HOLLIDAYSBURG — Some time ago, Cheryl Gonsman of Family Services Inc. answered a victim services hotline call from a woman who said she was in an abusive relationship and wanted help getting back her car from her husband, who had driven off with it.

Gonsman suggested that the woman call the police, while musing about common ownership of marital property — and only found out later that despite the woman’s “fixation” on the car, there was a far more serious issue: she’d been strangled by her husband.

At a workshop Friday on brain injuries caused by intimate partner violence, Gonsman and others learned that domestic violence victims, when interacting with social workers, often don’t reveal the full reality of their abuse, and that it’s necessary for such workers to be alert for signs of what’s under the surface — while asking probing questions to uncover that reality.

If she had it to do over, Gonsman would have asked such questions as, “are you safe at home?” or “has he been hurting you?” she said, following a presentation by Frank Hillary and Elizabeth Rebuck of the Brain Injury and Plasticity Lab in the Department of Psychology at Penn State University Park.

It’s often necessary for social service providers to overcome a natural tendency not to ask such apparently prying, personal questions, because in many cases, brain injuries that occur with abuse — including strangulation, due to the oxygen deprivation it causes — make it hard for victims to express what’s on their minds, much less plan successfully to make their escapes, officials said.

Ironically, brain injuries resulting from the abuse that women need to flee make it hard for them to escape by compromising the “executive function” required to do so safely, due to the barriers against escape that perpetrators often erect, like hiding credit cards, according to Ashley Gay Vocco, program director at Family Services, and the presenters.

‘Just leave’ difficult

The compromising of those mental functions is why so many women can’t do what many observers encourage them to do — “just leave,” Gay Vocco and the presenters said.

One in three women — and one in four men — are victims of domestic violence at some point in their lives, according to Hillary.

That means that social service workers of all kinds inevitably encounter such victims regularly — including victims who don’t show obvious signs of being abused, Gay Vocco said.

People generally think of soldiers or football players when they think of brain injuries, according to Gay Vocco.

They don’t often think of ordinary women, she said, noting their injuries are often “untreated and unnoticed.”

Brain injuries to abused women can occur from blows to the head, impacts with hard objects like a wall or floor and shaking — and the effects can accumulate, according to Hillary and Rebuck.

Damage can occur when it’s not obvious either to the victim or observers.

Most of the individuals that social service workers encounter who have traumatic brain injuries due to abuse will have symptoms that indicate only mild damage, based on a common measurement of brain trauma, Hillary said.

But the damage is real and often life-altering, he said.

Signs of the victimization that underlies that damage include fear of her intimate partner, anxiety to please her partner, her defense of her partner’s concerning behavior, her loss of contact with friends and family, her no longer doing the things she previously enjoyed, her lack of control over her finances, a requirement that she keep him always informed of her whereabouts, him showing up unannounced and her cutting off her conversation when he shows up, Hillary said.

Signs that indicate a dangerous partner include a push for quick commitment; excessive jealousy; prohibiting the woman from being in the company of loved ones; not letting her obtain employment; degrading language; excessive mood swings; pressure for her to engage in concerning behaviors, including sex, substance abuse or illegal activities; intimidation and threats; or threats of self-harm if she leaves, he said.

Social service workers need to be careful not to give advice that would subject victims to greater danger, according to the presenters.

That means not allowing evidence of those victims seeking support to be viewed by abusers, and it means ensuring that if victims are planning to leave, such plans unfold without abusers’ knowledge.

Signs of head injury

Common troubles after a head injury include physical ones like headaches, sleep disruption, sensitivity to light or noise, dizziness, balance issues, fatigue and seizures; emotional problems like worry and fear, panic, flashbacks, sadness, depression, hopelessness, anger and irritation; and thinking problems like trouble remembering or understanding or paying attention or following directions or starting tasks or deciding what to do next, along with problems of organization and controlling one’s emotions or reactions, according to a flier presented at the workshop.

Victims should seek medical help when a headache won’t go away, when the pupils of one’s eyes aren’t the same size, when one has trouble remembering what has just happened, when one is extremely drowsy or has trouble waking up or has slurred speech or numbness or decreased coordination or repeated vomiting or nausea or shaking or twitching or confusion, or restlessness or agitation or incontinence or unconsciousness, according to the flier.

There are strategies for dealing with the problems head injuries cause, according to the flier.

For nightmares and flashbacks or anxiety or a desire to withdraw or a racing heart, it can help to focus on breathing deeply, or to find something that serves as distraction, or to seek support by talking to others, according to the flier.

For memory issues, it can help to set down events in a calendar, to record things on one’s phone, to put important items always in the same place, to set up alerts on one’s phone and to ask for appointment reminders.

For hypersensitivity to light or noise, it can help to use earplugs, headphones, sunglasses or dimmers and to make electronic text a larger size — and also to schedule an eye exam.

For communication and comprehension issues, it can help to ask people to talk more slowly and to explain what they’re saying; and it can help with information being given more than once.

For problems with planning and organization, and for problems with making decisions and starting tasks, it can help to break things into small steps, to write down different ideas, to discuss issues with a trustworthy person and to work on an issue for a set period of time, then take a break when frustration sets in.