Excuse #5: Traumatic Brain Injury
Traumatic brain injury (TBI) from falls, assaults, motor vehicle crashes, sports injuries, etc., can sometimes lead to aggressiveness and incidents of physical violence.
Injury-related violence can be mistaken for domestic abuse . For instance:
- Dave suffered a TBI several years ago, and recently his memory loss, confusion, agitation and paranoia have gotten worse. He talks about events that never happened. He has become very violent and has threatened to kill Fran while she sleeps. Fran doesn’t feel safe in her own house.53 Is this loss of control, or coercive control?
- Greg, who has a TBI, was watching TV when Louise started talking to him. He yelled at her to stop being so demanding. Is he being abusive and controlling, or is he simply unable to process listening to her and watching TV at the same time?
People who have a TBI often do not understand why they react the way they do, and may not attribute their behavior to their injury. However, there are two kinds of clues that an individual’s violence may be related to a TBI.
- Recognizable, injury-related triggers:
- Memory and attention difficulties.54
- Inability to tolerate stressful situations. (Abusers mistreat their partners both when they’re under stress and when they’re not, and use stress as an excuse for abuse.)
- Resentment at forced dependency or physical pain.
- Other co-occurring problems:
- Cognitive, emotional and physical impairments.
- Problems in social relationships, work, and physical health.
- Apparently good functioning at one moment, followed by tremendous difficulty the next.55 (The reverse is typical of many abusers, who may switch rapidly – and purposefully – from seemingly out-of-control, to calm, cool and collected.)
TBI does not lead to coercive control
Many people with brain injuries get arrested for violent or non-violent crimes,56 and many felons have suffered a TBI – often a childhood concussion – before their first run-in with the law.57 Childhood concussions are very common, often go unrecognized, and can lead to long-term problems with aggression and impulsivity,58 59 but they do not lead to an intentional pattern of coercive control, or domestic abuse.
Abusers who have a TBI
Some service providers mistake domestic abuse for injury-related violence, and some abusers use a TBI (real or fabricated) as an excuse for controlling behavior. Someone who insists “it’s because of my TBI” is likely to be making an excuse. For instance:
- Albert was in a car crash. He says he has a TBI and uses it as an excuse for abusing his wife and manipulating other people. His doctor says that his behavior is due to his injury and is not his fault, but he is the exact same person he was before the accident. Only now he has the doctor’s support.60
Abusers who sustain a TBI as an adult may become more physically violent toward their partner. They may also become violent toward others. Their violence and control tactics may become less predictable due to a decreased ability to sustain attention, follow through on a goal, or see connections between actions and their consequences, or due to the use of substances to deal with the effects of the TBI.61
Implications for Intervention
If an individual who has a TBI becomes physically violent, their partner’s safety needs must be addressed.
Careful assessment is critical. Assessing whether a particular case involves injury-related violence or domestic abuse involves looking at the context, the individual’s behavior and attitudes, and the history of their injury. If the injured partner has none of the entitlement attitudes that underlie coercive control, safety plans may focus on seeking rehabilitation services or medication. Interventions aimed at changing abusive attitudes and behaviors are likely to make no sense to someone whose aggression is the result of a TBI, and they may increase his/her sense of frustration and helplessness.
Difficulty controlling aggressive impulses does not excuse hurting others. Individuals with TBIs who know right from wrong and are aware of their problems must bear the responsibility for working on modifying the behavior and avoiding situations that are likely to cause outbursts.62
Questions to ask yourself if your partner has a brain injury
- Which came first – his violence or his injury?
- Has her behavior changed since the injury? How?
- Does he use stress just as an excuse for beating you, or does he also come apart under stress in situations that have nothing to do with you?
- Does she seem to be aware of her deficits? People with TBI’s may not be.
- Does he blame you for his violence? If so, does he blame you as a way to control you, or because his brain injury stops him from seeing other explanations for his frustration? (For instance, he blames you for lying about a fight you had, because he doesn’t remember the fight in the first place.) These are very different things.
- Is he using or abusing substances to deal with the effects of the injury? Did he abuse substances before he was injured?
If you answered “yes” to many of these questions…
- Seeing your partner’s behavior accurately could help you stop thinking he/she is abusive only because of the injury.
- You may want to talk over your situation with an advocate at a local domestic violence program, or with your counselor, if you have one.
- Think about making a safety plan.
- You may want to talk with someone at the Brain Injury Association of New York. (The Brain Injury Association of America has information on other state Brain Injury Associations.)
- Do not assume that treatment for the TBI will make your partner treat you better. It may be necessary, but it won’t be enough to end the violence.
- If you want to know more about the relationship between domestic abuse and TBI, scroll up to read this section, and visit the OPDV TBI page.
- Ibid. Adapted from Chat with Pat 18.
- Ibid., Chat with Pat 12.
- McMorrow, M.J. (n.d.). Behavioral challenges after brain injury, Brain Injury Association of America.
- Sarapata, M., Herrmann, D., Johnson, T. & Aycock, R. (1998). The role of head injury in cognitive functioning, emotional adjustment and criminal behavior. Brain Injury: 12 (10), 821-842.
- TBINRC, Chat with Pat 17.
- Brower, M.C. & Price, B.H. (2001). Neuropsychiatry of frontal lobe dysfunction in violent and criminal behavior: A critical review. Journal of Neurology, Neurosurgery & Psychiatry, 71, 720-726.
- Adapted from TBINRC, Chat with Pat 12.
- TBINRC, Chat with Pat 18.
- TBINRC, Chat with Pat 17.