This Hits Home

In a new documentary by Sydney Scotia, the under-researched and underreported issue of traumatic brain injury in victims of domestic violence is presented. This documentary features all four of the co-founders of the Boston University chronic traumatic encephalopathy research program.

WARNING: This article contains information pertaining to domestic violence that may be triggering/sensitive to some readers.

This Hits Home is an in-depth documentary feature film distributed by Gravitas Ventures in 2023; it is available on the streaming service Amazon Prime Video. The director, Sydney Scotia, interviewed medical professionals, advocates, and several domestic violence victims and their family members to accurately tell each of their stories. Scotia uses the combination of heartfelt recollections and scientific expertise to drive home her point that domestic violence victims are at risk of developing neurodegenerative diseases such as chronic traumatic encephalopathy (CTE) and Alzheimer’s disease (AD). Chris Nowinski, PhD, CTE Center co-founder and CEO of the Concussion Legacy Foundation was one of the experts interviewed in the documentary.  

The list of worst nightmare scenarios changes because we keep learning about new nightmare scenarios through the [UNITE] Brain Bank. (Nowinski, This Hits Home) 

One of the featured stories is that of Dr. Maria Garay-Serratos, the daughter of a decades-long victim of domestic violence. Dr. Garay-Serratos tells the story of her mother and her early onset Alzheimer’s disease diagnosis. She was later able to have her mother’s brain pathology examined by BU CTE Center director, Ann McKee, MD at the UNITE Brain Bank. Dr. Garay-Serratos learned that her mother had both Alzheimer’s disease neuropathology and severe CTE. Dr. McKee was astounded by the level of neurodegeneration she saw. 

[Alzheimer’s and CTE] were both very severe by the time of death and then compounding that is just this incredible loss of nerve cells and white matter fibers; the likes of which I’ve never seen in CTE or in Alzheimer’s disease. (McKee, This Hits Home) 

The film explains how many women who are victims of domestic violence are unable to obtain adequate medical treatment for many reasons. Although the mechanism is different than in contact sports like football, victims of domestic violence often sustain repetitive head impacts (RHI) that do not rise to the level of clinical, symptomatic concussions. Without symptoms, individuals often do not report or think to seek treatment for their injuries. Robert Stern, PhD, Director of Clinical Research at the BU CTE Center, describes this phenomenon in the film.  

If someone’s in some kind of situation where they keep getting hit, to the body or the head, so that their brain gets jolted but they don’t have symptoms, that’s much more common than someone having the symptoms that would lead to a concussion. And what we’ve found in a variety of research studies, it’s these smaller hits, not the ones that produce the symptoms of concussion, but the repetitive smaller hits that seem to turn on this cascade of changes in the brain that lead to CTE. (Stern, This Hits Home) 

Unfortunately, as Scotia continues to explain in her documentary, there is very little research done on the history of RHI and traumatic brain injuries that domestic violence victims endure over the course of their lives. Travis Danielsen, MD, a forensic pathologist from the El Paso County Coroner’s Office explained how, “The amount of CTE cases in domestic violence [victims] is essentially one in scientific literature at this point.” His case report, “Chronic Traumatic Encephalopathy (CTE)- Type Neuropathology in a Young Victim of Domestic Abuse,” published in the Journal of Neuropathology and Experimental Neurology in 2021, described a 29-year-old female with CTE pathology and a history of domestic violence, including significant remote head injuries.  

These women aren’t in an area where medical treatment is instantly available such as on a football or soccer field, or in a warzone with medics. They didn’t enlist in the military or try to make it to the professional level of any contact sports. Their injuries are often undetected and untreated. 

My family, we weren’t playing on a football field, we weren’t NFL players, we weren’t fighting in a war somewhere in the world. The battle was in my home. My mother sustained those kinds of [hits] that NFL players and people who go into boxing or the military sustained. (Garay-Serratos, This Hits Home) 

Hypothetically if those hits cause neurodegeneration in that specific population, there doesn’t seem to be a reason why domestic violence victims wouldn’t have the same outcome.  

What if a woman is hit every day? Hits to the head, to the face, thrown against the wall, their heads go [back and forth]? A few times in a day, day after day, over a long period of time? If those repetitive hits keep on happening then our current knowledge is that that can lead, in some people, to long-term problems including a brain disease called chronic traumatic encephalopathy, CTE. (Stern, This Hits Home) 

Chronic traumatic encephalopathy is a progressive degenerative disease of the brain that can only be diagnosed post-mortem. The UNITE Brain Bank at the BU CTE Center is the largest tissue repository in the world focused on traumatic brain injury (TBI) and CTE. The BU CTE clinical team works to integrate the UNITE Brain Bank neuropathological data with clinical research studies to find biomarkers to diagnose CTE in living persons. Robert Cantu, MD, BU CTE Center and Concussion Legacy Foundation co-founder discussed CTE in the film.  

CTE is diagnosed in people with certainty only after they die. In living individuals, if they’ve had a very high exposure to head trauma… and they exhibit the symptoms of CTE — the cognitive symptoms, the impulsivity symptoms, the mood symptoms — you can [predict that it’s] very likely that they do have CTE… because that’s what we’ve found when we look at brains of symptomatic people after they’ve died. But while they’re alive you can just talk about probabilities; you can’t be certain. (Cantu, This Hits Home) 

Although post-mortem neuropathological research on domestic violence victims is scarce, we are grateful to Scotia and her team for bringing awareness to this issue through the documentary. We hope to expand upon existing research and encourage victims of domestic violence to pledge their brains.  

We suspect this is an issue for many victims of DV but we don’t have the number to prove it. We are very anxious to examine the brains of these individuals after they’ve passed because we think that women clearly can get this disorder. There’s actually recent evidence that women may be more susceptible to brain damage after these repetitive hits to the head. (McKee, This Hits Home) 

If you or someone you know is a victim of intimate partner violence and would like resources or support, visit thehotline.org. Advocates are available 24/7 to assist with customized safety planning, emotional support, and more. Call 1-800-799-SAFE (7233) or text “START” to 88788 to connect with an advocate.  

Read Danielsen et al. (2021) here. 

To rent or buy This Hits Home, visit Amazon Prime Video. 

To learn more about participating in brain injury research, please visit the BU CTE Center website.