffered a TBI at an early age proved to be more severely impaired in spatial learning and orientation than older children.     

Loving the One You Hurt: Positive Effects of Recounting a Transgression against an Intimate Partner

Intimate partners described a past transgression in which one of them had been a victim and the other a perpetrator and then evaluated each other and their relationship. Participants had been randomly assigned to the perpetrator or victim role. Perpetrators described their actions as more justifiable, perceived greater improvement since the transgression, and were more optimistic about the future of their relationship than were their victims or control participants. The results support the authors' contention that temporal appraisals are an important mechanism enabling people to maintain positive images of themselves and their relationships.     

Resilience and Other Possible Outcomes After Mild Traumatic Brain Injury: a Systematic Review

The relation between resilience and mild traumatic brain injury (TBI) outcome has been theorized but empirical studies have been scarce. This systematic review aimed to describe the research in this area. Electronic databases (Medline, CINAHL, PsychINFO, SPORTdiscus, and PILOTS) were searched from inception to August 2015 for studies in which resilience was measured following TBI. The search terms included ‘TBI’ ‘concussion’ ‘postconcussion’ ‘resilience’ and ‘hardiness’. Inclusion criteria were peer reviewed original research reports published in English, human participants aged 18 years and over with brain injury, and an accepted definition of mild TBI. Hand searching of identified articles was also undertaken. Of the 71 studies identified, five studies were accepted for review. These studies were formally assessed for risk of bias by two independent reviewers. Each study carried a risk of bias, most commonly a detection bias, but none were excluded on this basis. A narrative interpretation of the findings was used because the studies reflected fundamental differences in the conceptualization of resilience. No studies employed a trajectory based approach to measure a resilient outcome. In most cases, the eligible studies assessed trait resilience with a scale and used it as a predictor of outcome (postconcussion symptoms). Three of these studies showed that greater trait resilience was associated with better mild TBI outcomes (fewer symptoms). Future research of the adult mild TBI response that predicts a resilient outcome is encouraged. These studies could yield empirical evidence for a resilient, and other possible mild TBI outcomes.     

Changing Public Attitudes as a Prevention Strategy to Reduce Intimate Partner Violence

ABSTRACT

Although violence by intimate partners has decreased in the past decade, it is still a problem affecting many women. For instance, IPV accounted for 22% of violent crimes against women between 1993 and 1998 (NCVS). The paucity of research evaluating the effectiveness of primary prevention strategies to reduce IPV has been recognized in various reports on intimate partner violence. Experts have suggested that public awareness campaigns would be helpful both to inform abused women about strategies for getting help, and to potentially change pub-Address correspondence to Jacquelyn C. Campbell, PhD, RN, Johns Hopkins University, School of Nursing, 525 North Wolfe Street, Room 436, Baltimore, MD21205. lic attitudes and norms about IPV. This article reviews published research available on public education campaigns regarding intimate partner violence, as well as education campaigns conducted for other issues, in order to better understand the potential for success and the limitations of this type of intervention.     

Sawdust For Brains: Definition and Disconfirmation After Mild Traumatic Brain Injury

Abstract

Mild brain injury, despite its name, has lasting effects for many of its sufferers. This article is a firsthand account of one person's struggle with its onset and effects. Mot least of the symptoms is the sense of disconfirmalion and confusion that ensues because sufferers usually look “normal.” However, inside, their cognitive functioning and sense of self have changed markedly. Moreover, the effects often last longer than seem likely to medical professionals and laypeople alike, leading to evaluations of malingering or prior emotional distress. This first-person account is framed within the context of current literature on mild head injury.     

Depression After Mild Traumatic Brain Injury: A Review of Current Research

Research pertaining to the occurrence of depression and/or depression symptomatology after a Mild Traumatic Brain Injury (MTBI) was reviewed. We found that methodological differences such as the criteria used to assess MTBI and depression, time that elapsed since brain injury, and control group variations confounded comparisons across studies. Nevertheless, the studies are consistent with at least a 35% prevalence of, and left frontal damage with depression after MTBI, an overlap of symptoms of depression and Postconcussion Syndrome (PCS), and indicate that depression can continue for many years following the injury. Our conclusion is that MTBI is the triggering event for a set of pathophysiological changes and a concomitant depressive episode in a vulnerable subset of the population. Due to a paucity of research, it cannot be definitively concluded that the underlying substrates of depression seen after MTBI and clinical depression are the same. Implications for future investigations are discussed.     

