For years, Paula Walters had no idea why she was forgetting things, losing control of her emotions, struggling to concentrate and facing other unexplained and troubling problems, including fainting spells. She was so distressed that she attempted suicide.

Walters, who survived strangulation at the hands of an ex-boyfriend in 2006, said she now understands that all of those things stem from brain injury.

Domestic violence survivors commonly suffer repeated blows to the head and strangulation, trauma that has lasting effects that should be widely recognized by advocates, health care providers, law enforcement and others who are in a position to help, according to the authors of a new study.

In the first community-based study of its kind, researchers from The Ohio State University and the Ohio Domestic Violence Network found that 81 percent of women who have been abused at the hands of their partners and seek help have suffered a head injury and 83 percent have been strangled.

“This is happening to lots of people and it’s a really, really lonely place to be,” Walters said.

The 45-year-old Toledo woman worked in the hospital where she was seen the night of the strangulation, after a neighbor checked in on her and realized she’d been severely beaten. But neither Walters, nor the team of doctors and nurses who cared for her, thought to consider brain injury at the time.

After a car crash in 2017, a brain MRI revealed the problem. She still struggles with the fallout of the damage to her brain, and is determined to keep telling her story in hopes of helping health care providers, police officers and others understand that they should think about brain injury when working with someone who’s been physically abused.

The new research suggests that brain injury caused by blows to the head and by oxygen deprivation are likely ongoing health issues for many domestic violence survivors. Because of poor recognition of these lasting harms, some interactions between advocates and women suffering from the effects of these unidentified injuries were likely misguided, said the authors of the study, which appears in the Journal of Aggression, Maltreatment & Trauma.

“One in three women in the United States has experienced intimate partner violence. What we found leads us to believe that many people are walking around with undiagnosed brain injury, and we have to address that,” said lead researcher Julianna Nemeth, an assistant professor of health behavior and health promotion at Ohio State.

The study included 49 survivors from Ohio and 62 staff and administrators from five agencies in the state.

Previous research has acknowledged brain injury as a product of domestic violence. But this is the first study to gather this kind of detailed information from the field. It’s also the first to establish that many survivors have likely experienced repeated head injury and oxygen deprivation – a combination that could contribute to more-severe problems including memory loss, difficulty understanding, loss of motivation, nightmares, anxiety and trouble with vision and hearing, Nemeth said.

“Nobody really knows just what this combination of injuries could mean for these women,” she said. “When we looked at our data, it was an ‘Oh my gosh’ moment. We have the information we need now to make sure that people recognize this as a major concern in caring for survivors.”

Almost half of the women in the study said they’d been hit in the head or had their head shoved into another object “too many times to remember.” More than half were choked or strangled “a few times” and one in five said that happened “too many times to remember.”

In some cases, the survivors lived through both experiences multiple times.