The 16 days of Activism Against Gender-Based Violence is observed annually from November 25 to December 10. It began as a UN initiative in 1991, encouraging the global community to speak out against gender-based violence – including violence toward women, girls, and 2SLGBTQIA+ people.
The campaign kicks off with the International Day for the Elimination of Violence Against Women, observed on November 25, and ends on December 10 with Human Rights Day.
Violence against women continues to be a significant issue around the world. Last year in Canada alone, 240 women and girls were murdered. Most of the perpetrators were men. Ending gender-based violence remains a priority – and providing appropriate medical and social support for survivors of gender-based and intimate partner violence (IPV) can provide women and gender-diverse people with better opportunities to heal and escape from abusive situations.
Dr. Cheryl Lea Wellington and IPV Research
In honour of this annual observance, we spoke with Dr. Cheryl Lea Wellington, whose current research seeks to illuminate the physiological processes involved in IPV-related brain injury and the impact that these types of brain injuries can have on both short- and long-term health outcomes.
One of the factors that Dr. Wellington’s research explores is the difference between IPV-related brain injury and sports-related brain injuries, and how the emotional involvement of IPV-related injuries may contribute to their severity and impact on other body systems.
Examining blood biomarkers of IPV-related brain injury, Dr. Wellington’s research will potentially serve to improve treatments for these types of injuries, and allow for more accurate diagnosis of the root causes of injury.
Ultimately, knowledge gained through this research will inform clinical practice for diagnosing and treating IPV-related brain injuries with tailored treatment modalities and trauma-informed practice guidelines.
The Importance of Accurate Diagnosis
Not all brain injuries are alike, and growing research suggests that brain injuries stemming from IPV may have a different physiological profile, and different long-term impacts, than sports-related injuries.
Brain injury is linked to a variety of health conditions. Some of the most well-known of these conditions are neurological issues like depression, anxiety, sleep disturbances and chronic stress. In the long term, a history of brain injury may influence a person’s likelihood of developing Alzheimer’s and other dementias.
The brain influences other body systems in a variety of highly complex ways that are not fully understood. Accurately diagnosing not only the injury itself, but its cause, is important for ensuring that patients receive appropriate treatment. It can also tell us more about how physical and emotional trauma are intertwined, and how the presence of both can potentially compound the repercussions of an injury. In the case of IPV-related brain injury, accurate diagnosis can also be crucial from a legal and forensic perspective.
There are many challenges with conducting research in this area, many of which relate to patient confidentiality and ethical concerns in having patients re-engage with deeply traumatic experiences.
Unique Challenges in Researching IPV
Survivors of intimate partner violence face complex barriers to accessing healthcare. In some cases, concerns around confidentiality and the potential for an abuser to retaliate can prevent someone from seeking specific care. In other cases, a person may not even be aware that they have suffered a brain injury. Survivors of intimate partner violence may be referred to shelters or other community support organizations – helpful facilities that are nonetheless not always equipped to diagnose or treat a suspected brain injury.
Pervasive stereotypes around the appearance and nature of IPV cases can also hinder a clinician’s ability to spot and treat IPV-related brain injury. The broad assumption is often that cases of IPV are “one-and-done,” or situations where a young woman finds herself on a bad date, comes to the emergency room for treatment, and then leaves and moves on with her life. Dr. Wellington stresses that IPV survivors vary widely in their age, socioeconomic status, and cultural backgrounds. The circumstances that IPV survivors find themselves in are often very complex, and a great deal of nuance and cultural competency is required for optimal treatment.
This is also one of the challenges that Dr. Wellington has seen in terms of study recruitment and retention. For obvious reasons, some would-be study participants are reluctant to spend time in spaces that require them to relive their trauma, and recall is difficult due to both emotional and confidentiality concerns. Adding to this challenge, IPV itself tends to go underreported in healthcare settings.
Dr. Wellington and her team have worked with clinicians to create a study design developed from the ground up to be safe for participants, that allows for the collection of data to be done in a trauma-informed and culturally competent way. The team collects as much data as they can in one appointment, so participants are not required to return. These ethical considerations are also helpful in evaluating future treatment modalities and ensuring that clinics and services are designed to be accessible and to meet the needs of people with experience of IPV or who may be living with recurrent IPV.
Looking to the Future
There are currently no evidence-based diagnostic tools that allow for accurate documentation of IPV-related brain injury, and clinical practice guidelines in general are limited. In some cases, IPV-related brain injury can go undiagnosed for months or years. The need for sensitivity and flexibility in treatment adds complexity, as there is no one-size-fits-all approach.
Though current research has focused on recruitment through one specialist clinic in BC, the team is looking for opportunities to expand into other clinics that provide this type of support. Dr. Wellington’s research will help inform more detailed clinical guidelines to support healthcare practitioners in approaching these types of injuries.
The WHO estimates that globally, 27% of women who have been in a relationship have experienced some form of intimate partner violence. The drivers behind IPV are complex, but it remains a significant public health and human rights issue.
Dr. Wellington notes that it has been profoundly meaningful to speak to people with lived experience of IPV, and to share information about the research that is being done in this field. Many survivors are simply grateful to have someone listen to their story without judgement or blame. Providing a space for survivors to speak up has in turn encouraged others to speak up and find a supportive community.