From Recognition Lag to the Treatment Gap in Intimate Partner Violence-Related Brain Injury: The Cognitive Entrapment Prospective Framework

Intimate partner violence-related brain injury is the most recent condition in a 150-year arc in which biological brain injury has been misattributed to psychological or moral causes before formal clinical recognition emerged. Earlier conditions in this pattern were each recognized only after decades of delay. In each prior case, that delay was constrained by limits in available diagnostic technology. Intimate partner violence-related brain injury is the first condition in which diagnostic technology, including computed tomography, magnetic resonance imaging, diffusion tensor imaging, and neurocognitive assessment, has been continuously available throughout the period of non-recognition. This review identifies three structural barriers that sustain this recognition gap: a diagnostic barrier that leaves the injury without formal criteria, an administrative coding barrier that leaves it absent from ICD architecture, and a population surveillance barrier that leaves it indistinguishable from broader assault categories. Each barrier reinforces the others, limiting visibility, resource allocation, and access to care. Across these conditions, this review argues that deferred recognition reflected an institutional dynamic that shaped which injured populations became clinically legible. Recent neuroimaging and cognitive studies make the biological imperative explicit. A cognitive entrapment framework reframes the reduced capacity to engage the cognitive and material resources leaving requires as injury-driven rather than as ambivalence or motivational deficit. The framework offers a mechanistic account of how brain injury may disrupt the multistep planning that leaving demands. Intimate partner violence-related brain injury is not only underdiagnosed but structurally underserved; correcting the mechanisms of recognition failure is necessary for access to treatment and rehabilitation.