I want to start with something personal, because I think it matters for how you receive what comes next.
I have sat across from professionals — case workers, officers, court-appointed evaluators — who were making decisions about my life and my children while looking at me like I was a problem to be solved. I have watched the confusion on their faces when my account didn't come out clean and linear. I have felt the shift in the room when I couldn't remember the exact date something happened, or when I started crying in the middle of a sentence I couldn't finish.
I know what it looks like to be assessed by someone who doesn't have the framework to understand what they're actually seeing. And I know what it costs when they get it wrong.
This piece is not written in anger at those individuals. Most of them were doing their jobs with the training they had. This is written to change what that training includes.
The Scale of What You're Walking Into
Traumatic brain injury among domestic violence survivors is not rare. It is not an edge case. In clinical and shelter populations, research consistently finds that 60–92% of women experiencing severe intimate partner violence report head injuries or probable TBI. Many of those injuries are repetitive, mild, and completely invisible.
These survivors will not look injured. They will not have visible bruises. They will not always be able to explain what happened, or in what order, or with the kind of clarity and consistency that practitioner training has taught professionals to expect from a credible witness.
That inconsistency is not a red flag for dishonesty. It may be evidence of a brain injury.
Strangulation: The Injury That Leaves No Mark
Between 27–68% of IPV survivors experience non-fatal strangulation. It causes brain injury through oxygen deprivation — often with no visible marks, no bruising, and no immediate medical presentation. Survivors may not even realize it caused harm.
Strangulation is also one of the strongest predictors of future lethality in any abuse case. A single incident raises homicide risk by 7 to 10 times.
If a survivor reports or implies any history of strangulation — even casually, even minimized ("he just grabbed my throat once") — treat the encounter as a potential brain injury case. Cognitive and emotional symptoms may be neurological, not psychological. UK data on domestic abuse survivors found that 1 in 2 may be living with brain injury, compared to 1 in 8 in the general population. 80% had experienced a serious blow to the head. 75% had been held in a way that prevented breathing.
What TBI Looks Like in the Field — and What It Gets Mistaken For
The following behaviors are documented neurological and psychological effects of repeated mild TBI and non-fatal strangulation. They are commonly — and incorrectly — interpreted as signs of mental illness, deception, or parental unfitness. Every time that misread happens, a survivor pays for an injury with their credibility.
| What You Observe | What It May Actually Be |
|---|---|
| Inconsistent or fragmented story; changes details across interviews | Memory impairment from TBI — episodic memory disruption is a documented effect |
| Flat affect, appears "checked out" or emotionally unavailable | Dissociation + TBI-related emotional blunting; also trauma response to repeated harm |
| Difficulty following instructions, completing paperwork, or attending appointments | Executive function deficits from cumulative concussive injury — not negligence or non-compliance |
| Minimizes or defends the abuser; doesn't present as a "victim" | Coercive control conditioning, fear-based bonding, and cognitive effects of ongoing abuse |
| Emotional volatility, crying, anger, shutting down during interview | Neurological dysregulation + trauma response — not instability or parental unfitness |
| Cannot recall dates, sequences, or specifics clearly | TBI-related short-term and working memory impairment — common after repeated head injury |
| Appears confused, slow to respond, or "spacey" | Post-concussive cognitive effects, possible oxygen deprivation sequelae from strangulation |
Interpreting TBI symptoms as parental incapacity, non-cooperation, or dishonesty has resulted in children being removed from non-abusing parents — and placed, in some cases, closer to the perpetrator. The injury caused by the abuser becomes the evidence used against the survivor.
Coercive Control: The Context That Changes Everything
Coercive control is not a single incident. It is a pattern of behavior — isolation, surveillance, financial control, threats, degradation, and physical violence — designed to erode a person's autonomy and judgment over time.
In coercive control relationships, head and neck targeting is deliberate. It causes injury without reliable visible evidence. Strangulation is used as a dominance tool, not just in moments of rage. The result is a survivor whose neurological and psychological functioning has been systematically damaged — often over years — before you ever meet them.
A Practitioner Checklist: Before You Draw a Conclusion
Use this checklist when assessing any case involving a current or former intimate partner relationship with a history of physical abuse.
- Have I asked — in a trauma-informed way — about any history of blows to the head, face, or neck?
- Have I asked specifically about strangulation, choking, or being held by the throat?
- Have I considered that cognitive or memory inconsistencies may be neurological rather than deceptive?
- Have I noted how long the relationship lasted — longer duration increases cumulative TBI likelihood?
- Have I distinguished between behaviors caused by the survivor's injury versus behaviors reflecting character or parenting capacity?
- Am I applying criteria designed for uninjured people to someone who may have sustained repeated brain trauma?
- Have I documented any visible or reported signs of TBI in the case record, even if unconfirmed medically?
- Is there a referral pathway available to a TBI-informed advocate, neurologist, or specialist?
- Am I aware of any recent changes in the survivor's cognitive functioning that may indicate new or worsening injury?
Principles for Trauma- and TBI-Informed Practice
Injury First, Character Second
Before assessing behavior as a personality trait or parenting deficit, consider whether it could be a symptom of physical injury. The same behavior means something entirely different in each context.
Inconsistency Is Not Deception
Memory impairment, fragmented recall, and changing accounts are documented effects of TBI and trauma. Credibility assessments must account for neurological injury.
Absence of Visible Injury Is Not Absence of Injury
Most IPV-related TBIs have no visible marks. Strangulation often leaves none. Do not require physical evidence to take neurological symptoms seriously.
The Abuser's Tactics Become the Survivor's Liabilities
In coercive control cases, the abuser deliberately causes injury and isolation. Holding survivors accountable for the effects of that deliberate harm compounds the original abuse.
Screening Changes Outcomes
A single well-placed question — "Were you ever hit in the head or choked?" — can completely reframe a case, a service plan, and a family's trajectory. Ask it.
Why This Is a Civil Liberties Issue
I want to end where I started — with the personal, because the personal is political and the political is legal.
When a survivor's TBI symptoms are misread as dishonesty, instability, or neglect, and when that misread drives a child welfare determination or a family court ruling — a constitutional rights violation may be occurring. The right to parent. The right to due process. The right not to be penalized for an injury you did not choose and were not protected from.
The practitioners who make those calls are not always malicious. Many of them genuinely believe they are protecting children. But good intentions paired with the wrong framework produce the same outcome as bad ones: families separated, survivors re-harmed, and abusers who walk away while the person they injured loses everything.
This is the work. Changing the framework. Building the training that should already exist. Making the invisible injury visible before another case is decided by someone who didn't know to ask the right question.