Domestic Violence, TBI, and the Case for Hyperbaric Oxygen Therapy

PRESS RELEASE

Arlington, VA

EXECUTIVE SUMMARY:

THE HIDDEN WOUND: Domestic Violence/Intimate Partner Violence (DV/IPV) Is an Untreated Brain Wound Crisis

75–80% of intimate partner violence survivors sustain a brain wound. Up to 1.6 million a year — a number that may rival combat and contact-sports TBI combined.

The mechanism: blunt trauma and strangulation-induced oxygen deprivation. Strangulation alone shows up in 58–80% of survivor populations, often with zero external marks.

The problem isn’t a mystery: it’s invisibility.

There is no screening protocol. Symptoms are absorbed into PTSD/depression/Mental Health labels. No institutional infrastructure exists like the military or pro sports built over decades of advocacy.

New York took the first step — shelter-based TBI screening pilots, a new City Council training mandate. But even there: the law names the injury and funds no treatment.

HBOT — already backed by 29 peer-reviewed studies — is the treatment nobody’s funding for this population.

It’s the same brain wound TreatNOW has documented in veterans for 20 years. Different population. Zero infrastructure. Proven, science based success. Medicine dragging its feet.

It’s not a red-state or blue-state issue. It’s physiology, and brain wound healing.

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TreatNOW has run head-on into a related national epidemic that parallels epidemics of Veteran Suicides, Opioid Overdose Deaths, Undiagnosed/Untreated TBI, and Veteran Diabetic Foot Amputations. That slow-to-recognize epidemic is Domestic Violence/Intimate Partner Violence (DV/IPV).

The numbers are staggering. A 2023 Report from the Department of Justice, A National Protocol for Intimate Partner Violence Medical Forensic Examinations, is the basis for a TreatNOW report: “The Hidden Wound” — DV, TBI, and the Case for HBOT.”

This national policy white paper, prepared by the TreatNOW Coalition with the BART Foundation, argues that domestic violence and intimate partner violence (IPV) are among the largest and least-recognized causes of traumatic brain injury (TBI) in the United States — and that hyperbaric oxygen therapy (HBOT), already supported by 29 peer-reviewed studies in other populations, is the most directly applicable treatment available, yet is absent from the policy conversation in every state.

The Core Argument

The paper’s central claim is that 75–80% of survivors who experience physical IPV sustain one or more brain injuries, through two distinct but related mechanisms: traditional TBI from blows, falls, or being thrown against objects, and hypoxic-anoxic brain injury (HAI) from strangulation-induced oxygen deprivation. Researchers, led by Dr. Eve Valera at Harvard Medical School/Massachusetts General Hospital, estimate this population may sustain up to 1.6 million brain injuries annually nationwide — a number that may rival or exceed combined totals from military combat and contact sports, despite receiving almost none of the screening, diagnosis, or treatment infrastructure built around those better-known groups. Crucially, the paper frames this as the same underlying physical wound TreatNOW has spent two decades documenting in veterans — not a new category of injury, but a previously invisible population experiencing it.

National Scale

Drawing on the CDC’s NISVS survey (2023/2024), the paper cites 34% of U.S. women (roughly 43.5 million) experiencing lifetime IPV, with a $3.6 trillion estimated lifetime economic burden. It highlights stark disparities: non-Hispanic Black women show lifetime IPV prevalence around 53.6%, women with disabilities face elevated risk across nearly every IPV category, and multiracial/American Indian or Alaska Native women report the highest exposure of any group (over 57%). Strangulation receives particular emphasis as the most lethal and overlooked mechanism — present in 58–80% of service-seeking survivor populations, frequently leaving no external marks, and capable of causing permanent injury within minutes.

