Research Links Strangulation in IPV to Long-Term Brain Injury

Mass General Brigham

In a federally funded study, Mass General Brigham investigators found self-reported vision problems and traumatic stress are experienced years after strangulation

Around the globe, nearly one in three women have experienced intimate partner violence (IPV). Among those women, 68% experience strangulation, which blocks air and blood flow to the brain and can cause brain injury. A new study by investigators from Mass General Brigham of 139 women found that strangulation-related brain injury was negatively associated with women's health over time, including self-reported vision problems and traumatic stress. Their results are published in the Journal of Neurotrauma .

"This study highlights potential long-term consequences of IPV-related strangulation and reinforces the importance of IPV prevention and providing treatment for women in need," said corresponding author Eve Valera, PhD, an investigator in the Mass General Brigham Department of Psychiatry.

As part of their federally funded study, the researchers recruited 139 mostly white women through flyers, online advertisements, and social media. Strangulation does not always result in brain injury, so carefully designating study participants into groups based on their experience was critical to understand the varying severity of symptoms. Three major subgroups were identified: strangulation; strangulation with altered consciousness—seeing stars, tunnel vision; and strangulation with full loss of consciousness. Participants in either altered or loss of consciousness categories were assumed to have acquired brain injuries.

Among the participants, 64% reported a history of IPV-related strangulation; 30% reported strangulation-related alterations in consciousness; and 15% reported strangulation-related loss of consciousness. The researchers asked the three subgroups to self-report symptoms like dizziness, vision and hearing problems, poor concentration, anxiety, depression, and traumatic stress, between July 2020 and February 2023. On average, the last strangulation event participants experienced was 8.7 years prior to the participant's interview.

Vision problems and traumatic stress symptoms were greater in women who had experienced strangulation, with those that also experienced strangulation-related brain injury reporting more symptoms like stress, dizziness, and poor concentration. Strangulation-related alterations in consciousness were associated with escalated vision problems compared to strangulation alone, while full loss of consciousness was associated with escalated traumatic stress symptoms. The findings suggest self-reported neurobehavioral issues and traumatic stress may linger long after strangulation for all participants.

"Strangulation is under-reported, and more work is needed to encourage disclosure, social interventions, and timely health care for those subjected to these violent events," said Valera.

Authorship: In addition to Valera, Mass General Brigham authors include Grant L. Iverson. Additional authors include Maria C. Xu, Aylin Tanriverdi.

Disclosures: Iverson serves or has served as a scientific advisor for NanoDX®, Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He has received past research support or funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, and the Schoen Adams Research Institute at Spaulding Rehabilitation. None of the above entities were involved in the study design, analysis, interpretation, the writing of this abstract, or the decision to submit it for presentation.

Funding: This work was supported by grant R01NS112694 (EMV) from the National Institute of Neurological Disorders and Stroke.

Paper cited: Xu MC et al. "Title: History of Strangulation is Associated with Current Traumatic Stress, Self-Reported Vision Problems, and Other Neurobehavioral Symptoms in Women who have Experienced Intimate Partner Violence" Journal DOI: 10.1177/08977151251394000

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