Medicine Information Article:

Health Needs of Survivors of Domestic Violence

Domestic violence is not over when the victim is safe and out of harm's way. It's notover until justice has been served. Even then, it's not over. It's not over until thevictim is safe, justice has been served, and the victim is well.

Consider these facts:

  • Abuse, especially repetitive abuse, leaves a lasting "impression" on thehealth, well-being, and post-abuse functioning of the victim. This impact lingerslong after the bruises fade, the bones mend, and the abuse is over.
  • Victims of violence seek healthcare more often than non-victims. Theseverity of victimization is a powerful predictor of the healthcare costs generated bythese victims.
  • Most healthcare visits by victims of domestic violence are not domesticviolence patients presenting with injuries, but rather medical problems thatseemingly are not related to current or past injuries.

The health effects of violence can reach across the life span. Studies have nowshown that adults who were abused in childhood vs. those who were not have more:

  • Infectious diseases
  • Mental health disorders
  • Hypertension
  • Diabetes
  • Dermatitis
  • Asthma
  • Allergy
  • Acne
  • Abnormal menstrual bleeding
  • More heath-threatening behaviors such as smoking, the use of alcohol,driving while intoxicated, avoiding regular gynecological examinations, not wearingseat belts, sedentary lifestyle, and high-risk sexual encounters.

The abuse sustained in an intimate partner relationship does not have to be physicalto cause poor health. Intimate partner violence and abuse (IPVA) can take severalforms: physical abuse, verbal abuse, and forced sex. When Dr. Ann Coker and hercolleagues looked at domestic violence in a large seriesof patients, they found that approximately 14% of domestic violence victims haveonly been victimized psychologically, not physically. These victims had higher ratesof numerous medical problems that the non-abused do not have. Among them:

  • Disability that prevented working
  • Arthritis
  • Chronic pain
  • Migraine and other frequent headaches
  • Stammering
  • Sexually transmitted infections
  • Chronic pelvic pain
  • Stomach ulcers
  • Frequent indigestion, diarrhea, or constipation.

These findings pose an interesting question: Do victims of psychological abuse havefewer or more health problems than victims of physical violence? Dr. Coker and hercolleagues found that "psychological IPV was as strongly associated with themajority of adverse health outcomes as was physical IPV." The old childhood tauntof "Sticks and stones can break my bones, but words can never hurt me," is wrong,wrong, wrong. And now we have research to support the idea that it's wrong.

Survivors of domestic violence or IPVA will tell you that life after abuse is never thesame. Some experience insomnia, multiple aches and pains, problems withconcentration, intrusive thoughts, fatigue, and irritability. Any one of these caninterfere with effective functioning and set the stage for depression and evendespair.

Violence and abuse of all forms is complex and the resulting health effects areinterwoven. No single approach cures all. Medical help for domestic violence victimsand survivors exists but is scattered. Appropriate care is often difficult to find andaccess, but it can be done. Healthcare providers and survivors must learn to worktogether to secure the best state of health possible for survivors of domesticviolence.

My recent book on using expressive writing to help resolve lingering health issuesoffers one way to give aid to survivors and their supporters. You can read asummary about the book at website http://healthaftertrauma/

© Copyright Ellen Taliaferro, MD 2005. All rights reserved. . You have permission topublish part or all of this article electronically or in print, in your newsletter, on yourwebsite, or in your e-book, as long you maintain the hyperlinks in the article andinclude the following information: "Written by Ellen Taliaferro, MD, author, speaker,and expert witness. Dr T. can be contacted through http://www.healthaftertrauma.com. A copy of your reprint or publication would beappreciated.

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