[Ctd] Alexis Koskan - Health Needs of Survivors of Domestic Violence

[paul.kholer paul.kholer]

Alexis Koskan

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

Consider these facts:

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

The health effects of violence can reach across the life span. Studies have
now shown 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 wearing seat belts, sedentary lifestyle, and high-risk
   sexual encounters.

The abuse sustained in an intimate partner relationship does not have to be
physical to cause poor health. Intimate partner violence and abuse (IPVA)
can take several forms: physical abuse, verbal abuse, and forced sex. When
Dr. Ann Coker and her colleagues looked at domestic violence in a large
series of patients, they found that approximately 14% of domestic violence
victims have only been victimized psychologically, not physically. These
victims had higher rates of 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 have fewer or more health problems than victims of physical violence?
Dr. Coker and her colleagues found that "psychological IPV was as strongly
associated with the majority of adverse health outcomes as was physical
IPV." The old childhood taunt of "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 the same. Some experience insomnia, multiple aches and pains,
problems with concentration, intrusive thoughts, fatigue, and irritability.
Any one of these can interfere with effective functioning and set the stage
for depression and even despair.

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