Problem: Intimate partner violence (IPV) is an under-reported but extremely prevalent problem in North America. It is estimated 51.9 million (29%) women and 18 million (10%) men living in Canada (or USA) will experience rape, stalking, or physical violence from an intimate partner at some point in the lives. Recently it has been reported there are >10 million people in North America each year who are victims of domestic abuse, with 25% of survivors report being hit in the head more than 20 times in the past 5 years. The prevalence of traumatic brain injuries (TBI) within this population is thought to range between 30% and 74%, as the face, head and neck are among the most commonly reported targets of the physical assault by IPV survivors. Given these injury mechanisms, it is understandable some of the mental health challenges faced by victims of IPV may be rooted in alterations in brain physiology/function.

Objectives: The overall objective of this investigation is to understand the physiological changes underlying the symptoms and deficits in neurocognitive function observed in the women who have experienced IPV. Primary Hypothesis: TBI as a result of IPV will lead to quantifiable impairments in cerebral blood flow regulation (i.e. cerebral autoregulation and neurovascular coupling metrics). Secondary Hypothesis: The degree of impairment in cerebrovascular and cardiovascular functions will correlate with higher degrees of brain injury severity in survivors of IPV.

Methods: Eighteen female IPV survivors (35.4 ± 8.7 years; BMI 25.5 ± 7.4 kg/cm2) with 13.4 ± 1.7 years of education participated in this investigation. The survivors were tested on 2 separate days. The first day consisted of the psychopathological self-reported and semi-structured interviews performed by a trained clinician. The second day consisted of the SCAT5 and a series of laboratory based examinations including an assessment of cerebral autoregulation and neurovascular coupling tasks.

Results: IPV survivors with greater brain injury severity assessment scores (indicative of more frequent, recent and severe TBIs) displayed greater alterations in certain cerebrovascular markers (increase buffering in cerebral autoregulation, reductions in cerebral blood velocity) with minimal changes to others (area under the curve for neurovascular coupling). 

Conclusions: These findings of reductions in cerebral blood velocity and increased buffering in cerebral autoregulation are indicative of stiffening of the cerebrovasculature in this population. Of additional concern is these impairments appear to be related to the severity of self-reported brain injury and may contribute to the augmented symptoms reported in this population. Taken together, the current study provides objective evidence of TBI-related cerebrovascular impairments in women who have experienced IPV and suggests this should be taken into account in providing support services to this population as they negotiate the myriad changes required to break the abuse cycle.

Physiological Alterations within the Cerebrovasculature in Survivors of Intimate Partner Violence