Post by Denise on Aug 2, 2011 9:02:40 GMT
Breaking the Silence: Violence as a Cause and a Consequence of Traumatic Brain Injury Jean Langlois, ScD, MPH, Brain Injury Professional magazine (page 1 of 5) Page 1 of 5
Multimedia
Learn about shaken baby syndrome and mild traumatic brain injury in babies.
New Mexico's Aging and Long-Term Services Department with funding from the State of NM and the US Health Resources and Service Administration. Used with permission.
Transcript of this video. Shaken Baby Syndrome
Acknowledgements
The authors thank Dr. Tom Simon from the Division of Violence Prevention, National Center for Injury Prevention and Control, CDC for his critical review of the manuscript.
Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Background
The overlap between traumatic brain injury (TBI) and violence is an important yet little understood problem. The exact number of violence-related TBIs each year is not known. The Centers for Disease Control and Prevention (CDC) estimates that 11% of TBI deaths, hospitalizations, and ED visits combined (a total of 156,000 each year) are related to assaults (Langlois et al, 2004). But this number likely is low because it excludes the many other TBIs, including concussions, caused by violence that go unidentified and unreported. Although not a focus of this article, prisoners and young children are two of the groups at high risk of a violence-related TBI that may not be identified. (See articles by Wald, et al, and Berger, this issue).
Furthermore, the problem of TBI and violence is complicated by the fact that violence is not only a cause, but a consequence of TBI. Specifically,TBI-related cognitive and behavioral problems can also result in aggressive behavior that leads to perpetration of violence, or a lack of insight and judgment, and resulting vulnerability, that can lead to victimization. Depression after TBI can lead to an increased risk of self-inflicted injury, including suicide (Oquendo et al., 2004). Although not a focus of this article, suicide is an important aspect of violence that is addressed elsewhere in this issue (See Brenner article).
The goal of this article is to increase awareness among TBI and health care professionals about the overlap between TBI and violence by summarizing the epidemiology and providing case examples for victimization and aggressive behavior. In addition, we focused on intimate partner violence and TBI because of the limited information published about this topic.
Violence as a Cause of Traumatic Brain Injury
Intimate Partner Violence
The term intimate partner violence (IPV) is also known as domestic violence, spouse abuse, or woman abuse. An “intimate partner” is defined as a current or former partner, including a spouse, boyfriend, or girlfriend (Saltzman et al., 1999). After a relationship ends, many people continue to be at risk for violence from former partners. Intimate partners can be the opposite or the same sex as the victim (Burke et al., 1999; Moracco et al., 2007).
Each year in the United States, women experience about 4.8 million intimate partner-related physical assaults and rapes; men are the victims of about 2.9 million intimate partner violencerelated physical assaults (Tjaden et al., 2000). However, these numbers may underestimate the extent of the problem as certain populations who are more likely to report IPV (prisoners, those living in shelters, transient people, and the homeless) are less likely to be surveyed.
The number of cases of TBI associated with intimate partner violence is not known. However, as mentioned above, CDC estimates that at least 156,000 TBI-related deaths, hospitalizations, and emergency department visits in the U.S. each year are related to assaults (Langlois, et al., 2004). Strangulation or blows to the head may occur in 50 to 90 percent of IPV physical assaults against women (Wolfe et al, 1997; Greenfield et al., 1998). Thus, the true number of violence-related TBIs may be much higher than the CDC estimate. Multiple TBIs, including concussions are frequently reported by incarcerated women with a history of IPV (Pamela Diamond, PhD, University of Texas-Houston, Personal Communication, October 2007).
In one study, 60 percent of the women with IPV-related TBI continued to exhibit TBI-related symptoms 3 months after the injury (Monahan and O’Leary, 1999). Women with TBI frequently exhibit reduced capacity to make informed, consistent choices about whether to leave or return to the perpetrating partner, and their ability to plan and to respond appropriately to safety, health, child care, and parenting issues may be significantly compromised (Monahan and O’Leary, 1999). This increases the likelihood that they will remain in a violent relationship and the risk of sustaining additional injuries, including TBI.
Many victims do not report IPV to police, friends, or family because they think others will not believe them and that the police cannot help (Tjaden et al., 2000).
This may be particularly true for persons with traumatic brain injury (Reichard et al., 2007) for several reasons. First, individuals with TBI are more likely to be dependent on a perpetrator for financial support and physical care. Second, communication problems associated with TBI may make it difficult for victims to report victimization. Third, the perpetrator may claim that the victim should not be taken seriously because of their TBI-related cognitive problems. Finally, victims may not be willing to admit that they have had a TBI because of the fear of negative consequences such as losing custody of their children.
