IPV (Domestic Abuse) and TBI: Why Survivors Are So Often Misdiagnosed

When a survivor of intimate partner violence (Domestic Violence)  walks into a clinic reporting headaches, memory problems, difficulty concentrating, mood swings, and disrupted sleep, a clinician who does not know to ask about head trauma will almost certainly reach for a psychiatric diagnosis. Depression. Anxiety. PTSD. Those diagnoses may all be accurate. The problem is that they are frequently incomplete.

Research estimates that between 75 and 92 percent of women who experience intimate partner violence sustain at least one traumatic brain injury during that relationship. The symptoms that result from that injury overlap almost completely with the symptoms of the psychiatric conditions those same women are commonly diagnosed with. Without a specific inquiry into the mechanism of injury, the brain injury remains invisible and untreated.

The Symptom Overlap Problem

The table below shows how the symptoms of IPV-related TBI map against the symptoms of the conditions survivors are most commonly diagnosed with instead. The overlap is not coincidental. In many cases, the psychiatric symptoms are downstream effects of the neurological injury, not independent conditions.

Balance and coordination problems are among the few symptoms that point more specifically toward neurological injury rather than psychiatric diagnosis. Their presence alongside the others on this list should prompt a clinician to ask about head trauma directly.

Why Clinicians Miss It

The misdiagnosis problem is not primarily about clinical negligence. It is about a structural gap in how intake and assessment are conducted. Most clinical settings do not include standardized screening for TBI as part of routine care for women presenting with mental health symptoms. The history is simply never taken.

A second factor is time. Symptoms of TBI do not always present immediately after an injury. Cognitive changes, mood instability, and chronic headaches can develop or worsen over weeks and months following repeated head trauma. By the time a survivor reaches a clinician, the connection to the original injuries may not be obvious to anyone in the room.

Third, strangulation complicates the picture further. Non-fatal strangulation causes hypoxic brain injury through oxygen deprivation rather than direct impact. It frequently leaves no visible marks and is often not documented in medical records at all. The neurological effects can appear days to weeks after the event and are almost never attributed to their actual cause.

The Cost of an Incomplete Diagnosis

When TBI goes unidentified, treatment is built around the wrong framework. Antidepressants and therapy may address some symptoms but will not resolve the neurological components of cognitive dysfunction, sensory sensitivity, or balance problems. Survivors who do not improve on standard psychiatric treatment are sometimes described as treatment-resistant, when the more accurate description is that the primary diagnosis is incomplete.

A 2025 study from the University of Kentucky called explicitly for systematic TBI screening as part of standard care for IPV survivors, noting that the polytrauma clinical triad of TBI, PTSD, and chronic pain requires an integrated treatment approach that cannot be built without first identifying all three components.

What Survivors and Advocates Can Do

1. If you are a survivor currently in care, ask your provider specifically about TBI screening. Name the mechanism of injury directly if you can. Your provider may not ask, but you can make the request.
2. If you work with survivors in any capacity, familiarize yourself with two validated screening tools that can be administered in community settings without a physician: the HELPS Brain Injury Screening Tool and the Ohio State University TBI Identification Method (OSU TBI-ID). Both are free and validated for use with IPV populations.
3. Connect survivors to the Brain Injury Association of America's state affiliate network at biausa.org for referrals to specialists who understand the intersection of TBI and trauma.
4. Share this information. Survivors often cannot search for it themselves while in an abusive relationship. The people around them frequently do not know what they are looking at. Advocacy work and clinical work both depend on accurate information reaching the right people.

For the full clinical picture, including the research on strangulation, the polytrauma triad, and the emerging dementia risk data, see our anchor article: Brain Injury and Intimate Partner Violence: What the Research Shows.