A Multi-Method Approach to a Comprehensive Examination of the Psychiatric and Neurological Consequences of Intimate Partner Violence in Women: A Methodology Protocol

Abstract

The number of women in the United States that experience blows to the head during assaults by intimate partners is substantial. The number of head blows that result in a traumatic brain injury (TBI) is virtually unknown, but estimates far exceed numbers of TBI in parallel populations (e.g., blast exposure, accidents, sports) combined. Research on the impact of TBI on post-traumatic stress disorder (PTSD) in survivors of intimate partner violence (IPV) is sparse. This methodology paper describes the comprehensive, multi-method approach used by a multi-disciplinary team of investigators from several different fields of expertise to assess the interaction of psychiatric, cognitive, psychological, and physical conditions that result from IPV. Using state-of-the-art instruments, a comprehensive assessment of lifetime trauma exposure, lifetime history of TBI, psychiatric history, and a full assessment of current cognitive, neuropsychological and biomedical function was conducted with 51 female survivors of IPV who screened positive for PTSD. This multi-method assessment included clinician-administered diagnostic interviews modified to specifically assess the sequelae of IPV, standardized self-report surveys, neuropsychological tests, structural, diffusion, and functional neuroimaging and blood-based biomarkers. The specific details and full report of the results of the full study are beyond the scope of this methodology paper. Descriptive characteristics of the complex clinical presentation observed in this unique sample are described. The sample reported high rates of trauma exposure across the lifespan and 80% met full criteria for current PTSD. Women also reported high rates of lifetime subconcussive head injury (88.2%) and TBI (52.9%) from various etiologies (35.3% secondary to IPV). Descriptive findings from the methodological protocol described here have begun to reveal information that will advance our understanding of the impact of subconcussive head injury and TBI on recovery from mental injury among IPV survivors.

Massed cognitive processing therapy for posttraumatic stress disorder in women survivors of intimate partner violence.

“…Twelve women who experienced IPV and a current DSM–5 PTSD diagnosis (American Psychiatric Association, 2013) were recruited for the pilot study. These women had participated in a larger observational study of PTSD and head injuries among female IPV survivors (Galovski et al, 2021). At the time of recruitment for this pilot study, 27 women had completed the larger study.…”

Neural Correlates of Traumatic Brain Injury in Women Survivors of Intimate Partner Violence: A Structural and Functional Connectivity Neuroimaging Study

“…Participants took part in a larger study on the impact of TBI and PTSD among women survivors of IPV. 3 Participants were recruited throughout the St Louis metropolitan area via flyers sent to agencies that serve survivors of IPV and through advertisements on social media (eg, Facebook, Menlo Park, California). Inclusion criteria were assessed via a telephone screening and included (i) being a woman (biological and identified sex); (ii) being between the ages of 18 and 45 years; (iii) having experienced lifetime IPV as indicated by 1 or more incidents of physical, psychological, and/or sexual violence; and (iv) screening positive for PTSD based on the PTSD Checklist for DSM-5 (PCL-5) 18 via telephone screening.…”

Feasibility and clinical usefulness of the Unified Protocol in women survivors of violence

“…The number of moderating variables that can contribute to the impact of violence is immense (Galovski et al, 2021).…”

“…Some examples of functional impairment indicated by these authors include difficulties in finding or keeping a job, difficulties in continuing to attend work, problems concentrating, difficulties in maintaining friendships and interacting with other people, or difficulties in participating effectively in a group (Helfrich et al, 2008). In fact, women who experience violence are 2.3 times more likely to develop Post-Traumatic Stress Disorder (PTSD) than those who do not experience violence (Galovski et al, 2021). Also, the likelihood of experiencing symptoms like depression and anxiety (although anxiety and depressive responses can be sometimes an adaptative response to the environment) is higher in people exposed to violence compared to the normal population (e.g., Graham-Bermann et al, 2011) because, in the former, these disorders range between 30 and 60% (Larizgoitia, 2006).…”

“…However, it is important to note that the cases of these three participants tend to be the most common among survivors of violence. As mentioned in the introduction, the number of moderating variables that can contribute to the impact of violence is immense (Galovski et al, 2021), so that an intervention can often result in limited progress due to all these moderating variables. In these cases, medical problems and family dynamics have an important influence and could be framed as factors that impact exposure to the trauma of violence (Helfrich et al, 2008;Herschell et al, 2017).…”