Read more:
www.brainline.org/content/2008/07/breaking-silence-violence-cause-and-consequence-traumatic-brain-injury.html
Multimedia
Learn about shaken baby syndrome and mild traumatic brain injury in babies.
New Mexico's Aging and Long-Term Services Department with funding from the State of NM and the US Health Resources and Service Administration. Used with permission.
Transcript of this video. Shaken Baby Syndrome
Acknowledgements
The authors thank Dr. Tom Simon from the Division of Violence Prevention, National Center for Injury Prevention and Control, CDC for his critical review of the manuscript.
Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Background
The overlap between traumatic brain injury (TBI) and violence is an important yet little understood problem. The exact number of violence-related TBIs each year is not known. The Centers for Disease Control and Prevention (CDC) estimates that 11% of TBI deaths, hospitalizations, and ED visits combined (a total of 156,000 each year) are related to assaults (Langlois et al, 2004). But this number likely is low because it excludes the many other TBIs, including concussions, caused by violence that go unidentified and unreported. Although not a focus of this article, prisoners and young children are two of the groups at high risk of a violence-related TBI that may not be identified. (See articles by Wald, et al, and Berger, this issue).
Furthermore, the problem of TBI and violence is complicated by the fact that violence is not only a cause, but a consequence of TBI. Specifically,TBI-related cognitive and behavioral problems can also result in aggressive behavior that leads to perpetration of violence, or a lack of insight and judgment, and resulting vulnerability, that can lead to victimization. Depression after TBI can lead to an increased risk of self-inflicted injury, including suicide (Oquendo et al., 2004). Although not a focus of this article, suicide is an important aspect of violence that is addressed elsewhere in this issue (See Brenner article).
The goal of this article is to increase awareness among TBI and health care professionals about the overlap between TBI and violence by summarizing the epidemiology and providing case examples for victimization and aggressive behavior. In addition, we focused on intimate partner violence and TBI because of the limited information published about this topic.
Violence as a Cause of Traumatic Brain Injury
Intimate Partner Violence
The term intimate partner violence (IPV) is also known as domestic violence, spouse abuse, or woman abuse. An “intimate partner” is defined as a current or former partner, including a spouse, boyfriend, or girlfriend (Saltzman et al., 1999). After a relationship ends, many people continue to be at risk for violence from former partners. Intimate partners can be the opposite or the same sex as the victim (Burke et al., 1999; Moracco et al., 2007).
Each year in the United States, women experience about 4.8 million intimate partner-related physical assaults and rapes; men are the victims of about 2.9 million intimate partner violencerelated physical assaults (Tjaden et al., 2000). However, these numbers may underestimate the extent of the problem as certain populations who are more likely to report IPV (prisoners, those living in shelters, transient people, and the homeless) are less likely to be surveyed.
The number of cases of TBI associated with intimate partner violence is not known. However, as mentioned above, CDC estimates that at least 156,000 TBI-related deaths, hospitalizations, and emergency department visits in the U.S. each year are related to assaults (Langlois, et al., 2004). Strangulation or blows to the head may occur in 50 to 90 percent of IPV physical assaults against women (Wolfe et al, 1997; Greenfield et al., 1998). Thus, the true number of violence-related TBIs may be much higher than the CDC estimate. Multiple TBIs, including concussions are frequently reported by incarcerated women with a history of IPV (Pamela Diamond, PhD, University of Texas-Houston, Personal Communication, October 2007).
In one study, 60 percent of the women with IPV-related TBI continued to exhibit TBI-related symptoms 3 months after the injury (Monahan and O’Leary, 1999). Women with TBI frequently exhibit reduced capacity to make informed, consistent choices about whether to leave or return to the perpetrating partner, and their ability to plan and to respond appropriately to safety, health, child care, and parenting issues may be significantly compromised (Monahan and O’Leary, 1999). This increases the likelihood that they will remain in a violent relationship and the risk of sustaining additional injuries, including TBI.
Many victims do not report IPV to police, friends, or family because they think others will not believe them and that the police cannot help (Tjaden et al., 2000).
This may be particularly true for persons with traumatic brain injury (Reichard et al., 2007) for several reasons. First, individuals with TBI are more likely to be dependent on a perpetrator for financial support and physical care. Second, communication problems associated with TBI may make it difficult for victims to report victimization. Third, the perpetrator may claim that the victim should not be taken seriously because of their TBI-related cognitive problems. Finally, victims may not be willing to admit that they have had a TBI because of the fear of negative consequences such as losing custody of their children.
Read more:
www.brainline.org/content/2008/07/breaking-silence-violence-cause-and-consequence-traumatic-brain-injury.html