If you or someone you know is experiencing abuse, you are not alone. Free, confidential services are available 24/7. Contact the National Domestic Violence Hotline at thehotline.org, call 800-799-SAFE (7233), or text “START” TO 88788. Click here to learn more about brain injuries from domestic violence.

Every October, Domestic Violence Awareness Month highlights the life-changing role each of us can play in supporting people we know and care about who might be experiencing abuse and feel alone. Domestic violence impacts our families, friends, and communities, and most people talk about unsafe relationships first with someone they trust. This month also calls attention to the many ways violence leaves lasting harm—some visible, others hidden. One of the least recognized is concussion and brain injury.

When someone experiences a concussion, there’s a path to care that feels pretty clear: get checked out, follow medical guidance, and take the time to rest and recover. But for survivors of domestic violence, that path can be far more complicated.

Concussions caused by intimate partner violence are common, yet the people experiencing them face several barriers to diagnosis and treatment. These injuries often happen behind closed doors, without witnesses, and the very systems designed to help, like healthcare, law enforcement, and social services, can feel unsafe or out of reach.

That’s what Rachel Ramirez and Kasey Holderbaum of the Ohio Domestic Violence Network (ODVN) are working to change. Ramirez, ODVN’s Director of Health and Disability Programs, also founded the Center on Partner-Inflicted Brain Injury, a project of ODVN that provides statewide, national, and international leadership on the emerging field of brain injuries caused by domestic violence. The Center helps professionals and advocates better recognize, respond to, and support survivors with brain injuries.

Holderbaum, ODVN’s Health and Disability Coordinator, works alongside Ramirez to bridge the gap between systems—bringing together healthcare providers, researchers, and domestic violence advocates—to build safer, more compassionate pathways to care.

Why getting help isn’t always simple

The typical concussion message of “just go get checked out” doesn’t fit the realities of domestic violence.

“For many survivors, that advice assumes a level of privilege and safety they don’t have,” Ramirez says. “You can’t ‘just go’ if your partner controls your transportation, your money, or whether you’re allowed to leave the house.”

“These assaults happen in private,” Ramirez continues. “There’s no athletic trainer or teammate saying, ‘Hey, you need to get that checked out.’ Often, the only person there is the person who caused the injury.” Even when survivors want medical help, fear often overrides it—fear of retaliation or of being found by their abuser, and, as national data show, fear that seeking care could trigger outside intervention, such as law enforcement or child welfare involvement.

Holderbaum sees another layer: years of trauma can blur what “normal” feels like. “Survivors have often been through so much that they minimize what’s happened,” she says. “They’ll say, ‘Yes, I was hit—but it wasn’t as bad as last time.’ When you’ve been injured repeatedly, you stop distinguishing one incident from another. You wake up, you can move, you keep going. Why would you think you need medical care?”

Invisible symptoms and misread signs

Even when survivors reach a clinic or emergency room, the signs of a concussion may go unnoticed—or worse, misinterpreted.

Ramirez notes that survivors often describe feeling foggy, unable to concentrate, or “off,” only to have those symptoms dismissed as anxiety or depression. “We’ve seen that pattern over and over,” she says. “Symptoms that point to a possible brain injury get attributed to mental health instead.”

That diagnostic blind spot leaves survivors cycling through treatments that never address the root cause. It also reinforces stigma. Holderbaum adds that when survivors are repeatedly told their struggles are emotional rather than physical, “they start to doubt themselves—it’s another way their voices are dismissed.”

Ramirez advocates for a simple but crucial shift: when survivors present with these symptoms, healthcare providers should consider concussion or brain injury as part of the differential diagnosis—the process doctors use to evaluate and rule out possible causes. “We can’t treat what we don’t recognize,” she says.

When screening falls short

Even a well-intentioned medical screening can backfire if not handled carefully. Holderbaum recalls a time when she visited a doctor and the routine intake questions took an unexpected turn.

“She asked, ‘Are you safe at home?’ I said, ‘I am—but what if I wasn’t?’ The doctor admitted they weren’t sure and eventually told her that they’d “probably call the police.”

That moment underscored how ill-equipped many providers are to respond safely to disclosure. “If the only plan is to call law enforcement, survivors will stop being honest,” Holderbaum says. “We have to make sure that asking the question doesn’t cause more harm.”

For ODVN, that means helping healthcare providers understand what trauma-informed practice really looks like: explaining why a question is being asked, ensuring privacy, and knowing how to connect a patient with confidential advocacy instead of automatic reporting.

The cost of these barriers

Every October, the ODVN releases its Domestic Violence Fatality Report at a press conference at the Ohio Statehouse—an event that gathers advocates, lawmakers, and survivors to honor those lost and call for action. The 2025 report, released last week, documented 157 fatalities in Ohio between July 2024 and June 2025. Of those, 84 percent involved firearms, and 40 incidents were murder-suicides.

For Ramirez and Holderbaum, these numbers represent the most devastating outcome of the same patterns they see every day. Strangulation and blows to the head—the same assaults that cause concussions and other brain injuries—are among the strongest indicators that violence could turn fatal. When oxygen to the brain is cut off or the head is repeatedly struck, the risk isn’t only long-term impairment—it’s losing one’s life.

“These injuries show up again and again in fatality reports,” Ramirez says. “They’re part of the stories of people we’ve lost—and part of the stories of survivors still living with the impact.”

Breaking through the silence

The barriers are immense—but they’re not immovable.

Through the Center on Partner-Inflicted Brain Injury, ODVN partnered with Ohio State University to develop the CARE Framework. The framework guides advocates, medical practitioners, and partner programs in supporting survivors through a trauma-informed and brain-injury-informed lens:

• Connect: Build trust and create a foundation for survivors to work with advocates.
• Acknowledge: Recognize the challenges and successes survivors are experiencing.
• Respond: Provide trauma and brain injury-informed care, including appropriate accommodations and referrals to healthcare and brain injury support and services.
• Evaluate: Continually check in with survivors to assess what’s working and adjust as needed.

The framework gives advocates a tool that allows them to be flexible and meet survivors where they are. It helps them slow down, adapt to individual needs, and recognize that diagnosis and care don’t follow a straight line, especially when both trauma and brain injury are involved.

A call to listen, and to help

Domestic violence causes concussions. It causes brain injuries. And the survivors living with those injuries are often the least likely to be heard. Awareness is growing, but until every healthcare provider and advocate knows how to respond safely and compassionately, those voices will stay unheard—and the barriers will remain.

The good news is that there’s progress is being made. ODVN’s partnerships with healthcare and policy leaders, like Concussion Awareness Now and the Brain Injury Association of America, are helping bridge once-separate worlds and create safer pathways to care. “When domestic violence and brain injury professionals learn from each other, we can build stronger systems,” Holderbaum says.

Recent advances include Ohio Senate Bill 100, which makes it illegal to use GPS or AirTag devices to track partners or family members—a measure inspired by a survivor whose persistence led to legislative change.

Holderbaum says it best: “It’s proof that awareness leads to action.” Each new connection, policy, and partnership builds a world where survivors no longer have to choose between safety and care.