Following the lecture she delivered on September 12, 2025 — now available for replay. Christine Padgett, Ph. D.,, agreed to answer our questions on a topic that remains largely unknown: brain injuries related to intimate partner violence, particularly strangulation.
She was invited by Carolina Bottari’s research team, which is developing a support ecosystem for women at risk of having sustained a traumatic brain injury. The clinical and scientific perspective of Christine Padgett, a doctor in psychology and senior lecturer-researcher at the University of Tasmania, deepens this reflection. A specialist in traumatic brain injury and principal investigator of the international TALK-TBI project, she examines the cognitive and psychological effects of a form of violence that often leaves few visible marks, yet causes profound consequences.
Here is the interview.
Q1. Why study brain injury in the context of intimate partner violence?
Because it remains largely invisible. For decades, research on intimate partner violence has focused on psychological trauma while overlooking the internal physical injuries that often accompany it. Blows to the head, shaking, and non-fatal strangulation can all cause lasting neurological damage. Understanding the interaction between brain injury and violence, Dr. Padgett explains, is essential to truly grasp the complexity of survivors’ recovery.
Q2. What is an acquired brain injury?
An acquired brain injury refers to any damage to the brain that occurs after birth and is not caused by a congenital or degenerative condition. It includes traumatic injuries (such as those from a fall, collision, or assault) and non-traumatic injuries (such as anoxia, hypoxia, or strangulation). Both types harm the brain, but through different mechanisms—one mechanical, the other oxygen-related.
Q3. What are the typical consequences of these injuries?
They affect the body, the mind, and emotions. There are a range of consequences, and the below are some examples of the more common ones. Physically, survivors may experience headaches, dizziness, visual or hearing disturbances, or chronic fatigue. Cognitively, they may struggle with concentration, memory, and planning. Psychologically, anxiety, depression, irritability, and difficulty controlling emotions are common. These symptoms often combine and deeply affect a person’s ability to work, socialize, or feel like themselves again.
Q4. What exactly is “non-fatal strangulation”?
It is any pressure applied to the neck or chest that restricts oxygen flow to the brain without causing death. Just a few seconds of oxygen deprivation can cause brain damage. The amount of pressure required is surprisingly low—about 5 kg (11 lbs), much less than a firm handshake. These assaults often leave no visible marks, which explains why they are so rarely recognized in medical or legal settings.
Q5. Why are these injuries often called “invisible”?
Because external signs are rare, and survivors may not remember the episode. When people experience a brain injury (for example from a blow to the head or strangulation) consciousness can be lost within seconds, and memory of the event is often fragmented. This disruption to function, combined with fear or shame, makes it less likely that the violence will be disclosed or documented.
Q6. What makes diagnosis so difficult?
A lack of training, the absence of standardized screening tools, and the overlap between psychological and neurological symptoms. Uninformed clinicians might attribute fatigue, confusion, or speech problems to post-traumatic stress rather than to a brain injury. The intimate nature of the violence and the lack of witnesses also make clinical documentation difficult.
Q7. How do brain injuries interact with psychological trauma?
They reinforce each other. A brain injury can worsen post-traumatic stress symptoms—anxiety, hyper-vigilance, nightmares—while psychological trauma can, in turn, exacerbate cognitive difficulties. This double burden complicates rehabilitation and requires an integrated medical, psychological, and social approach.
Q8. Are there tools to screen for brain injuries in cases of intimate partner violence?
Yes, but they are rarely used. Dr. Padgett mentions tools such as HELPS-IPV and CHATS, which help identify individuals who may have sustained blows, shaking, or strangulation. These questionnaires are not diagnostic; they are gateways to care. She stresses the importance of asking questions gently and within a trauma-informed framework.
Q9. What do we know about the frequency of these injuries?
Available studies show alarming prevalence rates. Between 28 % and 100 % of people experiencing intimate partner violence show signs of altered consciousness related to brain injury, depending on the study’s definition. In cases of non-fatal strangulation, 27 % – 56 % report some loss or alteration of consciousness. Even though the data remain limited, Dr. Padgett emphasizes: “Whatever number you choose, it’s happening—and it’s common.”
Q10. Which populations are most vulnerable?
Indigenous women, people living with disabilities, and gender-diverse individuals face higher risks. Structural inequalities—poverty, isolation, systemic racism—both increase exposure to violence and reduce access to specialized care.
Q11. How can clinicians better support survivors?
By adopting systematic screening and interdisciplinary collaboration. Clinicians should recognize that cognitive difficulties may stem from physical injury, not only psychological trauma. Training, awareness, and collaboration among psychologists, occupational therapists, neuropsychologists, and social workers are key to comprehensive care.
Q12. What is your main message?
“Talking about these injuries means making the invisible visible.” Dr. Padgett urges the scientific and clinical community to acknowledge that the neurological consequences of intimate partner violence are a public-health issue. Recognizing, documenting, and sharing this knowledge is both a form of care and an act of justice.