Part Two: Evidence the Injury Is Real and Routinely Missed

The paper synthesizes prevalence research showing wide but consistently elevated rates: Valera’s 2018 study of 99 women found 75% had at least one partner-violence-related TBI and 50% had multiple; a 2022 scoping review of 42 studies found rates from 19–75%, reaching 100% in populations specifically screened for head injury. Frontline data reinforces this — Ohio’s domestic violence network found 81% of survivors reported head/neck/face trauma and 83% reported strangulation, while a New York Justice Center chart review found all 40 assessed survivors had a probable brain injury, with 92.5% showing signs of hypoxic injury from strangulation.

The paper identifies five reasons this injury goes unrecognized: no standardized screening protocol (unlike sports or military contexts), diagnostic substitution (symptoms absorbed into PTSD/depression labels rather than treated as physical injury), absence of external markers (especially with strangulation), survivor-side barriers (stigma, fear, lack of awareness), and a persistent research/funding gap relative to military and sports-related TBI. Downstream consequences include memory and executive function deficits, emotional dysregulation, triple the rate of ICU admission when TBI co-occurs, and a generational pattern — about 75% of women with adult DV-related TBI also report childhood abuse.

Part Three: The Treatment Case

The paper argues that HBOT’s mechanism — supersaturating blood plasma with oxygen to reach damaged, “idling” brain tissue — is identical regardless of injury cause, making evidence from veteran and civilian trauma populations (including Israeli RCTs at the Sagol Center, which now treats civilian PTSD patients at government expense) directly relevant to IPV survivors, even though none of the existing 29-study evidence base was generated using a DV/IPV population specifically. It singles out strangulation-related hypoxic injury as an especially direct physiological fit for HBOT, since both the injury and the treatment center on oxygen delivery — yet notes this is also the mechanism least likely to be recognized or treated today. The section also explains structurally why this population has been overlooked: veterans and athletes are embedded in institutions (military, organized sports) that eventually built tracking and research infrastructure, often after sustained advocacy or litigation; DV survivors have no equivalent institutional structure, so their injuries disappear into an already-overwhelmed response system rather than triggering a distinct medical pathway.

Part Four: New York as the National Model

The paper positions New York as the first state to formally name this connection, citing three concrete 2024 actions: the VOA–Greater New York shelter-based TBI screening pilot (the first in the nation, launched 2022 across seven NYC shelters); NYC Council Int. No. 29 (introduced by Majority Leader Amanda Farías), requiring first responders and DV providers to be trained on TBI prevalence and symptoms; and joint awareness efforts from the NYS Department of Health, OPDV, and Sanctuary for Families. New York’s 2024 OPDV dashboard data is cited directly: 249,077 NYC domestic incident reports, 241,351 statewide orders of protection, and a combined 71 IPV/family violence homicides across NYC and non-NYC counties. The paper’s key critique, however, is that New York “named the clinical problem” but did not name a treatment — Int. No. 29 mandates training and awareness but funds no treatment response, including HBOT. That gap between diagnosis and treatment is what the paper argues every state, including New York, still needs to close.

Part Five: Policy Roadmap

The paper closes with six recommendations for state and local policymakers: (1) mandate TBI awareness training modeled on New York las Int. No. 29; (2) fund TBI screening at first contact (shelters, justice centers, EDs), modeled on Volunteers of America-Greater New York; (3) write an actual treatment pathway into legislation, not just training mandates, since currently no state — including New York — specifies what happens after a positive screen; (4) fund an HBOT pilot connecting screened survivors to treatment, modeled on Kentucky’s HBOT4KYVETS; (5) direct state research funding specifically toward IPV-related brain injury; and (6) require strangulation to be charged and documented as a brain wounding event, not merely an assault, to improve both legal and medical response.

IPV-related brain injury is not a regional or partisan issue — the underlying physiology doesn’t vary by state. New York’s momentum proves a state can name and begin addressing this problem within a single legislative session. The unfinished work, everywhere, is connecting the diagnosis to a treatment that can heal the underlying wound. And it is as true for Veterans, athletes, citizens, first responders, and is no respecter of age: we are all potentially vulnerable.

HBOT Heals Brains, Stops Suicides, Restores Lives. TreatNOW.

Information provided by TreatNOW.org does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made.