Two women who endured decades of intimate partner violence including dozens of brutal assaults and head injuries before they died have been diagnosed with chronic traumatic encephalopathy — the first cases of CTE in victims of domestic violence in Australia and two of just a handful globally.

The grim findings, published today in the journal Acta Neuropathologica, were made by a group of pathologists from several states and territories who teamed up to understand whether the degenerative brain disease found mostly in deceased male football players and boxers is also prevalent among abused women with histories of repetitive head injury.

The women, aged in their 30s and 40s, died from blunt force injuries and impact trauma — one in an alleged assault and the other after being struck by a car. 

The pathologists examined their brains after reviewing their clinical records and learning they had at least 70 assault-related medical presentations and 35 documented head injuries related to partner violence between them. 

One was found to have stage I CTE and the other stage II, the earliest, mildest forms of the disease.

Though CTE is likely to be found only in the most extreme examples of domestic violence, experts say the discovery of these new cases underscores the importance of screening victims for the disease at autopsy — and the urgency of supporting women to leave violent relationships. 

It is also a confronting reminder of the overlooked risks of brain trauma for abused women, a group that has long been neglected in research despite suffering physical abuse and brain injuries at staggering rates.

“I was a bit shocked that in this first-world country with supposedly world-class public health care that these sorts of histories were popping up through the women’s exposure to violence,” said Michael Buckland, head of the Department of Neuropathology at the Royal Prince Alfred Hospital in Sydney, director of the Australian Sports Brain Bank and one of the new paper’s authors.

“The pathology we found in these cases is identical to what we find in contact sports players — this abnormal deposition of tau protein in the cortex of the brain where you do most of your thinking, most of your planning, and where most of your impulse control comes from … and the fact that we’ve found it in women in their 30s and 40s is quite striking.”

The difference between contact sports players and domestic violence victims, Dr Buckland added, “is that contact sports players choose to participate, whereas obviously these women did not choose to be hit in the head a lot”.

Screening for CTE in victims of abuse

First identified as “punch-drunk syndrome” in boxers in the 1920s, CTE is a progressive brain disease that has been found mostly in athletes and military veterans who have typically suffered hundreds or thousands of concussions and sub-concussive hits. 

Its symptoms can include memory loss and confusion, poor impulse control, severe depression and suicidality, though some people seemingly show no signs of illness at all. It can only be diagnosed post-mortem.