A new review highlights a population with high rates of brain injury and almost no targeted treatment evidence.
Intimate partner violence affects 1 in 3 women globally. Most clinicians are aware of the mental health consequences — PTSD affects up to 64% of survivors. Fewer are aware of the physical ones. Head, face, and neck injuries occur in 35% to 100% of IPV cases, and the resulting brain injuries are frequently repetitive, often combined with non-fatal strangulation events, and almost always underrecognized.
A review, “Existing and Potential Therapies for Post-Traumatic Stress Disorder and Persistent Post-Concussion Symptoms in Intimate Partner Violence,” just published in Brain Sciences by researchers at Monash University took a systematic look at what therapeutic options exist for two of the most common long-term consequences of IPV: PTSD and persistent post-concussion symptoms (PPCS). What they found should prompt clinicians to think differently about how they approach this population.
Two Conditions That Amplify Each Other
Before getting to treatment, the biology matters. PTSD and concussion do not simply coexist in IPV survivors — they interact in ways that make each worse.
Brain injury can disrupt limbic, neuroendocrine, and autonomic nervous system regulation, increasing vulnerability to PTSD symptoms like hypervigilance and exaggerated fear responses. At the same time, the neuroinflammatory processes driven by chronic stress and PTSD — overactivation of microglial expression, oxidative stress, impaired glutamate neurotransmission — can worsen brain injury outcomes.
The result is a self-reinforcing cycle. A survivor with PTSD may be hypervigilant toward any symptom she perceives as threatening, interpreting normal post-concussion symptoms as signs of serious injury. This amplifies avoidance behaviors and prolongs recovery. Among veterans, PTSD is the single strongest predictor of persistent post-concussion symptoms, even after controlling for symptom overlap — and similar patterns are emerging in IPV-specific literature.
What the Research Found
The review searched for intervention studies specifically targeting PTSD or PPCS in women IPV survivors. Here is where the gap becomes stark.
For PTSD, 19 studies were identified. Most used psychotherapy, predominantly cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), and trauma-focused adaptations. The results are generally encouraging. CBT has demonstrated efficacy for PTSD in this population, and CPT — originally developed for sexual assault survivors and endorsed by both the American Psychological Association and the VA/DoD — has shown durable reductions in PTSD, depression, and guilt, with gains sustained at 5 to 10 years. A CBT adaptation specifically designed for battered women (CTT-BW) showed PTSD remittance in 94% of participants in pilot studies, and has demonstrated neuronal reorganization in trauma-related circuitry. It can also be delivered without extensive mental health training, which matters for community-based settings.
For PPCS, the number of qualifying studies was zero. Not a small number. Zero. No intervention studies targeting persistent post-concussion symptoms specifically in IPV survivors exist in the literature.
What Clinicians Are Left With
The absence of IPV-specific PPCS evidence means clinicians must extrapolate from adjacent populations — athletes, military veterans, and general TBI samples. The review does this thoughtfully, walking through four therapeutic categories:
Psychotherapy shows the most promise for PTSD and has some indirect evidence for PPCS through psychoeducation and early intervention approaches that reduce catastrophizing and symptom misattribution. Early psychoeducation about what to expect after a concussion significantly reduces PPCS risk in general TBI populations.
Mindfulness and meditation offer accessible, lower-cost options, particularly for women who cannot access or afford traditional clinical care. Mindfulness-based stress reduction (MBSR) has been qualitatively reported to reduce stress and increase self-compassion and empowerment in IPV survivors, and a meta-analysis of clinical, athletic, and veteran populations suggests mindfulness may improve mTBI-related fatigue, depression, and quality of life. IPV-specific evidence is still preliminary.
Exercise is well established for both PTSD and PPCS in other populations — sub-symptom aerobic exercise is accepted as an effective intervention for concussion recovery, and trauma-informed yoga has shown reductions in stress and improved self-efficacy among IPV survivors. The practical barriers for this population are real, though: housing instability, childcare demands, safety concerns, and extracranial injuries that limit physical activity all complicate exercise-based approaches.
Pharmacotherapy is commonly prescribed but limited. SSRIs reduce PTSD symptoms but are less effective than trauma-focused psychotherapy alone, and medication non-adherence is well documented in IPV survivors due to financial barriers and logistical challenges. Current medications largely manage symptoms rather than address underlying neurobiological mechanisms.
The Clinical Implications
Several things stand out for the clinician seeing these patients.
Screen for brain injury. Women presenting with PTSD symptoms following IPV should be asked about head, face, and neck injuries, including strangulation. These injuries are frequently not volunteered and not routinely asked about. The symptom overlap between PTSD and PPCS — fatigue, cognitive difficulty, sleep disturbance, emotional dysregulation — can lead to misattribution of concussion sequelae to psychiatric causes alone.
Treat the intersection, not just one condition. The review makes a compelling case that PTSD and PPCS are synergistically linked in this population, and that treating one without addressing the other is likely to produce incomplete results. Integrated protocols do not yet exist for this specific population, but clinicians can begin by ensuring that both conditions are on the diagnostic radar simultaneously.
Trauma-informed framing is not optional. Standard concussion management protocols developed for athletes or young adults do not translate directly to IPV survivors. Exercise recommendations, return-to-activity progressions, and symptom monitoring all need to be delivered within a framework that accounts for ongoing safety concerns, trauma history, and the specific barriers this population faces in accessing and adhering to care.
Access is a real constraint. The average number of psychotherapy sessions needed for PTSD recovery is 9.5, but the range extends to 50. Long wait times, financial barriers, cultural appropriateness, and the risk of retraumatization all limit uptake. When traditional psychotherapy is not accessible, mindfulness-based approaches and community exercise programs — particularly trauma-informed yoga and structured walking programs — offer scalable alternatives with emerging evidence.
Why Objective Assessment Matters Here
One of the core challenges in this population is distinguishing PPCS from PTSD symptoms, given their substantial overlap. Both conditions produce cognitive difficulty, fatigue, hyperarousal, and emotional dysregulation. Without objective markers of neurological function, clinicians are largely relying on self-report in a population with known hypervigilance toward symptoms — which can inflate symptom scores independent of actual injury severity.
Objective oculomotor assessment, the kind EyeBOX provides, provides exactly the kind of quantifiable neurological data that can help differentiate injury-related dysfunction from purely psychological symptom amplification, track recovery over time, and inform treatment decisions without relying on patient self-report alone. In a population where symptoms are both real and potentially amplified by trauma-related attentional bias, that kind of objective anchor has particular clinical value.
The Bottom Line
IPV survivors face high rates of both PTSD and brain injury, and the two conditions likely worsen each other through shared neurobiological mechanisms. The treatment evidence for PTSD in this population is encouraging but incomplete. The treatment evidence for PPCS is nonexistent. Clinicians seeing these patients are operating largely on inference from other populations, and that is not sustainable.
The authors call for integrated, trauma-informed protocols that address both conditions simultaneously, and for research that actually tests them in this population. Until that evidence exists, the clinical imperative is to start asking about brain injury, screen for both conditions, and resist the assumption that PTSD explains everything.
Oculogica develops objective, FDA-cleared eye tracking tools for concussion assessment. For more information about how quantitative oculomotor data can support clinical decision-making, visit oculogica.com.