The hidden impact of brain injury in domestic abuse

Brain injury is often described as a hidden disability. In the context of domestic abuse, there may be even more reasons why it goes unrecognised.

I spend much of my working life with people and families affected by brain injury, so I see just how easily some of its effects can be missed or misunderstood. That makes the growing evidence of a link between brain injury and domestic abuse particularly concerning.

Whilst domestic abuse affects both men and women, women are disproportionately affected. In the year ending March 2025, the Crime Survey for England and Wales estimated that around 2.2 million women and 1.5 million men aged 16 and over had experienced domestic abuse. Women also made up 72.1% of victims of domestic abuse-related crimes recorded by the police.

Domestic abuse is not limited to physical violence; it can include coercive and controlling behaviour, emotional abuse, financial abuse, isolation, threats and intimidation. Where violence does occur, repeated blows to the head, falls, assaults and episodes of strangulation can all cause injury to the brain. These injuries may be traumatic or caused by a lack of oxygen.

One piece of research gives some idea of how often brain injury may be part of the picture. Brainkind’s 2024 report, Too Many to Count, looked at 60 women using community-based domestic abuse services. More than half, 55%, screened positive for a history indicative of brain injury. Eighty per cent reported having suffered a serious blow to the head, while 75% said they had been held in a way that prevented them from breathing.

There are several reasons why brain injury in this context can go unrecognised. Survivors may not describe what has happened as a “head injury”, may not seek medical help, or may understandably prioritise immediate safety over treatment. For survivors living with fear, trauma, shame, isolation or ongoing risk, getting medical help or identifying what has happened as a brain injury may not be possible.

The effects of trauma and abuse can also overlap with, mask, or be mistaken for the consequences of brain injury. That does not mean every survivor of domestic abuse will have a brain injury, but it does mean that services need to be alert to the possibility and able to respond appropriately.

Headway London provides vital specialist support, understanding and community for people living with acquired brain injury. Like many Headway groups across the country, it helps to fill gaps in statutory provision by offering practical information, connection and a place where people affected by brain injury can feel understood.

In 2026, Headway London introduced a dedicated Domestic Violence Support Pathway. This is an important and forward-thinking development. It recognises that people living with brain injury may also be experiencing, or may have experienced, domestic abuse, and that staff need clear information, referral routes and procedures to respond safely and consistently.

In Headway London’s own words:

Over the past year, Headway London has been developing a Domestic Violence Support Pathway to better support people living with an acquired brain injury who have experienced or may be experiencing abuse, to make sure that the right ongoing support is available.

The journey began through a combination of research as well as practical learning, with growing evidence continuing to highlight the links between domestic abuse and brain injury. Given the scale of this issue, some reports suggesting that as many as one in two women who have experienced domestic violence may potentially be living with a brain injury, we recognise that there is a clear need to develop approaches and services that recognise and accommodate these complex needs.

We recognise that within our community there are people who have sustained their injury through instances of domestic violence and that people may be experiencing violence and abuse. Through shared conversations within our membership, it has become clear that having a consistent way of responding and a stronger understanding of the specialist support available would be necessary for all our team to access.

Over the last year, we have spent time listening, learning and building relationships with organisations working across the domestic abuse sector. We have met with Refuge, Women’s Aid, IRISi, Independent Domestic Violence Advocates (IDVAs), brain injury nurse specialists and researchers whose work has explored the connection between brain injury and abuse. These conversations have helped shape our understanding and highlighted the importance of a response that recognises the unique challenges faced by survivors with brain injuries. It also gave us the opportunity to share information with those organisations about brain injury and the support systems available.

What has stood out throughout these explorations is the importance of being heard and understood. Feedback from our members has reinforced why this pathway is important.

“Something has been taken away from us but having time with people that understand brain injury to help us access the right support is so important.”

“Some people just need time and kindness from someone that they trust when they feel alone or unheard, this could help people not to feel like that and have all the connections in one place.”

In response to this we have developed a Pathway which includes a Domestic Violence Policy, a comprehensive index of key contacts and resources, and a practical procedure for our staff to follow in order to support our membership.

We will now have a focus on strengthening the partnerships we have built and ensuring that staff have easy access to information, resources and specialist contacts so that referral routes remain active, responsive and easily accessible for those who need them. This pathway aims to provide opportunities for people to feel listened to, believed and connected to the right help at the right time.

The link between domestic abuse and brain injury is not something we can afford to overlook. A survivor may already be dealing with fear, trauma and isolation. If the effects of a brain injury are then missed or mistaken for something else, they may never get the help they need.

In my work with people and families affected by brain injury, I see how much difference it can make when someone understands what has happened to them and is able to access the right support.

That is what makes Headway London’s new pathway so important. It gives staff practical guidance, strengthens links with specialist domestic abuse services and, crucially, helps people get to the right support when they need it.

Sometimes the first step is simply recognising that a brain injury might be there.