The Hidden Crisis: Female Acquired Brain Injury as an Unrecognised Public Health Emergency

May 25, 2025

The Hidden Crisis: Female Acquired Brain Injury as an Unrecognised Public Health Emergency

When we think of acquired brain injuries (ABIs), the typical image is often a male athlete with a concussion or men involved in workplace accidents or violent incidents. While statistically, men do experience higher rates of traumatic brain injury, this focus has created a significant blind spot in healthcare systems, research priorities, and public awareness. Female acquired brain injury represents a largely unrecognised public health emergency that demands urgent attention.

Women with ABIs frequently suffer in silence. Their injuries are often misdiagnosed, undertreated, or overlooked entirely. Unlike male ABI survivors, who commonly display externalised behaviours that prompt intervention, women tend to present with symptoms that are less visible but often more complex and disabling. This “out of sight, out of mind” reality masks the true scale and severity of female brain injury.

This blog post explores the scope of this hidden crisis, the unique challenges women with ABIs face, and why recognising female ABI as a public health emergency is vital to improving outcomes and reducing the substantial human and economic costs associated with these injuries.

Understanding Acquired Brain Injury: The Basics

Acquired brain injuries refer to brain damage occurring after birth, unrelated to congenital disorders, developmental disabilities, or degenerative diseases. They fall into two primary categories:

Traumatic Brain Injuries (TBIs): Result from external forces such as falls, assaults, motor vehicle collisions, and sports injuries.
Non-Traumatic Brain Injuries: Result from internal causes including strokes, aneurysms, tumours, infections, oxygen deprivation, or toxic exposure.

Severity can range from mild to severe, with impairments affecting cognitive, physical, emotional, and behavioural functioning that may be temporary or permanent.

The Prevalence Gap: What the Data Reveals

ABI affects both men and women, but gender differences in prevalence and causes are evident:

In the UK, between 2005/06 and 2016/17, ABI rates were higher in men (595 per 100,000) than women (468 per 100,000) (Statista, 2023a).
In the US, the 2019 TBI-related death rate for females was 8.1 per 100,000 population, lower than for males (Statista, 2023b).
In Canada, women constitute about one-third of those with TBI, with a higher incidence in early reproductive years (15–24 years) (Brain Injury Canada, 2023).

These figures might suggest female ABI is less common and thus less critical. However, such interpretations ignore key factors contributing to the under-recognition and underdiagnosis of female brain injury.

The Invisibility Factor: Why Female ABI Often Goes Unrecognised

Differences in Symptom Presentation

Male ABI survivors often exhibit externalised behaviours that attract attention and intervention, including:

Aggression and irritability
Risk-taking
Substance misuse
Antisocial behaviour

Women, by contrast, more frequently present with internalised symptoms such as:

Depression and anxiety
Social withdrawal
Fatigue and cognitive difficulties
Somatic complaints

These symptoms are often misattributed to psychological conditions rather than neurological injury, leading to inappropriate or delayed treatment.

The Intimate Partner Violence Connection

A particularly concerning, yet under-recognised cause of female ABI is intimate partner violence (IPV). Recent research highlights that physical violence to the head, face, and neck is common in IPV. Population-based estimates in the US indicate:

Over 40.5 million women (one in three) report severe physical IPV
Over 4 million report being “knocked out” due to IPV-related trauma
4.5 million report IPV-related head injuries (Goldin et al., 2024)

Despite these alarming statistics, the link between IPV and brain injury remains poorly addressed in healthcare. Women exposed to repeated TBIs from IPV may develop chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease better known in contact sports contexts (Psychiatric Times, 2023).

Diagnostic Challenges

Multiple factors contribute to the underdiagnosis of female ABI:

Research Bias: Historically, women have been excluded from brain injury studies, leading to diagnostic criteria based largely on male presentations.
Symptom Attribution: Women's neurological symptoms are often wrongly ascribed to mental health disorders.
Self-Reporting Barriers: Shame, fear, and lack of awareness, especially in IPV contexts, reduce reporting of head injuries.
Healthcare Provider Knowledge Gaps: Many clinicians lack training in recognising ABI signs specific to women, particularly in IPV-related cases.

The Complex Reality: Outcomes and Challenges in Female ABI

More Profound Disability

Contrary to assumptions that women fare better after brain injury, emerging evidence suggests women often experience:

More severe cognitive impairments
Greater difficulty resuming previous roles
Higher rates of depression and anxiety
More persistent post-concussive symptoms
Increased challenges with social reintegration

Economic Impact

Female ABI’s economic consequences extend well beyond direct healthcare costs:

Lost Productivity: Undiagnosed or untreated ABI impedes employment retention.
Caregiving Burden: Women with ABI often cannot fulfil caregiving roles, impacting children and dependent adults.
Healthcare Utilisation: Lack of diagnosis leads to repeated healthcare encounters seeking symptom explanations.
Social Services: ABI intersects with homelessness, substance misuse, and child welfare involvement, increasing societal costs.

Breaking the Silence: Steps Toward Recognition and Response

Addressing female ABI as a public health emergency requires a multifaceted strategy:

Improved Screening and Assessment

Routine ABI screening in emergency departments for women presenting with IPV-related injuries
Incorporating ABI into differential diagnoses in primary care for women with persistent cognitive, emotional, or physical symptoms
Training mental health professionals to recognise neurological causes behind psychological presentations

Research Priorities

Increasing female inclusion in brain injury research
Investigating gender differences in ABI presentation, progression, and treatment responses
Studying the intersection of IPV and ABI in depth
Developing female-specific diagnostic criteria and assessment tools

Public Awareness Campaigns

Educating about ABI signs and symptoms common in women
Highlighting the IPV-ABI link
Destigmatising brain injury to encourage reporting and help-seeking

Policy Implications

Including brain injury screening within IPV intervention programmes
Allocating funding for female-specific ABI research and services
Mandating healthcare provider training on gendered differences in ABI
Establishing specialised rehabilitation services tailored to women’s unique needs

Conclusion: A Call to Action

Female acquired brain injury is a significant, yet largely invisible, public health crisis. The consequences - silent suffering, misdiagnosis, family strain, and economic loss - are profound. Bringing female ABI into the spotlight demands commitment from healthcare, research, policy, and society.

The first step is acknowledgement. Beyond statistics and entrenched paradigms lies a population of women whose brain injuries have long been overlooked. Progress requires prioritising research, improving clinical practice, raising awareness, and driving policy change. Only then can this hidden crisis become a visible priority deserving of collective action.