Examining the Association Between Childhood Trauma, Brain Injury, and Neurobehavioral Symptoms Among Survivors of Intimate Partner Violence: A Cross-Sectional Analysis

Abstract

Objective: Understanding factors contributing to neurobehavioral symptom burden among intimate partner violence (IPV) survivors has important implications for prevention, screening, and intervention in this vulnerable population. This study aimed to (1) identify the relationship between childhood trauma and neurobehavioral symptoms among a shelter-and community-based sample of IPV survivors, including investigating the mediating role of posttraumatic stress symptoms and alexithymia in this relationship; (2) assess the association between IPVrelated brain injury (BI) severity and neurobehavioral symptoms; and (3) assesses whether physical, emotional, or cognitive domains of neurobehavioral symptom burden show differential associations with childhood trauma or IPV-related BI. Setting: Community sites serving women who had experienced IPV such as domestic violence shelters and transitional housing sites. Participants: Women survivors of IPV with and without BI (n = 99), aged 18 to 54 years. Design: Retrospective, cross-sectional study design. Measures: The following self-reported questionnaires were used: Rivermead Post Concussion Questionnaire (RPQ); Childhood Trauma Questionnaire (CTQ); a modified version of the Conflict Tactics Scale; Brain Injury Severity Assessment (BISA); Clinician-Administered PTSD Scale for DSM IV; and Toronto Alexithymia Scale. The final multivariate regression model assessed the association between childhood abuse, BI severity, and neurobehavioral symptoms (as measured by the RPQ) adjusting for age, educational attainment, and abuse in the past year. We created separate models with total neurobehavioral symptom score as an outcome, as well as somatic, emotional, and cognitive symptom scores. We used structural equation modeling to assess whether posttraumatic stress and alexithymia mediated the effect of childhood trauma and neurobehavioral symptoms. Results: Childhood trauma was associated with higher levels (P < .01) of overall neurobehavioral symptom burden in women independent of BI and specifically associated with RPQ Emotional and Somatic subscale symptoms (P ≤ .05). BI was positively associated with somatic symptoms in the full sample and cognitive neurobehavioral symptoms in the sample of women with IPV-related BI (P < .05) independent of childhood trauma. Posttraumatic stress symptoms, but not alexithymia, partially mediated the effect of childhood trauma effect on neurobehavioral symptoms. Conclusion: Childhood trauma and BI should not be overlooked as part of efforts to meet the needs of IPV survivors who may experience a range of emotional, somatic, and cognitive symptoms.

Intimate Partner Violence and Alexithymia: Do Emotions Matter? A Systematic Review and Meta-Analysis

“…Regarding the study area, five studies were performed in Spain (Comes-Fayos et al, 2022; Mata-Gil et al, 2021; Romero-Martínez et al, 2019, 2020, 2021), four were conducted in Italy (Craparo et al 2014; Mannarini et al, 2021; Signorelli et al, 2014, 2020), three in the United States (Berke et al, 2017; Saadi et al, 2022; Yelsma, 1996), two in Australia (Brown et al, 2010; Strickland et al, 2017), one in Romania (Popa-Velea et al, 2016), one in Dominican Republic (Vergés-Baéz et al, 2021), and one in Canada (Vignola-Lévesque & Léveillée, 2022).…”

“…Taking all the studies together, the perpetrators of IPV amount to 837, with sample sizes ranging from 30 (Comes-Fayos et al, 2022) to 187 (Vergés-Baéz et al, 2021), whereas the victims of IPV amount to 465, with sample sizes ranging from 25 (Mata-Gil et al, 2021) to 99 (Saadi et al, 2022). Regarding sociodemographic characteristics, 781 perpetrators of IPV were male, with a mean age ranging from 33.90 (Yelsma, 1996) to 52.24 (Vignola-Lévesque & Léveillée, 2022) years, while 461 victims of IPV were female, with a mean age ranging from 31.62 (Craparo et al, 2014) to 41.55 (Popa-Velea et al, 2016) years.…”

“…Regarding victims of IPV, data on alexithymia mean level were obtained from seven studies (Craparo et al, 2014; Mannarini et al, 2021; Mata-Gil et al, 2021; Popa-Velea et al, 2016; Saadi et al, 2022; Signorelli et al, 2020; Yelsma, 1996). One study was not included because data on mean levels of alexithymia could not be obtained from the authors of the article.…”

Childhood Trauma Questionnaire-Short Form: Evaluation of Factor Structure and Measurement Invariance

“…The CTQ-SF has been used clinically both to diagnose and treat individuals with trauma (Hagborg et al, 2022;Horak et al, 2021;Nakajima et al, 2022;Rasmussen et al, 2018;Zhang et al, 2020). Scores from the CTQ-SF have been shown to positively correlate with confirmed reports of abuse, neglect, and violence (Bernstein et al, 1997;Liebschutz et al, 2018;Saadi et al, 2022). In addition, the CTQ-SF has shown good convergent validity; it has been demonstrated to correlate with, and predict risk for, interpersonal violence, posttraumatic stress disorder, depression, eating disorders, addictions, suicide attempts, personality disorders, and sexual problems (Bethell et al, 2019;Liebschutz et al, 2018;Pedrotti Moreira et al, 2018;Sacchi et al, 2018).…”

Brain Injury and Intimate Partner Violence

“…To further understand symptoms of women from a lifetime of trauma perspective, Saadi and colleagues8 examined the relations between child abuse and an IPV-related BI score reflecting neurobehavioral outcomes. They show that childhood trauma is positively associated with emotional and somatic neurobehavioral symptoms independent of BI; furthermore, they found that BI is positively associated with cognitive neurobehavioral symptoms in women who had experienced IPV-related BI.…”