Experiences of Head Trauma from Intimate Partner Violence and Help-Seeking

Abstract

Experiences of Head Trauma from Intimate Partner Violence and Help-Seeking: A Systematic Review Purpose Head trauma often occurs within experiences of intimate partner violence (IPV-HT) and whilst health implications of these phenomena and survivors’ help-seeking have been considered separately, understanding complexity of comorbidity is lacking. IPV-HT survivors are often hesitant to seek help and when they do, may not be able to effectively access and receive help. A synthesis of current literature will identify knowledge gaps and recommendations to support the development of health services for IPV-HT survivors to effectively seek help. Methods A systematic review involving narrative thematic synthesis was undertaken to identify, critically appraise and synthesise evidence related to the research questions. Relevant studies were systematically identified and then assessed for inclusion eligibility to explore the experiences of IPV-HT survivors and their help-seeking along with influencing factors of help-seeking experiences and receipt of help. Results Fifteen studies were included, from which three themes and seven subthemes were identified, which all contributed to understanding the experiences of IPV-HT and help-seeking, influencing factors, and receipt of help. Cycles of abuse were experienced, including the cyclical nature of abuse and subsequent “damage”. “Fear” and “instability” maintained difficulties. Survivors considered their “priorities” along with the “repercussions” of seeking help. IPV-HT survivors were also described as being silenced “through systemic violence” involving a lack of “awareness”, lack of service provision, and help-seeking experiences with services involving “stigma”, “discrimination” and “racism”, contributing to traumatic experiences and help-seeking. Conclusions In IPV-HT the experiences and difficulties of help-seeking cannot be separated from the difficulties of abuse and influence each other. Abuse was experienced in a cyclical nature maintaining difficulties and influencing help-seeking. IPV-HT survivors were described as experiencing systemic challenges in which societal influences and systems maintain and reproduce harm and impact help-seeking and receipt of help. Whilst help-seeking may consist of stages, within each stage, the survivor may experience a “push” or “pull” to continue the help-seeking process. Furthermore, IPV-HT survivors often later enter professional roles to help other survivors, further contributing to IPV-HT and help-seeking cycles. Clinical recommendations have been made at a clinician, service, and societal level to improve receipt of help-seeking following IPV-HT in the U.K. Future research is needed specifically with IPV-HT survivors to understand first hand experiences of this phenomenon and the individual factors impacting help-seeking.

Women’s Experiences of Head Trauma from Intimate Partner Violence and Help-Seeking: A Narrative Analysis Purpose Survivors of head trauma from intimate partner violence (IPV-HT) may narrate their experiences in different ways, which can affect accessing help. IPV-HT survivors must cope with complex difficulties due to comorbidity which may compound the trauma experienced and impact help-seeking. Characteristics of trauma narratives provide an understanding of difficulties and are utilised within therapy. Women’s narratives of abuse have often been discounted as they are told in inconsistent or incoherent ways which act as a barrier to help. This study aimed to understand the IPV-HT and help-seeking narratives of survivors in the U.K. to inform the practice of healthcare professionals to better support survivors. Methods A total of five women who self-reported IPV-HT engaged in two repeated narrative interviews to understand participants’ personal stories. Participants’ accounts were analysed using narrative approaches including how the women viewed and positioned themselves, others, and concepts. The narrative structure and strategies employed within these were further analysed. Results There were common ways in which women attempted to understand and share their IPV-HT and help-seeking experiences, in terms of the narrative pattern, expression, and strategies employed. It seemed women were stuck in narrative cycles; they spoke in circularity which progressed the narrative. Women struggled with narrative construction through an unavailability of words and hesitation which also created uncertainty. The listener was positioned as “knowing”, this increased narrative incoherency. Narrative strategies acted to sense-make and increase narrative coherency, often accounting for why survivors remained in the cycle of abuse and/or experienced difficulties help-seeking. The women seemed to attempt to aid narrative understanding through contextualisation (utilisation of subject positions and drawing upon societal norms). This constructed coherency and normalised their experience and narrative. The women accounted for uncertainty to improve narrative coherency through positioning themselves with a lack of knowledge and using memory as a narrative resource. They constructed a representation of reality, encouraging the listener to believe their narrative. Conclusions This research has provided insight into common ways female survivors of IPV-HT attempted to understand and share their experiences of IPV-HT and help-seeking. Women struggled to construct coherent narratives and employed strategies to increase coherency and further sense-make, often accounting for their experiences. Such strategies seemed to encourage the listener to believe their narrative and constructed influences that “pushed” or “pulled” the survivor towards or away from the abuse cycle and/or help-seeking. Others, particularly professionals, should be aware of IPV-HT survivors’ common narrative features to aid proactive identification of survivors and offer help, along with reducing their role in either “pushing” or “pulling” survivors away from help-seeking and towards cycles of abuse. Benefit from trauma-informed psychological therapy is proposed. Suggestions for future research are also provided.