Creating Structure in a Time of Intense Stress: Treating Intimate Partner Violence

Violence is an increasingly visible problem in the United States, with the news and other forms of media bringing this into the forefront of the public’s awareness. Violence comes in many different forms, including intimate partner violence (IPV), which occurs for about 36% of women and about 29% of men across the United States. Given the high incidence in the United States, it is imperative to consider the best ways for mental health professionals to treat violence in relationships. Some professionals in the field have developed and utilized conjoint treatment models for working with couples who have a history of violence. This article presents the application of attachment theory to a conjoint treatment model for couples that have experienced violence. A case study is included to demonstrate the implementation of an emotionally focused therapy framework and provide a sample outcome of this treatment approach. The framework of this article provides clinicians with insight into how to approach working with violent couples in a safe and productive way. Mental health professionals are at the front lines of implementing evidence-based interventions and creating lasting change for the clients whom they work with.     

Preventing Intimate Partner Violence: Towards a Framework for Supporting Effective Community Mobilisation

Community mobilisation is a promising new strategy for preventing intimate partner violence (IPV) against women in low‐income settings. However, little is known about the contextual factors (e.g. socio‐economic, cultural, historical and political conditions) that enable the effective mobilisation of communities for IPV prevention. This paper draws from the theoretical work of Campbell and Cornish (2010) on the relationship between context and community action in addressing HIV/AIDS to propose a framework for situating community mobilisation for IPV prevention in its surrounding symbolic, material and relational contexts. The framework is refined using empirical data from a case study of a gender‐based violence (GBV) prevention intervention in Rwanda, including interviews with members of government‐mandated GBV Committees and focus group discussions with members of two village communities (n = 35). A thematic analysis identifies various contextual factors needed to support community mobilisation for IPV prevention, including: broad symbolic understandings of what constitutes IPV; capacity to economically support women who choose to leave violent relationships; mechanisms for addressing the silence that often surrounds IPV; support from policy and government authorities; and opportunities to effectively challenge inequitable policy and legal frameworks. This framework is useful for policy‐makers and programme planners interested in IPV prevention in and by communities. Copyright © 2017 John Wiley & Sons, Ltd.     

Intimate Partner Violence Assessment in an Historical Context: Divergent Approaches and Opportunities for Progress

This paper provides a brief history of the assessment of intimate partner violence (IPV) in the United States. We examine strengths and weaknesses of the original IPV assessment approaches and describe the modifications and extensions that have been employed to improve our understanding of the multifaceted nature of IPV. We next discuss more recent movements in IPV assessment, including the assessment of non-heterosexual relationships, the examination of various (and often intersecting) forms of IPV, and the identification of qualitatively different types of IPV. We provide an analogy between the assessment of IPV and the assessment of other problems such as depression, and compare the differences between an assessment of symptoms and an assessment of impairment or harm. We conclude by highlighting the need for multi-method assessment approaches that can account for both the frequency and intensity of aggressive acts, as well as the context, motivations, and impacts of such acts, in order to develop a comprehensive understanding of violence in intimate relationships.     

Negotiating the Cultural Steps in Developing an Online Intervention for Korean American Intimate Partner Violence

Korean American (KA) immigrants experiencing intimate partner violence (IPV) underutilize existing services, but instead rely on KA clergy for assistance. However, there had not yet been an intervention curriculum developed for KA clergy to help them address IPV in their congregations. There was a lack of understanding regarding what needed to be included in an intervention curriculum for KA clergy, as well as the most effective form of curriculum design and delivery for such an intervention. This article discusses the process of developing an online IPV intervention curriculum for KA clergy to increase their capacity for IPV prevention and intervention within their congregations. Researchers developed Korean Clergy for Healthy Families by incorporating feedback from expert consultants and engaging study participants. The result is an IPV curriculum that speaks to participants’ cultural values and religious beliefs, and identifies barriers KA clergy experience when confronted with IPV. Specific steps to assist those who would want to develop culturally appropriate interventions are provided.